Health

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Most of us worry at some point about what’s going on ‘below decks’, but few of us like to mention it! Here’s all you need to know about your child’s bowel habits

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Eating, sleeping, tantrums - we're all used to swapping tips about these familiar aspects of childrearing. But how many of us ever admit to worries about our kids' bowels? We're naturally a bit hesitant to share our concerns with others. Perhaps your child doesn't go quite as often as you think he should. Or maybe he's reluctant to use the toilet, or tends to go in places where you'd rather he wouldn't.

Before you start getting worried about how many times your child moves his bowels every day, it's worth finding out just what the 'normal' frequency is. As you might expect, it's a pretty wide spectrum: anything from three times a day to twice a week.

When something is wrong, children tend to fall into one of two clear categories - those who strain a lot and those who don't strain at all. So if you're concerned that your child is taking too long on the loo, or not long enough, watch how he goes about having a bowel movement. If he goes red in the face without producing anything once or twice, it may sort itself out. But if a child keeps getting off the toilet, not doing anything, then going back again, that could be a problem.

Before going to the doctor, try upping the fibre in your child's diet

CONSTIPATION

Watching a red-faced child trying to move his bowels without success can be distressing for child and parent. It's worth knowing a little more about the different causes of constipation to get to the bottom - so to speak - of the problem.

Constipation falls roughly into two problems. One is the problem of transit - the movement of the faeces through the intestines being too slow. The other is a problem with the pelvic floor. It’s a little like getting toothpaste out of a tube. You need to squeeze the tube (the transit) and take the lid off - that's the pelvic floor side of things.

If the problem is slow transit, there could be several different causes. It could be a change of diet, or not enough liquid in the diet. Some medications can also cause constipation. As well as spending longer in the loo, your child might also lose his appetite or complain of tummy ache or feeling sick. You might also notice that he's repeatedly soiling his pants, as liquid faeces can leak out from behind the hard, impacted ones.

Before going to the doctor, try upping the fibre in your child's diet. Give more fruit, vegetables, cereal or wholemeal bread, and making sure your child is drinking plenty of water. But be aware that if you up the fibre and that doesn't result in an improvement, your child may just get more bloating and discomfort. In this case, there's no point increasing the fibre intake again.

If your child is still suffering after a couple of weeks, it's time to go to the GP. He or she may prescribe a mild laxative, such as senna liquid or lactulose. These should only be used in the short term and as infrequently as possible, as too many laxatives could make your child's bowel stop working properly.

Your child could also be prescribed glycerin suppositories to make bowel movements easier. But the emphasis should always be on adjusting your child's diet and liquid intake to get things moving again. Never give your child laxatives unless a GP has prescribed them and never give that old wives' remedy, castor oil - it can actually damage the nerve endings in the bowel.

DIARRHOEA

Many diarrhoea cases in children under seven are caused by a viral infection, such as norovirus - the 'winter vomiting bug' - or a rotavirus. Rotavirus is spread through the faeces of the infected child when they don't wash their hands after going to the toilet, while norovirus can also spread in the air after the infected person is sick. Food poisoning is another common cause. Good hand hygiene is the best way to prevent viral infections, and making sure food is cooked and stored properly will help avoid food poisoning.

Sadly, there’s not a great deal you can do about diarrhoea. It's just a case of riding out the bout and making sure your child drinks plenty, as diarrhoea can dehydrate a young child very rapidly. Symptoms of dehydration include lethargy, sunken eyes, dry mouth, and not urinating for 10 hours or more.

You can stave off dehydration with over-the-counter rehydration sachets such as Dioralyte, which also contain vital minerals and salts. If the diarrhoea doesn't stop after 48 hours, call your GP for advice. Never give over-the-counter remedies like Imodium to a child without talking to your GP first

BOWELS AND BEHAVIOUR

Children in emotional distress may sometimes respond by changing their toilet habits. They might start smearing their poo on themselves or around the house. Or they might start going to the toilet in inappropriate places, or soiling. If your child has already been potty trained and is doing this, you need to find out what's bothering him. Ask your GP to recommend a counsellor if you feel you need help.

Sometimes small children become scared to go. When children associate going to the toilet with a negative event, such as a public toilet they didn’t like, they may lose that natural instinct to open the bowels that most of us don't even think about. ‘Holding on' becomes a learned behaviour. In this case, your GP should be able to refer your child for a form of counselling known as 'biofeedback' which helps children to listen to their bodies, know the signs when they want to go, and feel more confident about the outcome.

When children associate going to the toilet with a negative event, such as a public toilet they didn’t like, they may lose that natural instinct to open the bowels that most of us don't even think about

PERFECT POTTY TRAINING

It's common for us to pass on our own feelings about going to the toilet to our kids. So if you do have any hang-ups – perhaps you were brought up not to talk about it, or your mum was obsessed with going at a certain time of day – try to identify these so you avoid passing them on to your child.

Try not to worry too much about frequency. Make toilet training and wearing the new pull-ups part of your routine and make the child aware that it feels different when he soils or wets himself. Accidents have to happen so the child becomes aware of this difference. When they do happen, deal with them calmly with plenty of positive reinforcement.

WHEN TO WORRY

Two indicators of a more serious bowel condition are blood or mucus in your child's stools, and if you see these you should visit the GP immediately. It’s very rare for children to get inflammatory bowel disease like Crohn's disease, but it can happen. Juvenile polps may also need to be ruled out. These are benign growths in the bowel which can bleed.

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