• Dharma Nemani

Scoop on consti-poop with Dr. Breanne Pacheco Shah

What technically constitutes constipation? Is it the number of days without poop / type of poop? When I see parents and children in the Emergency Department who are concerned about constipation my guidance is as follows: All babies and children are different when it comes to stooling. Some children stool daily, others much less frequently and that's ok as long as the stools are soft and easy to pass. Babies can also strain to stool, but pass soft stools, which is also normal and a way for them to build pressure to pass the stool itself. But at any age, if stools are hard, dry and painful to pass, that's constipation. Some other clues to constipation may be episodes of crampy abdominal pain or blood streaked stools.

How common is constipation in younger children? Should parents be more worried if constipation continues past a certain age?

Constipation is VERY common. I see a patient with concerns of constipation every shift I have in the Emergency Department and it is one of the most common reasons that children are referred to a pediatric gastroenterologist. There is no reason that a parent should be worried if a child has constipation issues after a certain age. Constipation is common in adults as well, so spans the spectrum of ages.

What are some common causes for constipation in children? Diet? Fear of pooping? Recently potty trained?

The most common causes of constipation in children are:

- Diet: diet changes, low fiber content in the diet or poor fluid intake can all contribute to constipation. Children who take in a lot of dairy, especially high volumes of milk can have constipation. Diet is probably the most common reason children are constipated.

- Withholding: if stools are painful, some children will hold stool to avoid pain. Toddlers will withhold to avoid stopping play. Constipation is also more common during potty training when young children are getting comfortable using the toilet. Older children may withhold to avoid stooling while not at home.

- Illness: poor intake while sick or change in diet while sick can cause constipation. Some medicines can contribute to constipation.

- Changes in general: changes in routine and stressful situations can cause a break in routine when it comes to a child's stooling.

What are some things parents can introduce to ease constipation?

My first go-to with mild to moderate constipation is trying to add more fiber to a child's diet on a daily basis. This can be hard for the picky eater. Fruits such as apples, pears, and raspberries; veggies such as carrots and broccoli; beans; and whole grains give you the best bang for the buck. For a bit faster change to help when a child is more uncomfortable, using prune juice, prune puree or plain prunes are great and usually relatively effective. I reach for a stool softener/laxative when parents have tried diet changes without great success.

If a child ends up in the Emergency Department because of constipation, I am often giving an enema for more rapid relief and/or starting Miralax, which can be easily titrated to get desired stool consistency. If diet changes aren't working for your child, and there doesn't seem to be an identifiable reason for constipation that can be addressed, talk to your doctor to see about adding a laxative or whether there is some other underlying medical condition that needs to be tested for.

Are wet wipes alone sufficient? Do bums need to be washed?

Bum hygiene is a big deal! Nobody wants skid marks 😉. I use wipes for my own kiddo but that isn't always the most environmentally sound option. You can also use a wet washcloth. TP alone is ok but certainly doesn't lend to the cleanest bottoms.


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