Tackling tummy troubles: How parents can manage functional constipation in children

KUALA LUMPUR: Functional constipation (FC), one of the most common gastrointestinal disorders in children, is defined as difficulty passing stool for reasons other than organic causes.

Consultant Paediatrician, Paediatric Gastroenterologist and Hepatologist at Sunway Medical Centre Velocity (SMCV) Dr Simon Foo Hee Wei said the disease has a worldwide prevalence of 9.5 per cent and accounts for 95 per cent of constipation cases among healthy children aged one year and older.

He added that while constipation might seem like a minor issue, untreated FC could lead to serious gastrointestinal complications such as tears in the colon and urinary tract infections, which could significantly impact a child's development as well as their quality of life.

"While many factors contribute to FC, it is important to note that children are particularly prone to developing it during their key life stages, such as the introduction of solid foods (six months to one year old), during the start of toilet training (two to three years old), and even when beginning pre-school (three to five years old).

"These developmental milestones can be critical periods because, for example, a child may develop FC during toilet training due to the stress and pressure of learning new routines," Dr Foo said in a statement recently.

He added that beyond life events, psychological factors such as stress, anxiety or trauma can also trigger FC, stating anxiety that comes with a change of environment, such as the uncleanliness of school restrooms, could also lead a child to avoid using the bathroom, resulting in stool withholding thus creating a cycle of increasing pain and worsening constipation.

Dr Foo said that constipation could 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 types of food allergies, 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," he said.

He also stressed that although occasional constipation is common and usually not a cause of concern, parents should be alert to the warning signs of FC, such as persistent abdominal pain and bloating, changes in appetite, weight loss or inability to control their bladder.

Dr Foo shared that understanding FC and its underlying causes is the first step for parents to effectively manage this condition in their children.

"Caregivers must maintain a collaborative approach, ensuring open communication not only with paediatricians but also with their children themselves to foster 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," he said.

He added that monitoring symptoms becomes more effective when all parties are well-informed and proactive and suggested a general guideline of ensuring 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 which defines functional gastrointestinal disorders.

Meanwhile, dietitian at SMCV Jillian Tan Foong Yinn emphasised the role of a balanced diet in promoting good bowel movements and overall gut health.

"Fibre-rich food like bananas, papayas, and steamed carrots or potatoes do not only promote regular bowel movements but also improve gut health.

"Alongside fibre, adequate hydration according to the recommended amounts based on age is equally important," Jillian said, cautioning against the misconception that introducing fibre-rich foods can alleviate FC symptoms immediately.

She explained that fibre-rich foods should be introduced gradually to give the child's digestive system time to adapt, help gauge their tolerance, and prevent issues like gas or bloating.

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.

"On top of that, parents are encouraged to instill positive lifestyle habits in their children from young, including consistent physical activity like walking, swimming, or even playing sports. Children learn by imitating their caregivers; hence, parents should set a good example by participating with their children," said Jillian.

Apart from that, potty training is a well-known developmental milestone 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.

"The recommended age to start potty training is around four years, when children can walk on their own, stay dry for a few hours, and understand and follow simple instructions. If children start potty training a little too early, with the lack of readiness and comprehension, they may associate going to the toilet with negative emotions, which can lead to stool withholding and, eventually, FC," Dr Foo explained.

He added that parents could take several measures to ensure that their child is comfortable throughout the process, such as dressing them in easy-to-manage clothing, which can help in case of accidents or the need for immediate changes to avoid discomfort.

Setting a fixed time for using the toilet with a potty chair or ring can help build initial habits, or parents can also introduce a reward system by giving them small incentives when children go to the toilet on their own within the set timeframe, which can create a positive relationship with the process.

Dr Foo also stressed that patience is key to successful potty training and that parents should not pressure their children but give them 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 elaborated.

He said patience is crucial for potty training and managing FC. This can be particularly challenging when young children struggle to understand the situation.

"Parents should not feel discouraged to seek open conversations with trusted paediatricians for professional advice. Sharing experiences with other parents can also help provide some form of support and relief," advised Dr Foo.

In addition to maintaining a routine or diet for their children, parents can incorporate interactive and creative approaches like involving children in meal preparation or making fun plating arrangements to help them view these changes positively.

-- BERNAMA

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