Persistent constipation in children

The article is professionally consulted by Master, Doctor Dang Huy Toan - Pediatrician - Neonatologist - Department of Pediatrics - Neonatology - Vinmec Nha Trang International General Hospital

For babies with persistent constipation, the first thing that parents need to think about is to change their diet and living habits before using the drug. Children with long-term constipation have a great impact on health, so parents need to find out the cause and remedy as soon as possible.

Many parents worry when their child only has a bowel movement every 4-5 days, or in the past, the child has been defecating regularly 2-3 times a day, now it is only 1 time. However, the nature of stools is still soft and spongy, the cases mentioned above are not called constipation. As the baby grows older, the number of bowel movements a day will decrease, this is a normal physiological phenomenon.
Constipation is defined as when the child has few bowel movements, less than 3 times per week or has difficulty in defecation, often uncomfortable, straining due to hard stools, very painful straining, sitting for a long time, difficult bowel movements, even anal bleeding.
Most children have at least one episode of constipation, which is usually transient and then goes away. The case of constipation that persists in children for several weeks is called chronic constipation, then parents need to pay attention to the child's care from diet, lifestyle, psychological reassurance and consideration. to drug use.

There are 3 times when it is easy to cause prolonged constipation in young children:
The period when the child changes from a liquid to a solid diet (weaning); The stage when children learn to sit on the potty alone (usually at the age of walking); The period when children start school (kindergarten, primary school).

Persistent constipation in children is determined based on the number of bowel movements per week and the nature of the stool. Besides, the baby with prolonged constipation may appear other symptoms that can easily be confused with other digestive disorders such as:
Abdominal distention; Stomachache; Children anorexia, slow weight gain; Leaky stools (there is a little loose stool on the crotch that the baby is completely unaware of). In addition, in some cases, children with prolonged constipation show signs of "holding back", refusing to have a bowel movement, such as trying to squat, stiffening, crossing their legs or blushing and clinging to their mother.

4.1. Functional constipation There are about 95% of cases of children with persistent constipation with no identifiable cause, including cases that have been examined by a doctor and have laboratory test results (such as blood tests). , ultrasound, X-ray) are completely normal, the child is constipated. This case is called functional constipation.
The mechanism of formation of functional constipation may be due to the incomplete development of the digestive system of young children or inadequate nutrition and living habits.
However, the most common risk factor for persistent constipation in young children is “hold-back behavior” because many children don't like the toilets at school, or the fear of having a hard bowel movement. So the child decided to hold back and refused to have a bowel movement. As a result, the child's stools are getting drier (in the last part of the intestine, connecting to the anus), increasing in size, and when it is imperative to have a bowel movement, the child has more difficulties.
The abnormal spiral keeps repeating, the more strongly the child has a strong aversion to bowel movements, the more they hold back, and the pain sensation increases in the next bowel movements.
4.2. Constipation Babies with long-term constipation may be the result of a certain disease such as congenital megacolon, congenital hypothyroidism, lead poisoning, injury or deformity of the sacrum, deformity. anus... At this time, to solve long-term constipation in children, parents need to treat the underlying cause.

5.1. Misidentifying the cause of long-term constipation in children We have always had the notion that constipation is simply a common disease of the gastrointestinal tract, mainly caused by a lack of diet. fiber (vegetables, fruits). For that reason, parents often try to feed their children a lot of green vegetables or add fiber from products to overcome prolonged constipation in young children.
However, there are still many cases that do not bring the results as expected of parents. In addition to the use of poor quality fiber supplements, parents misunderstand the cause of "lack of fiber" that causes long-term constipation in children. In fact, this is only an external cause and has overshadowed the main causes from within, including due to a poorly functioning digestive system related to the function of the liver and kidneys.
Young children have a digestive system that is in a stage of development and improvement gradually, so the functional ability of the parts is not good. Therefore, parents try to add nutritious foods that are good for the child's development, but forget that the baby's digestive system is capable of metabolizing those nutrients or not.
When the digestive system has to work to metabolize many energy-rich foods, it leads to overload, thereby increasing the accumulation of toxic wastes in the body. The consequence of the excessive accumulation of toxic wastes is the basic cause of frequent "hot flashes" in young children. The heat leads to an increased ability to absorb water in the stool, making the stool dry and harder to move, causing pain when the child has a bowel movement.
Through the above data, children with long-term constipation will be difficult to improve (even after adding green vegetables or using some fiber supplements) if parents do not find a way to remove them. remove the phenomenon of heat that is silently affecting the health of children.

5.2. Abuse of enemas Using enemas when your baby is constipated for a long time helps stimulate rectal contractions, thereby helping to push the stool out and making it easier for the baby to have a bowel movement. Therefore, anal enema is considered as a measure to help quickly solve long-term constipation in young children, reduce discomfort when children have bowel movements. However, applying this measure for a long time is like a double-edged sword that can cause many negative effects on the health of children.
The anus is a very sensitive part for humans (including adults or children), if parents use an enemas improperly, it can cause burning, anal damage and loss or damage to the anus. Decreased muscle elasticity around the anal opening.
Besides, children who are used to using enemas, the ability to defecate on their own will no longer be and thereby create a psychological inertia, dependent on enema without going to the toilet according to normal needs. of body.
5.3. Supplementing digestive enzymes, probiotics According to nutritionists, dysbacteriosis will be more related to diarrhea than constipation. While probiotics are often recommended to balance the intestinal flora, prevent digestive disorders in children (constipation is also considered a digestive disorder), but there is no evidence yet. Prove that probiotics are effective for constipation in children.
On the other hand, the abuse of digestive enzyme supplements by parents in all cases will cause a loss of natural enzyme regulation, making the body dependent on digestive enzymes provided from the outside, greatly affecting the health of the body. digestion and absorption of nutrients in children.
5.4. Just focus on using drugs without changing your lifestyle Enemas and laxatives help improve constipation quickly, but these drugs often can't be used for a long time, do not have the effect of preventing constipation happen again. Therefore, even when using products to support defecation but do not pay attention to changing diet and activities, long-term constipation in children will not be treated completely, very easily. Occur again periodically.

6.1 Parents need to be patient The treatment of long-term constipation in children needs to be very patient because this disease will not go away as quickly as a common cold, especially for children who are also less cooperative. than. Treatment of long-term constipation in children requires a combination of many factors: Change in diet, change in bowel habits, physical activity habits, and medication (if any). Sometimes the long-term treatment of constipation in children needs to be monitored by a specialist.

6.2 Practicing good habits for children from a young age It is extremely important for children to form a habit of defecation every day at a fixed time, this habit will help children have a bowel reflex. , which helps remove stool and does not allow stool to sit for too long in the rectum.
Parents should practice for children to have a bowel movement at a certain time, if after 15 minutes the child does not feel the need to defecate, then stop, repeat the same the next day. Praise the child if he is willing to go to the toilet or sit on the potty to defecate, cheer and encourage the child when he is able to defecate. Letting children perform physical activities, avoiding sitting still is an effective measure to enhance bowel movements and avoid prolonged constipation.
6.3. Attention to nutrition Dietary fiber and water are two very important factors affecting the quality of stools when defecating. Foods containing a lot of fiber (fruits, vegetables, whole grain flour...) should be regularly present in children's daily meals.
However, most young children rarely eat vegetables and fruits, then parents need to support and encourage their children. Giving your child plenty of cooled boiled water and fruit juices is also very helpful in treating constipation.
In addition, to improve taste, eat well, reach the correct height and weight, and exceed the standard, have a good immune system, strengthen the resistance to get sick less often and have less digestive problems... baby need to add necessary micronutrients: zinc, selenium, chromium, vitamins B1 and B6, ginger, acerola fruit extract (vitamin C),...
Also according to leading nutrition experts recommend father Mothers need to be calm and persistent when supplementing with nutrients, even through eating or functional foods. In particular, the use of functional foods should choose those of natural origin that are easily absorbed, do not allow children to use many types at the same time or continuously change the types of functional foods. Besides, nutritionists also emphasize on the role of biological zinc; Parents should learn and supplement zinc for children properly at the appropriate time, to avoid zinc deficiency affecting the comprehensive development of children.
At the same time, add supporting foods containing lysine, essential micro-minerals and vitamins such as chromium, selenium, B vitamins,... to help support the immune system, enhance resistance so that children are less likely to get sick. and less likely to have digestive problems.
Parents can learn more:
Why do you need to supplement Lysine for your baby?
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