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.
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,
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.
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.
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.