About the Health Information

• Constipation is the passage of infrequent stools (less than 3 times a week) and/or excessive straining during defecation. Constipation is a common concern of childhood. In most children, constipation begins in the first year of life and can be a source of significant distress to a child and family. Here are some Q&As that might help you understand constipation in children and clear any doubts you have.

My child passes stools with straining once a day but it looks like pellets. Can she still be constipated?

• It’s possible! Observing the nature of your child’s stools would help. Check out ‘The Bristol Stool Chart’.

My child passes 3 or 4 stools a week with straining. Does she need an evaluation by a doctor?

• Yes. Passing 3 or more stools a week may not necessarily be normal. Constipation can present with other features like painful hard stools with/without blood, involuntary passage of stools in the child’s underpants after having acquired toileting skills and large stools obstructing the toilet. Your child may exhibit retentive behaviours, like hiding behind furniture, standing on their toes with legs crossed, sitting with their heels pressing against the perineum, rocking or might appear flushed. They give the appearance that the child is straining to pass stools whereas they are actually holding it in.

What causes constipation in children?

• Constipation is precipitated by inappropriate feeding (less fluids and/or fibre, excessive milk intake in late infancy, junk), lack of physical activity, premature toilet training, change in environment (home or school) and psychosocial factors. This is functional constipation and constitutes more than 90% of the burden. The rest might be due to abnormalities in intestine, brain, spinal cord, hormones or a side effect of some medicines.

When and how do I impart toilet training?

• Formal toilet training is best started only after 2 years of age. Premature initiation of toilet training is a common cause of constipation and should be avoided. Remember ‘Rule of One’! Toilet training is best done by one person, at one time (usually several minutes after each major meal), at one place in your house and using one word consistently (eg: potty).

What tests would my child be subjected to to evaluate her constipation?

• A detailed history followed by a good clinical examination are all that is required to effectively manage your child. Rarely, tests like an X-ray of the tummy or blood and urine tests to look for underlying causes might be required, which the doctor can individualise for your child.

Can I try purgatives at home before seeking medical care?

• Constipation is not effectively managed by medicines alone. A detailed analysis by your child’s doctor is essential to chart a comprehensive plan that will help in the long-term. At MGM Healthcare, we adopt a multi-pronged approach involving counselling, appropriate toilet training, realistically modifying the child’s food and fluid intake, use of the right medications for the right duration and a structured follow up schedule to ensure lasting successful outcome.

What are the consequences of untreated constipation?

• Potential complications in a child with untreated constipation include painful defecation resulting in worsened withholding, anal tears (fissures), bulging of veins through anus (haemorrhoids) or protrusion of a part of the intestine through the anus (rectal prolapse) due to excessive straining, involuntary soiling of underpants (faecal incontinence) and urinary tract infections.

How do I prevent constipation in my child?

• Prevention is always better than cure. You should ensure you toilet train your child only after two years of age, avoid situations where the child is forced to hold her stools, give the child adequate fluids and a balanced diet with whole grains, fruits, vegetables and fibre and avoid junk food. Some cough syrups and medicines used for stomach pain might precipitate constipation and so, consulting a doctor is necessary beforehand.

Is it necessary to be physically present in the hospital to treat my child’s constipation?

• Considering the time constraint of many parents and infection risk at certain times (like the COVID-19 pandemic), MGM Healthcare provides the option of video consultation, accessible through the website. History taking and basic assessment by your paediatrician would help in advising on the lifestyle modifications, medications and follow-up. If direct visit is necessary, your appointment will be fixed at a time that suits you and the duration of your hospital stay will be minimised.