A friend of mine has a little boy with chronic constipation. They have really struggled to access information and support, and felt that if they’d known earlier what they know now they could have avoided a lot of worry and washing. With him in mind, I’ve written the GP’s guide to avoiding childhood constipation. It is certainly not glamorous, but neither is parenthood!
Your 4 your old child is heading off to school. Dressed in their new uniform, waving bravely from the classroom door, and turning to embark on a new adventure away from your side. This is a familiar scene, and most parents feel pangs of pride and anxiety watching their baby step into the reception classroom.
We talk about it together at the school gates, sharing the highs and lows of our parenting journey. But we are less likely to share the details of our child’s toilet habits, or the trouble we are having toilet training them so they’re ‘school ready’. In a 2016 survey 100% of teachers of 4 and 5 year olds said they had seen an increase in the number of children not yet reliably toilet trained when they started school, and one of the most common reasons behind this is childhood constipation.
30% of children suffer from constipation, and it doesn’t always show in the obvious ways you might expect as an adult. Your 4 year-old might tell you that they need a poo and can’t go because its hard or it hurts, but they might not. They might have problems with soiling, recurrent abdominal pains, urine infections, or bed wetting. Some children avoid going to the toilet, some lose their appetite or just act up and misbehave because they are feeling uncomfortable.
Constipation commonly presents shortly after starting toilet training, around 2-4 years old. Causes can include lack of fibre in the diet, not drinking enough water (children of school age should be having 6-8 cups of water per day), but often there is no clear cause.
Less frequently it can be related to underlying conditions, and you should take advice if your child also has other symptoms like vomiting, weight loss, acid reflux, urinary problems and thirst. A little understood fact is that constipation in children can go on for months and often years before it resolves.
We describe a child as constipated if they poo less than 4 times in a week, but every child is different, some poo twice a day, some go every other day. Some children with constipation will actually go more often.
If your child is soiling their pants with very runny poo it is possible that they are having overflow symptoms. This occurs when soft runny poo leaks around a hard poo blockage higher up in the bowel. If this hard poo is stuck for a long time it can stretch the bowel. The stretched bowel stops sending messages to the brain to tell your child they need to have a poo – they can’t feel their bowel normally, so they have no control over their leakage.
It can also affect the sensation in their bladder, and is a common cause of bed wetting, and of urinary tract infections. This can be a source of enormous stress and frustration to parents, just as you finally hope you might be past the nappy stage you suddenly have to manage soiled pants and accidents at awkward moments. It can be terribly hard not to blame the child and feel that they could stop soiling if they just tried harder. Parents have told me how they felt embarrassed and ashamed of their ‘inability to toilet train their child’, despite knowing that they were all trying so hard to get this right.
So, what can you do to help your child avoid constipation?
- Well, firstly, don’t toilet train too early. Wait for the signals your child is ready and interested before you begin, however desperate you are to see the back of nappies!
- Make sure you keep an eye on how often your child is going to the toilet, and what consistency their poo is, even once they are using the toilet independently.
- Encourage your child to drink plenty – often children avoid drinking while they are in school, make sure they are getting their 6-8 drinks per day if you can.
- Eat a balanced diet containing lots of fruit and vegetables, and keep a food diary for a couple of weeks to see if you can identify any possible triggers or patterns that might explain your child’s problems.
- Keep active – exercise keeps your bowels healthy.
- Try not to tell your child off for accidents – I know this is a big ask for a tired parent, and frustration gets the better of all of us at times- but your child really can’t help having accidents. Feeling supported and understanding their own body is key to them improving and getting over their constipation.
If you think your child is constipated get advice from your Health Visitor or GP early. I was taught during my paediatric training that the treatment for constipation in a child would take as long to work as that child had been constipated before treatment started. If simple measures like drinking more and changing diet have not been successful then your child is likely to need laxatives. Your GP can prescribe these. At first you might to use quite high doses to clear out any blockages, and it might seem that this is making the soiling problem worse- don’t give up at this stage!
Most laxatives for children work by getting more water into the bowel to soften the poo and make it easier to push out. If your child has been constipated for longer and their bowel has stretched they may also need stimulant laxatives to encourage the bowel to push the poos out. And after all of this it is likely your child will need a low dose of laxative for a long time, to prevent the constipation from returning while their stretched bowel has time to return back to normal.
It is important to let teachers know that your child suffers from constipation and soiling, so that they can support your child by prompting them to have regular drinks and toilet breaks in their day. It can have a big impact on teaching staff who may be helping clean up your child every day at school- keep them informed about school nurse and doctor’s appointments and any treatments you have in place.
I’m sure that your ‘Before Children’ self never dreamed how much time you would spend talking and thinking about, not to mention clearing up after, your child’s poo. I’m not going apologise for spending a little more time talking about it here in today’s blog. Glamorous it may not be, but for families living with childhood constipation it can feel a lonely and frustrating struggle to get the knowledge and support they need, and I hope some of the tips I’ve included today help. Great information for schools and parents can also be found at Eric.org.uk – where they also have simple child friendly resources to help you explain to constipation to your child.
A Guest Blog from Dr Sara Wood
Sara is GP near Stroud and spends her time juggling work and home life with 2 small boys. She loves family walks in the country and fun times with her #villagemumtribe to let her hair down, and is currently trying to persuade her husband they need to add chickens to their brood!