Childhood constipation often causes real misery for families. Constipation commonly starts around potty training. Discomfort of bowel evacation leads to avoidance which, in turn, leads to retention and larger/harder bowel motions so causing more discomfort, and so on. This is called “funcational constipation.” Constipation is also quite common in infants at weaning, and can start in school age children.
What can I do to help?
Regular toileting - make use of the “gastrocolic reflex” whereby there is a tendency to want to go to the toilet after a meal - so sit the child on the toilet after meals. If the child is old enough to understand rewards then explain that you will reward your child by sitting on the toilet. You can praise your child for actually pooing but the key is reward the process (sitting on the toilet) rather than the “result”. You might want to use stars or another reward system. Be consistent with the rewards. It is important not to punish the child for accidents.
Water requirements: Age 1-3 years 1300ml/day, 4-8 years 1700ml/day
Food - adequate fibre intake (fruit, vegetables, high-fibre breast, baked beans, wholegrain breakfast
cerials). Best not to have unprocessed bran that can cause bloating & reduce aborption of micronutrients.
For incontinence, you can focus on regular toileting and checking or changing of underclothes.
You may also want to reward your child for taking any medicine, and for drinking enough. It's important it doesn't turn into a fight!
What medication can help?
Movicol Junior (or Movicol half) is licensed for children 2 years or older (although it is also often used in younger children). The maintenance dose for a child age 1 to 6 is 1 sachet per day adjusted to produce regular soft stools (max 4 sachets daily). This is an “osmotic laxative” and is very safe and well tolerated. There is also a “disempaction” dose of gradually increasing doses over a week (up to 8 sachets), followed by the longer term maintenance dose.
The maintenance dose should be continued for several weeks after establishing a regular bowel habit. It's best not to stop medication abruptly but gradually reduce the dose over a period of a few months in response to stool consistency and frequency. Some children may require laxatives for several years.
Sometimes it may be necessary to add or switch to another type of laxative (a stimulant and/or lactulose). Stimulants laxatives include bisacodyl & senokot (both are only available in tablet form) and is added to movicol if needed. Lactulose liquid is added if the bowel motions are hard.
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