Functional constipation (FC), one of the most common gastrointestinal disorders in children, is defined as difficulty passing stool for reasons other than organic causes. According to Dr Simon Foo Hee Wei, a Consultant Paediatrician, Paediatric Gastroenterologist, and Hepatologist at Sunway Medical Centre Velocity (SMCV), the worldwide prevalence of FC is 9.5 per cent, accounting for 95 per cent of constipation cases in healthy children aged one year and older.
While constipation might seem like a minor issue, untreated FC can lead to serious gastrointestinal complications, such as tears in the colon and urinary tract infections. These complications can significantly impact a child’s development and quality of life. Therefore, recognising and learning the best ways to manage FC promptly is crucial for ensuring a child’s overall wellbeing.
Understanding functional constipation in children
While many factors contribute to FC, it is important to note that children are particularly prone to developing it during key life stages, such as the introduction of solid foods (6 months to 1 year old), the start of toilet training (2 to 3 years old), and even when beginning preschool (3 to 5 years old). Dr Foo explains that these developmental milestones can be critical periods; for example, a child may develop FC during toilet training due to the stress and pressure of learning new routines.
Beyond life events, psychological factors like stress, anxiety, or trauma can also trigger FC. For instance, the anxiety that comes with a change of environment, such as the uncleanliness of school restrooms, can lead a child to avoid using the bathroom, resulting in stool withholding. This can create a cycle of increasing pain and worsening constipation, causing significant distress.
Constipation can also result from a lack of fibre and fluids in the diet or an intolerance to cow’s milk. Transitioning from breast milk to cow’s milk can cause constipation in some infants, leading to anal fissures due to the passage of large, hard stools. To determine a cow’s milk allergy — or any other type of food allergy — clinicians often recommend the two-week elimination method, where parents remove the suspected allergen from the diet. If the child’s condition improves, it strongly indicates an intolerance to that allergen.
Occasional constipation is common and usually not a cause for concern, but parents should be alert to the warning signs of FC, such as persistent abdominal pain and bloating, changes in appetite, weight loss, or an inability to control their bladder.
Prevention and management of FC in children
Understanding FC and its underlying causes is the first step for parents to manage this condition effectively in their children. Caregivers must maintain a collaborative approach, ensuring open communication not only with paediatricians but also with their children. This fosters a better understanding of the child’s condition and any challenges they may be facing.
Such communication is invaluable for medical professionals in offering accurate advice and treatment plans tailored to each child’s needs. Monitoring symptoms also becomes more effective when all parties are well-informed and proactive.
While specifics may vary from case to case, Dr Foo suggests a general guideline of ensuring that the child has a regular defecation frequency of at least three times a week, without experiencing painful, large, or hard bowel movements, as described in the symptom-based ROME criteria for functional gastrointestinal disorders.
Meanwhile, SMCV Dietitian Julian Tan Foong Yinn emphasises the role of a balanced diet in promoting good bowel movements and overall gut health.
“Fibre-rich foods like bananas, papayas, and steamed carrots or potatoes not only promote regular bowel movements but also improve gut health,” she explains.
Alongside fibre, adequate hydration according to recommended amounts based on age is equally important. However, Julian cautions against the misconception that introducing fibre-rich foods can alleviate FC symptoms immediately.
“It should be introduced gradually to give your child’s digestive system time to adapt and to help gauge their tolerance, preventing issues like gas or bloating,” she clarifies.
Balancing a child’s diet with occasional snacks is also key to maintaining a healthy approach and fostering a positive relationship with food. Finding this balance ensures that children receive essential nutrients from their regular meals while still being able to enjoy occasional treats.
Additionally, parents are encouraged to instil positive lifestyle habits in their children from a young age, including consistent physical activity like walking, swimming, or playing sports. Children learn by imitating their caregivers; hence, parents should set a good example by participating with their children.
The role of potty training
Potty training is a well-known developmental milestone that every parent undertakes with their child. It is essential not only for instilling a sense of good hygiene and independence in children but also for potentially preventing FC. Despite its importance, many young parents may question the right age to begin potty training and how to ensure it is a positive experience.
According to Dr Foo, the recommended age to start potty training is around 4 years old, when children can walk on their own, stay dry for a few hours, and understand and follow simple instructions. If children start potty training too early, lacking readiness and comprehension, they may associate going to the toilet with negative emotions, which can lead to stool withholding and, eventually, FC.
To help ease children into potty training, parents should ensure their child is comfortable throughout the process. Small steps, such as dressing children in easy-to-manage clothing, can assist in case of accidents or the need for immediate changes to avoid discomfort. Additionally, setting a fixed time in their daily routine for using the toilet with a potty chair or ring can help build initial habits. Introducing a reward system, such as small incentives for going to the toilet independently within the set timeframe, can create a positive relationship with the process.
Dr Foo stresses that patience is key to successful potty training.
“Parents should not pressure their children but rather provide constant encouragement without getting too upset if toilet accidents occur. Being a source of support for your child during this time makes them feel safe and secure as they learn to use the toilet independently,” he elaborates.
Patience is not only crucial for potty training but also for managing FC. This can be particularly challenging when young children struggle to understand the situation. Parents should not feel discouraged; seeking open conversations with trusted paediatricians for professional advice is important. Sharing experiences and challenges with other parents can also provide support and relief. In addition to maintaining a routine and diet for their children, parents can incorporate interactive and creative approaches, such as involving children in meal preparation or making fun plating arrangements, to help them view these changes positively.
