Practical Parenting

Constipation among Children

Constipation is very common in children of all ages. Of all visits to the pediatrician, 3% are in some way  related to this complaint .25 percent of visits to a pediatric gastroenterologist are due to constipation.

Millions of prescriptions are written every year for laxatives and stool softeners.

What Causes Constipation?

Constipation is mostly functional. This means it is not due to any medication or anatomic abnormalities .Ninety percent of the causes of constipation come under this category

.

· Immature system: In some infants, constipation can be due to an immature system,improper relaxation of the rectal muscles.

· Some breast fed infants can go without a bowel movement for several days. However it is important to look for signs such as

 Distension of the tummy

  Persistent vomiting especially

 Inconsolable crying

If any of these are seen then it is important to contact your primary care provider or visit the emergency room. It is important to rule out obstruction of the intestines, ileus, Mal-rotation, Volvulus.

 

 Fiber: Lack of fiber can also cause constipation later on in life. Once the child has been constipated for more than a few days, the retained stool can fill up the Large intestine (the colon) and cause it to stretch. This overstretched intestine then does not work efficiently to expel stool.

 
Then constipation becomes a behavioral issue. The bowel movements are hard and painful .Most of the times children withhold their stools due to fear of pain. (Withholding Behavior)

In some children, constipation can begin when

· there are changes in the diet

· the time of toilet training

 Following travel, or after a viral illness.

· Older children can begin withholding the stool .Even if they have an urge to use the bathroom. They may be afraid to use public toilets. School or summer camps, with facilities that are not so clean, are common causes of stool withholding in this age group.

There are some causes that may be due to a problem with the muscles of the stomach, anatomic abnormalities, endocrine problems, drugs. These causes are not so common.

Hence it become extremely important to talk to you primary care provider with regard to the consistency of the stools, when and at what age did your child start having hard stools. It is also important to know if your child had difficulty passing the first stool. This may not be functional and may need to be further looked into.

When does constipation become a problem?

 

· If your child has Hard painful stools that are difficult to pass

· If your child consistently skips days without having normal

  Bowel movements

· If your child has symptoms such as constipation stomach pain, poor appetite, and  crankiness

· If you see bright blood in the stool or on the toilet paper after wiping. This hard stool can tear the lining of the anus which is also called a fissure. These fissures are very painful and bleed.

· If your child has Problems with passing the stool in the underclothes. Most of the times  the child is not aware of this soiling. The child does not feel the urge to have a bowel movement and has an accident. These stool accidents are often mistaken as diarrhea.

· Pain-abdominal or rectal

· Daytime or night time urinary incontinence and recurrent attacks of a urinary tract infection

In most cases there is no need for testing prior to treatment for constipation. However sometimes the doctor may need to do an X-ray of the tummy or perform other tests to asses the degree of stool or rule out other causes of constipation.

How do you treat constipation?

The goal of treatment is soft, regular stools. Positive results requires time and patience

Diet rich in fiber and fluids are important in the treatment of constipation. Fiber such as fruits, vegetables, whole grain breads, cereals.

Many a time’s behavior modification becomes extremely important. It is often helpful to start a bowel training routine where the child sits on the toilet for 5 – 10 minutes after every meal or before the evening bath. It is important to do this consistently in order to encourage good behavior habits. After every successful bowel movement a reward such as a sticker may be given that reinforced this positive behavior.

A few children may require an initial “clean-out” to help empty the colon of the large amount of stool. This typically entails the use of laxatives by mouth or even suppositories or enemas for a short period of time.

Please feel free to post any comments or questions

Preserving Your Home Language

Hello all,

As a kindergarten teacher, parents often approach me with concerns about their children's language skills in English. This is especially the case for parents who have recently arrived from another country, and who struggle with the English language. These parents will often say that they are trying to speak to their children in English as much as possible to help them learn the language. Many stop using their home language with their children completely. While it is important to introduce children to the English language and to communicate with them in English, it is absolutely critical for parents to continue using their home language. The research clearly indicates the many advantages of bilingualism (and multilingualism) on children's ability to learn English. These studies have shown that when children are fluent in their home language(s), many important language skills (e.g., phonemic awareness, vocabulary, higher order thinking skills, etc.) transfer over and help them learn the English language much more quickly and much more efficiently. 

In addition to helping children learn English, fluency in the home language is essential in helping children preserve their cultural identity. Moreover, as children grow older, their home language helps them to continue to communicate with family members who may not speak English (e.g., grandparents). This is so very important because if children lose their first language, they may potentially risk their relationships with family members. And while it is natural for children to communicate in English once they begin school, parents should still encourage them to use their home language as much as possible. For younger children, it is a great idea for parents to enroll them in classes where they have the opportunity to learn how to read and write in their home language.

Finally, our societies are becoming more and more global and our world is more connected now than it has ever been. Giving children the benefit of learning and mastering several languages (including their own) will enable them to thrive in this society.

Let's Talk! Let's Talk! Let's Talk!

Hello all,

As adults, we do not realize the critical importance of talking with children and, as a result, we spend most of our time talking to children (e.g., telling them what to do). Having conversations with children helps them develop their vocabulary, it helps them learn the rules and conventions of our language, and it presents them with a great opportunity to ask questions and to learn many new things. In addition, by initiating conversations with children when they are young, they become comfortable talking to you and it becomes easier for them to talk to you when they are older about serious issues (e.g., bullying at school).

There are many simple ways to engage in conversations with young children. These conversations can be centered around books that you read together, events you attend, or even around a question the child may ask. You can also initiate conversations when you play with your children. For example, if your child is building with blocks, you can have a conversation about what the blocks represent and make up a story together about the structure the child may be building.

During the early years, children's language skills grow very quickly. They learn the words they hear and the words that are spoken to them. By the time children are three, they have a vocabulary of nearly 1,000 words. So how do you initiate conversations with your children? You may find the following tips helpful:

• Children love to ask questions. Build your conversations around these questions and ask your own.
• Talk about what your child is doing and what you're doing. Ask questions that extend their thinking such as, for example,"what kind of picture are you drawing?" or "what do you think will happen next in the story?" and "what is your favourite part of the story?"
• Practice taking turns in conversations.
• Read with your children. Involve them in the reading. If they are still too young to read, do a "picture walk" with them and have them tell the story looking at the pictures and using their own words.
• Continue to have conversations with your children in your first langauge. Research has shown than language skills transfer over when children learn another language.

Remember, it is largely through conversations with more experienced adults that children come to learn about the world outside their own personal experiences. So continue to have fun conversing with your children. As always, if you have any questions or comments, don't hesitate to share them with me.

Irritable bowel syndrome

Have you ever had these tummy aches ----that everyone has dismissed as a pain of convenience. My own mother always thought it was my most played excuse to stay out of school.

Finally after going through a series of tests and half a dozen doctors i finallly had a diagnosis-irritable bowel syndrome.

So what is irritable bowel syndrome and how common is it?

It is chronic disorder that can cause abdominal pain ,bloating and abnormal bowel movements. About 15-20% of school aged children . Children with irritable bowel syndrome complain of bloating,abnormal bowel movements. They complain of constipation alternating with diarrhea. The abdominal pain is diffuse, occurs any time of the day. It may be non -existent for weeks  and then on a warm sunny morn when you have the whole day planned out the pain may recur.

What causes IBS?

Although the exact cause is not known, It is postulated that some chemicals secreted by the intestines  or brain, may cause the intestine  to be more sensitive to triggers like stretching of the intestine .

How is it Diagnosed?

A careful history of how of the site onset and character of the pain may help distinguish it from more serious problems. It is also quite possible that the doctor may obtain some tests. The reason for these tests is to look for signs of any serious disease. These screening tests may initially include blood and stool tests. The results of screening tests often guide the doctor in deciding whether further tests are needed .Often times a referral to pediatric gastroentrologist shall be made.

If any of the tests come back abnormal-then definitely its not Irritable bowel syndrome . Further testing like endoscopies or imaging studies such as CT scans and upper Gi series may be required.

It is also recommended to watch out for these red flags:

Weight loss

diarrhea with blood

Joint pains and rashes

Pain that is not easily controled and is different form the usual

The primary care doctor needs to be informed. Depending upon the case a visit to the Emergency may also be necessary.

So does your child have IBS ?

Does your child have pain in the tummy that has been present for weeks-

• Gets relieved with defecation
• Is often associated with a change in the frequency of stool.
• Onset is associated with constipation alternating with diarrhea.

Other symptoms that may or not be present:

• Abnormal stool form
• Abnormal stool passage(straining,urgency or incomplete evacuation)
• Passage of mucus
• Bloating or feeling of abdominal distension

Treatment

Physicians know that stress and anxiety do not cause the problem. But they do aggravate it. So things that could be done and are under our control are:

• Establish a good relationship with a physician
• Eat more fiber
• Avoid fatty foods. Fatty foods may aggravate symptoms in children with IBS
• Medications: such s antispasmodics can temporarily relieve symptoms
• in cases where there is a tendency to be more constipated-laxatives may be used. Diarrhea may also be an issue that can be relived by the use of anti-diarrheal medications
• Reduce stress .Relaxation and behavioral techniques are always helpful.
• The most important thing is to understand your child and his needs.

What do i anticipate in the future?

Irritable bowel syndrome may have negative effects on the child’s physical and psychological state. The pain may interfere with school attendance, participation in sports and other extra-curricular activities. Infrequently, it may affect appetite and sleep

Fortunately, the diagnosis of functional abdominal pain has a good prognosis. Half of these children getting better on their own .

Please feel free to post your comments or ask any questions.

Ritu Walia