There are several causes of constipation. There might not be enough fluid and fiber in the diet and the stool gets progressively drier, harder, and more difficult to pass. It is also thought that some children have gastrointestinal tracts that move at a more leisurely pace. There are families with more of a tendency to constipation, and one supposes that they have "slower" GI tracts. Yet another cause of constipation is a large S curve at the lower left abdomen. This is where the left descending colon joins the sigmoid and leads to the rectum.
The rectum has a complicated anatomy. There are many stretch receptors that detect the presence and quality of stool. Then there are two sets of circular muscle groups called sphincters that have to open. One of these sphincters is under voluntary control and is what you use to "hold it back" until the time is right. Toilet training requires that smooth contraction of the sensors and sphincters.
Many children have an occasional bout of constipation. This often happens during vacations when everyone is eating on the go, not eating as much fiber, or not drinking enough water. Toddlers tend to like dairy products. If most of the diet is milk and cheese, their stool can become hard and dry as the milk is digested. Increasing fluids and giving children more fruits and fiber cereals will offset the constipation.
When the child needs a little help, there are several over-the-counter laxatives you can use, but you should not use these laxatives on a long-term basis. If you do not get good results within 2-3 days, you must contact Dr. Ramsdell. If there is fever, vomiting, or abdominal pain, do not give any laxatives, and contact Dr. Ramsdell immediately.
Some Treatments for Constipation include:
Glycerin Suppositories: These provide gentle rectal stimulation which helps promote a bowel movement and also act as a lubricant when formed stool moves through the rectum and anus. Usually, a child will have a bowel movement within 2 hours after inserting a suppository into the rectum. This is usually the first treatment choice for acute constipation in infants and small children. They make sizes for infants and children, so make sure you choose the correct size for comfort.
Miralax: For children who have been holding back stool - a vicious cycle can build in which the stool becomes harder and more painful to pass. A new over-the-counter medication called Miralax acts to "bulk" up and soften the stool . It comes as a powder that can be mixed with food or liquids.
Milk of Magnesia: 1/2 to 1 tsp twice daily for up to three days for children over age 2. This should only be given for children who suffer from occasional constipation and should not be given for more than 3 days.
Fletcher's Castoria: this is a root beer flavored liquid that can be given to children ages 2 and over for occasional constipation. 1/2 to 1 tsp twice daily for up to three days.
Mineral Oil
A long-time standard treatment for chronic constipation is mineral oil. Mineral oil is given on a daily basis to soften and lubricate the stool so it is better able to slip through the sigmoid colon. The standard protocol is to give the child mineral oil once or twice a day for one month. The dose is 1-4 ml/kg/day. The low range of this dose translates into 1 tsp of mineral oil a day for every 10 pounds of a child's weight. Example: if your child weighs 30 pounds, he or she could take 3 tsps daily, 1.5 tsp inthe morning and 1.5 at night. Mineral oil will absorb fat-soluble vitamins such as A, D and E. If someone took mineral oil three times a day with every meal he or she would slowly develop vitamin deficiencies. When given twice a day (morning and bedtime), it's not a problem. Nonetheless, you can give the child a multivitamin around dinnertime.
Mineral oil on a daily basis will start giving your child a "slippery stool." If it gets too slippery and your child is having oily diarrhea, it means you've given too much and it's time to cut back. Once the child starts having easy, painless stools for a couple of weeks, start lowering the dose of mineral oil over a couple of weeks. Then, stop it altogether. Most child use mineral oil for about a two-month period. They might use it from time to time thereafter for recurrences. Chilling it in the refrigerator and immediately giving something sweetand tart (like a sip from a juice box) makes it more palatable. There are some flavored forms of mineral oil, such as Kondremul, which has a marshmallow taste.
Warm Water with Lemon: this is a natural remedy that has helped with digestion and elimination. Take 8 ounces of warm water and squeeze the juice of 1/2 lemon. Drink in morning. For children ages one and older.
Herbal Remedies: Alfalfa, Black Walnut, Chickweed, Flaxseed, Hibiscus, Senna, and Yellow Dock are western herbs that have been used to treat constipation in children. Herbal remedies should never be used without consulting an experienced practitioner and should not be used for more than 10 days.
Homeopathic Remedies: Calcarea carbonica, Causticum, Lycopodium, Natrum muriaticum, Nux vomica, and Silica are homeopathic remedies used to treat constipation in children. Consult an experienced practitioner prior to use.
High Fiber Diet (use common sense for choking hazards and puree for children at risk for choking!!!)
Fruit cocktails and canned peaches or pears if fresh fruits aren't available.
Crackling Oat Bran cereal (served by the handful as a snack, tastes like miniature oatmeal cookies)
Corn Bran ceral (also served as a snack - pretty crunchy and tasty)
Bran and Corn Chex cereal (also tasty)
Homemade oatmeal cookies (use the higher fiber types of oatmeal)
Popcorn (for older kids)
Corn on the cob (or frozen corn given at dinner as a side dish)
Dried apricots, prunes, and raisins
Canteloupe
Blueberries, raspberries, and blackberries
Fig Newtons or any snack made with figs or dates (minus the pit!)
Fruit Rollups made from dried apricots
Add bran or flaxseed to recipes when making cookies, cakes, muffins, pancakes, waffles.
Make cupcakes with frosting using bran muffin mix or a combination of carrot/bran cake mix.
Add pureed celery to meatballs, meat loaf, or tomato sauce, where your child won't notice it)
Branola Bread
Fruit punches made with chamomile tea (example: Celestial Seasonings Sunburst C tea)