Constipation in Children & Teens
Nov 30, 2021
By Barret Procyshyn, Pharmacist at Dauphin Clinic Pharmacy
Pharmacists are your most accessible health care provider. Through the pandemic when dental clinics, walk in clinics, physiotherapy and massage therapy clinics were forced to close, pharmacists were fortunate enough to be able to continue working and answering health related questions and solving problems. Some are easy and some are difficult. Some are also sometimes a little uncomfortable for the customer, but pharmacists are used to it. One question that might fall into the awkward category is constipation. While it occurs frequently as we get older and "things slow down" it is also quite common in children and teens.
Constipation means that stool is building up in the bowel and causing distress. Parents of small children and teens may feel embarrassed to ask about it, but it happens to most at some point during childhood. The great news is it can be treated and is rarely linked to any type of serious illness. Symptoms of constipation include stomach pain and cramps. They may also have trouble going pee or feel like they need to urinate often. Behavioural changes might be present, and they may avoid going to the washroom. Small amounts of blood may be present in the stool and stool may leak in their underwear.
Constipation across all ages is often due to stress, travel and change in diet. Not eating enough fibre or vegetables also contributes. Evidence of the need to have fruit and grains is not always strong, however; avoiding these in a diet may contribute. If a child or teen feels uncomfortable using a washroom withholding a bowel movement can cause constipation. This is where stress come comes into effect, embarrassment about using a toilet in school or previous painful experiences when trying to pass stool. Delaying going to the toilet while feeling the urge to go will not lead to good outcomes.
By the time you notice symptoms, constipation in usually in full effect and effective treatment can take time. If stool consistently builds up in the bowel it expands in making it harder for the muscles to do their job. Medications to treat the constipation can be started and then medications to assist with normal bowel movements can be continued until things return to normal.
The initial cleanout should involve Polyethylene Glycol for those aged 6 months and up for the first 3 days. Its given multiple times per day and is a powder taken orally making the process easy for the parents and child. Once the constipation is resolved the dose decreased and is given daily for up to two months. Doses are all based on the child's weight.
Healthy diet is extremely important. Children should have plenty of local fruits with skin, fresh vegetables, and whole grains. Unprocessed foods are always best and while some packaged foods claim to be whole grains it can be misleading. For all ages physical activity is very important to keep the bowels moving. With winter upon this it is more difficult but get your kids outside and moving for at least 1 hour per day.
Properly training the bowel is not a quick process and you have to give it time. However, working at a routine is very important. A child's body often has the natural urge to empty after a meal. About 30 minutes after a meal have your child sit on the toilet or potty. If your child is complaining of a "tummy ache" while or after eating encourage them to use the washroom. A good guide is 1 minute of sitting per year, 3 minutes for a 3-year-old is an example. The child may need a foot stool to make them more comfortable. For some children they may want privacy in the washroom. Give them a book so they have an activity for a few minutes. Some children may want you to join them which is encouraged because it makes them feel comfortable in the bathroom situation. Rewards like stickers may also be an option.
Rarely constipation can be dangerous or be a signal something else is wrong. Constipation in babies six months and younger is a red flag and deserves a doctor visit. Severe pain, pain lasting longer than 30 minutes and weight loss and some things which also merit medical attention. Rectal prolapses and anal fissures, which are cracks around the skin are also red flags.
If you need more information on constipation or help with doses of medication to give, your clinic pharmacist is available to help.
Soutrce: www.cheo.on.ca
The information in this article is intended as a helpful guide only. It is not intended to be used as a substitute for professional advice. If you have any questions about your medications and what is right for you see your doctor, pharmacist, or other health care professional.
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