Constipation can occur in a child of any age. This section, however, focuses on the problem of constipation in toddlers. This tends to be a behavioral problem. A bad experience with the process of bowel movement is enough to trigger a chain of events that eventually leads to chronic constipation. Once the fall from grace occurs, it's all downhill from there, and that's not a pretty sight.
The First Hard Stool
It all begins with a single bad experience. A simple dietary change can harden your child's stool to the degree that passing the hard stool is an unpleasant experience. Your child is no fool. He will not only remember this bad experience, he will do the best he can to avoid having to go through it again. In fact, it's possible that he will seriously consider not having another bowel movement for the rest of his life.
Of course, everyone knows that would be impossible, but such a daunting goal would not faze a stubborn toddler. Every time he senses the need to have a bowel movement, he'll do everything within his power to avoid passing the stool. You will undoubtedly witness many of these valiant struggles. When the urge to defecate comes, you'll find your child suddenly drops everything that he's doing and stiffens up. He will remain motionless and may cross his legs to help discourage the stool from coming out. Sooner or later, the wave of contractions will pass, and he'll resume his normal activities.
Infants less than a year old do not have the ability to willfully hold in stools. If your baby has hard stools, the best way to ameliorate the condition is to provide a small amount of diluted prune juice on a regular basis. Remember, babies can go for five to seven days without having a bowel movement, and this is considered to be normal as long as the stools are not hard.
This is the classic sign of constipation in children. Pediatricians refer to this as stool-withholding behavior. This behavior is the root of all evils, because it generates a cycle of pain and increasingly hardened stools. The task for the parents and the pediatricians is to break this relentless cycle of suffering.
The Initial Disimpaction
Once the vicious cycle of painful bowel movements and stool withholding is established, it must be broken one way or the other before your child can embark on the road to recovery. The first order of business is to eliminate all the hard stool that has been accumulating inside the intestine.
Of course, there is no way that your child is going to accomplish this willingly. After all, stool withholding is part of the problem, and logical reasoning with your toddler is usually futile.
Therefore, the only way this can be accomplished is by force. While this procedure doesn't have to be brutal, it is inevitably against the wish of your child, so a struggle is almost always guaranteed during this process.
The disimpaction can be accomplished in many ways. If a large bulky stool is stuck in the rectum, the doctor sometimes tries to disimpact the bulk by sticking a finger into the anus and manually remove the stool. If this is not feasible or not necessary, a large amount of gentle laxative or an enema can often do the trick.
Even though chronic constipation in a toddler is most likely caused by a behavioral problem, there are some rare but real medical conditions that can cause constipation. If your baby has had severe constipation since birth, or has other developmental delays, the constipation may be a manifestation of an underlying neurological problem (a condition called Hirschprung's disease).
The safest and most popular laxative for children is mineral oil. While there are other safe and effective alternatives, most pediatricians favor mineral oil because of its safety profile. The intestine cannot absorb this medicine, so even if your child ingests a large quantity of it, overdosing is practically impossible. The only thing that too much mineral oil can cause is excessive loose stool. But after all, isn't this the outcome you're shooting for when your child is constipated?
You may have to start with a repeat dose of mineral oil to empty the intestine of all the stool. Generally, it is a good idea to continue administering the mineral oil until what's coming out from the other end is colorless (neither brown nor yellow). Your pediatrician should advise you on the proper dosage, depending on the body size and age of your child.
After you have successfully cleaned out your child's intestine, the struggle against constipation has just begun. Getting a fresh start is only the beginning of the long and tedious process of treating constipation because the root of the problem is not resolved. Your child still fears going to the bathroom and having a bowel movement. In fact, after the torturous process of disimpaction with a laxative, your child probably has developed even more distaste for passing stools.
What parents must do at this stage is aim to keep the stool moving through the child's intestine without allowing it to be backed up. You can expect your child to actively fight against this goal because the fear of stooling still looms large over his head. Your job is to continue giving the mineral oil, usually at a smaller dosage than you did in the initial disimpaction phase, on a regular basis. You cannot allow your child to withhold stools again, or you'll be back at square one. Hopefully, after a few weeks your child will get used to the passage of soft stools and will stop trying to actively retain stools.
This maintenance phase may last for a long time, especially if your child has been suffering from constipation for quite a while. Once things are going well, you cannot grow complacent and slack off on the mineral oil treatments. Your child is at risk for a relapse for the first few months of the maintenance phase. If your stop treatment prematurely, your child will stop passing stools and become constipated again.
You can never go wrong eating lots of fresh fruits and vegetables. There is a reason why everyone touts their virtues: Not only do they ward off childhood obesity, but they are an excellent source of fiber. There is also increasing scientific evidence that a diet rich in fresh fruits and vegetables can lower the risk of cancer development.
Don't forget to increase your child's water intake while you're adding fiber to her diet. A diet high in fiber that does not also include an increased intake of water can actually worsen constipation instead of helping it. A high-fiber diet must be accompanied with a lot of water intake in order to maximize the benefit of the fiber in the intestine.
Fruits, vegetables, and beans are all excellent sources of fiber. Especially beneficial are pitted fruits, such as peaches, pears, and plums. Unbuttered popcorn is also a great and tasty source of fiber that most children love, and raisins also make a good snack for your child.
Even though increasing the amount of fiber and water in your child's diet is certainly an important aspect of treating constipation, the hardest part is changing your toddler's attitude about having bowel movements. It takes a tremendous amount of patience on the part of you and your child to correct the attitude. If you are determined to resolve this stubborn problem, you must be mentally prepared to be in it for the long haul.