Bowel problems: constipated children need immediate help – cleankids magazine

Children’s Health Foundation provides information about bowel problems in babies and small children

According to the German Society for Nutrition le >

How often a child does its big business, what is normal and no longer normal, depends very much on age. Especially with breastfeeding alone, the spread can be between six times a day and only every 10 days. Young infants sometimes squeeze when defecating. huge with a red head. This is also not to be confused with constipation and is normal as long as the chair is not hard and the children are thriving. With the introduction of bottled food or complementary food, the children usually empty the diaper 1 to 2 times a day, but as with older children and adults, a bowel movement every 2 days is also still normal.

“It is precisely this large range of variation in the first years of life that unsettles many parents. They observe the child’s stool habits particularly carefully and worry about any irregularities, ”reports Professor Dr. med. Sibylle Koletzko, pediatric gastroenterologist at the Dr. von Haunerschen Children’s Clinic of the University of Munich. “In many cases, this turns out to be unnecessary, but only one can determine whether the problem is really harmless pediatrician or pediatrician after a thorough questioning of the parents and a thorough physical examination of the child.

If necessary, the diagnosis is supplemented by ultrasound examination and a blood sample for the laboratory. Extensive studies are usually superfluous: Organic causes, such as B. the congenital bowel disease "Hirschsprung’s disease" are extremely rare beyond infancy. Sometimes a cow’s milk protein allergy is the cause. "The goal is to initiate quick and effective treatment so that constipation does not become a chronic problem," says Professor Sibylle Koletzko.

Typical signs of constipation are if the stool is emptied only every few days, but not in the normal consistency, but as hard chunks or in small balls ("sheep droppings"). It is so firm that the child has trouble pushing it out. The belly is distended, the child complains of pain.

What is behind the congestion in the intestine??

Sometimes it is changes in the normal daily routine that confuse the child’s bowel movements: a long journey, unusual eating, an illness that binds the child to the bed for a few days. Psychological stressful situations also affect intestinal function: for example, moving house, the birth of a sibling or family conflicts.

In babies, the switch from breast to bottle or the first porridge meal can be the trigger. Toddlers, in turn, sometimes develop constipation at the time of getting clean or after having diarrhea. Larger children disgust themselves from the dirty toilets in kindergarten or school or simply have "no time" to go to the toilet.

Some children also use the parents as a “test of strength”: they suppress bowel movements for many days. Sometimes there is a protest, e.g. if the parents want to raise the child too early for cleanliness.

When the "session" becomes torture

If the constipation lasts longer than two months, one speaks of "chronic constipation". "At the beginning of the persistent constipation there is often a sore bottom or a tiny but very painful tear in the anus mucosa," reports Professor Sibylle Koletzko. “It usually arises from the chair being too hard. Since the child fears the pain of defecation, he actively holds back the stool, which leads to the formation of stool that is too hard and to pain again – a vicious circle is created ”.

Trying to prevent the chair from being emptied often leads to adventurous maneuvers: the children cross their legs while sitting or standing, crouch on their own, slide around on the back of a chair, or crawl under the table. They often get a bright red head before exertion.

Another very unpleasant consequence can be the expansion of the intestine, whereby the child loses the feeling for the urge to stool after a while. Rotting creates a soft stool that flows past the accumulated feces and is deposited in small amounts in the underwear.

This "stool smearing" should not be misinterpreted as diarrhea. It has nothing to do with psychological misconduct: "The child can’t help it! Scolding and punishing are of no use in this situation and should be avoided at all costs, ”emphasizes Professor Sibylle Koletzko. "The child needs help to regain control of its bowel functions.".

Treat as soon as possible!

Constipation in children must be treated as soon as possible to prevent avoidance behavior if necessary. The treatment of constipation should initially relieve the child of the fear of a painful bowel movement. Depending on the age of the child and the duration of the problem, constipation is treated with different means. The Children’s Health Foundation recommends the following procedure based on the suggestions of the "Society for Pediatric Gastroenterology and Nutrition":

Infants and young toddlers:

  • Care of the bottom and anus, no manipulation e.g.. with a Thermometer;
  • Change of diet to keep the stool soft (e.g. with pear puree or whole grain porridge);
  • Cow’s milk protein intolerance can be the cause of persistent constipation. The "allergy test" in the blood or the skin prick test rarely helps. A cow’s milk-free diet over 2 to 4 weeks can bring clarification, but only after consultation with the pediatrician and appropriate nutritional advice;
  • Medicines to keep the stool soft according to the prescription by the pediatrician. They are harmless and do not create any dependency;
  • Cleanliness training only after the constipation has healed.

Kindergarten and school children:

  • Explain bowel function in simple words.
  • "Toilet training": After the main meal or if there are signs of a desire to stool, the child should be reminded to use the toilet. If the child tries to "pinch" it should be distracted from it.
  • The sessions should not last longer than 5 to 10 minutes. It is helpful to sit comfortably on the toilet (e.g. with a stool or child seat) and to praise you for stopping your chair.
  • Keeping the stool soft with medication as prescribed by the pediatrician.

What laxatives for children?

Meanwhile s
There are powder products available for children. They contain long-chain molecules, so-called polyethylene glycols (PEG, also called macrogol), which bind water in the intestine due to their osmotic effect and soften the stool. You will be eliminated unchanged. The powder is stirred into water or other liquids and drunk, but can also be given with soup or porridge. Due to their good tolerability, the preparations can also be used over a longer period of time.

Lactulose and – more rarely – paraffin oil are also used for laxation in children. However, they have more side effects like stomach ache and bloating than PEG.

Important: Laxatives for adults are not suitable for children!

Parents should be patient, the Children’s Health Foundation emphasizes: only consistent and long-term treatment can break the vicious cycle of stool retention and intestinal expansion. It can sometimes take many months for the emptying disorder to return to normal.

What else helps

The most important thing for prevention: Healthy diet with lots of fiber, enough fluid and exercise. Children who are prone to constipation should have less cake, white bread, chocolate, and milk. Instead, more fruit juices, vegetables, salads, whole grain bread, oatmeal, fruit and yogurt.

There are many scientifically unproven assumptions about the development and treatment of constipation. Here are two examples:

  • Constipation leads to "internal poisoning" of the body. This ancient concept can already be found in an Egyptian papyrus scroll from the 16th century BC and was particularly intensely propagated at the beginning of the 20th century (motto: "Death lurks in the intestine!"). However, there is no evidence to support such fears: the toxins that are allegedly produced in the intestine have never been proven.
  • Laxatives are dangerous in the long run. Carefully conducted studies contradict this assumption. An analysis of 105 scientific publications from 30 years showed that laxatives like PEG do not cross the blood-brain barrier and cannot be addictive. When used as intended, there is no risk of getting used to it.


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Christina Cherry
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