Managing functional constipation in children

Around 9.5 percent of children worldwide suffer from FC, a common gastrointestinal condition that is mostly caused by non-organic factors. Approximately 95 percent of children 1 year of age and older who experience constipation are attributable to FC. [J Pediatr 2005;146(3):359–363] Untreated FC, often seen as a small problem, can result in serious side effects such as urinary tract infections and colon tears, which can negatively affect a child’s development and quality of life.

Consistent symptoms such as bloating, weight loss, changes in appetite, abdominal pain, or problems with bladder control should raise the alarm bells. It is important to identify these symptoms in order to manage FC effectively and begin early intervention.

FC can occur during developmental milestones such as during introduction of solid foods (6 months to 1 year), the start of toilet training (2 to 3 years) and beginning of preschool (3 to 5 years). Children are subjected to stress during these times, which might result in constipation. Additional psychological elements that may contribute to FC apart from stress are worry and trauma eg, the dread of using filthy school facilities might lead to stool withholding, which exacerbates the issue.

Additionally, FC may be exacerbated by dietary factors such as sensitivity to cow’s milk or deficiency in fiber and reduced fluid intake. Further, switching from breast milk to cow’s milk may occasionally cause the formation of large, hard stools that cause constipation and anal fissures. If food allergy or intolerance is suspected, it can be determined using the 2-week elimination approach.

Prevention and management of FC in children

Understanding the causes of FC is the first step towards effective FC management. It is important that parents, children, and healthcare professionals work closely during this time. A customized treatment regimen is required to meet the specific needs of every child.

The ROME criteria for functional gastrointestinal diseases recommends maintaining a regular bowel movement frequency of at least three times per week, free of painful, big, or hard stools. Foods that encourage regular bowel motions and general gut health include bananas, papayas, and steamed vegetables. However, parents should be advised to avoid introducing fiber-rich foods too quickly as this may result in bloating and gas. They should ensure their child is drinking enough water.

Parents should also encourage children to engage in physical activity such as walking, swimming or other sports as it promotes healthy bowel function. Children often imitate their caregivers, so parents should also be encouraged to participate in these activities to set a positive precedence.

The importance and timeliness of potty training

A crucial time for establishing good hygiene practices and avoiding FC is during potty training. Potty training should begin at age 4, when kids are more likely to be ready and able to comply with basic directions. Beginning too early can cause negative associations with using the toilet, which can lead to stool withholding.

Parents can make sure their child is comfortable throughout toilet training by dressing them in easily managed clothes and designating a specific time for them to use the restroom. It can be made more enjoyable by using a potty chair or ring, as well as by implementing a reward system for successful toilet use. 

Patience is key to successful potty training and managing FC. Parents should provide constant encouragement and not pressure their children, even when accidents occur. Consultations with doctors or pediatricians and sharing experiences with other parents can provide the emotional support and relief that is needed. Further, creative approaches, like involving children in meal preparation or making fun plating arrangements, can help children view dietary changes positively.