Abnormally infrequent and difficult passage of motions
is not common in children, but can be quite troublesome when it does happen. A child may pass hard motions because of
which he may get fissures or cuts near the anus. These can be
very painful. The child starts thinking that the passage of
motions causes pain. He then purposely starts withholding his
stools. In consequence, the stools become drier and firmer,
making it more difficult for the child to evacuate. Soon, a
vicious cycle starts. Sometimes, the child soils his underclothes when liquid waste leaks around the
Normal Infrequent Motions
Some exclusively breastfed babies pass normal motions
once every 2 to 3 days and sometimes even less frequently. The motions are never hard. This is normal and requires no
TREATMENT: Eating sufficient fruits, vegetables, sprouts, whole grains and fluids helps in the prevention
as well as the treatment of constipation. Regular bowel
habits and a relaxed pace for morning routines also helps to
A glass of water on getting up in the morning is
helpful. Warm water with a teaspoon of honey is preferable. Many children may get a normal urge to pass a motion after
that. Others may get used to passing the motion after drinking
milk or after breakfast. The child should be relaxed while
sitting in the toilet. A younger child may be encouraged to sit for
about 15 minutes. He can be engaged by the mother or others
with something interesting like a toy or a book or a puzzle.
If he does not evacuate, he should not be forced to do so.
The diet should have more of fibre in the form of fruits
like figs (fresh as well as dry), raisins, plums, apricots
and prunes; vegetables, especially raw and leafy vegetables, peas
and beans, sprouts, whole wheat flour chapatis and bread, unpolished rice, and enough liquids.
Foods that should be omitted or reduced include white bread, bakery goods, milk, butter, cream, cheese, ripe
banana, nuts, popcorn, sausages, sweet potatoes, spaghetti,
macaroni and noodles. Avoid giving the child milk products since
they can depress the activity of the colon. Cow and buffalo
milk can also cause milk allergy and anal fissures which may
cause chronic constipation via stool avoidance. Soya-based milk may be tried in such cases.
Although medicines can be helpful, do not medicate without consulting your doctor. Bisacodyl suppository
(available as Dulcolax), 5 mg. for under-twos and 10 mg.
for children over 2, may be used. It should be inserted at
the same time each day, preferably after a meal. Use it
daily for a month, 2 times a week in the next month and then once a week for 3 months.
In severe cases, hospitalisation may be needed to manage the child and also to investigate for some other rare
causes like congenital megacolon (Hirschsprung Disease) and hypothyroidism that can give rise to constipation.
11 February, 2013