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"I can go potty all by myself now." You proudly celebrated the day when your toddler began to make toilet trips alone. But now you need to guide him or her through a childhood that is bound to have a tummy ache or two. How do you know what is normal?
Many parents expect their child to pass one bowel movement (stool) each day, and they begin to worry if this does not happen. But a daily bowel movement is not necessarily "normal" for every child, and your child may have anywhere from three bowel movements a day, to three a week, and still be okay. The key here is to check for signs of pain, cramps, bloating, or fullness in the abdomen. Stools should be soft and easy to pass - neither too watery, nor too dry and hard. And if your child sees blood with a bowel movement, either in the toilet water or on a toilet tissue, you should always check with your health care provider.
CONSTIPATION
Common adult bowel problems can affect children, too. For example, constipation ("irregularity") can trouble children who eat a typical "fast food" diet - rich in fats (burgers, fries, milkshakes) and processed sugars (candy, cookies, sugary soft drinks). These children may have bowel movements that are hard, dry, and painful. Their time between bowel movements may be four days or more.
If constipation is a problem for your child, you might first take a serious look at his/her diet - does it include enough water and enough dietary fiber? Check for good exercise habits, since physical activity nudges the bowels into action. Also, setting a regular meal schedule can help some children develop "regular" bowel habits, since eating is another natural stimulant for bowel activity. If necessary, schedule breakfast a little earlier to give your child a chance for a relaxed visit to the bathroom before school.
Some children become constipated because they ignore the natural urge to empty their bowels. They may not want to use a "strange" restroom away from home, or they may feel embarrassed to ask a teacher to be excused from class. When this happens, simple reassurance from you and your child's teacher may be the only treatment necessary.
Most childhood constipation problems can be helped by sensible changes in lifestyle or diet. Laxatives are not usually needed. In fact, using laxatives unnecessarily can actually cause constipation. So always ask your doctor before giving your child any of the popular medicines for "irregularity." Rarely, constipation can be a sign of other medical illnesses, so keep your health care provider informed if your child continues to have problems.
MoonDragon's Health Disorders: Constipation
IRRITABLE BOWEL SYNDROME
In adults, irritable bowel syndrome (IBS) is responsible for almost as many work absences as the common cold. IBS can affect children, too, giving them a puzzling set of digestive complaints. Sometimes it is cramps, gas, and diarrhea; sometimes it is bloating and constipation; and sometimes it's alternating bouts of both. Children with IBS may sometimes pass mucus with their bowel movements, but they have no rectal bleeding, and no fever. They do not look sick.
IBS often troubles children during times of stress - divorce, family problems, moving, taking exams, even going on vacations. But IBS is not a psychological problem, it has a physical cause. People with IBS have bowels that go into spasms more easily than those who do not, and scientists still do not know why.
What they do know is that certain types of foods (milk, chocolate, caffeine) can trigger IBS in both children and adults. And IBS symptoms often improve when these foods are limited. Increasing fiber in the diet, and using techniques to relieve stress also seem to help. If necessary, your health care provider may prescribe medicines to relieve symptoms.
LACTOSE INTOLERANCE
For many children, a summer sundae or a cool glass of milk at lunch time means an afternoon of cramps, gas, and diarrhea.
If this happens to your child, he or she may be one of the more than 30 million Americans who has lactose intolerance. This condition is common in Americans with Asian, African, and Mediterranean family origins. Across the world, about 70 percent of all people may have some degree of lactose intolerance.
In this condition, the body manufactures too little lactase, an enzyme found in the intestines. Lactase breaks down lactose, a sugar that's found in milk and milk products. When lactose is not broken down in the intestines, it ferments and causes gas and diarrhea.
If you notice that milk products seem to affect your child's digestive system, talk to your health care provider. Growing children still need the calcium and vitamins found in dairy products. So if milk is a real problem for your child, your health care provider can suggest other types of foods that will supply these nutrients. Dairy products especially for persons with lactose intolerance are sold in many supermarkets. Lactase enzyme supplements are also sold as drops and tablets. These are safe for children and may be used as your health care provider recommends.
INFLAMMATORY BOWEL DISEASE
Inflammatory bowel disease (IBD) is a general term for two different disorders, ulcerative colitis and Crohn's disease. Both illnesses can cause the walls of the intestines to become red, swollen, thickened, and marked with ulcers (open sores) that bleed. IBD can attack persons of all ages, but it most often affects young persons between the ages of 15 and 35. It can cause diarrhea, abdominal pain, bleeding from the rectum, fever, and weight loss. IBD is a serious illness that needs to be treated by a health care provider.
If your health care provider suspects that your child has IBD, you can expect a series of x-rays and an endoscopic examination. Endoscopy lets your health care provider look directly at the inside walls of your child's intestines to check for signs of inflammation and bleeding.
Once IBD has been confirmed, your health care provider will prescribe medicines to relieve symptoms and control bowel inflammation. You may also need to change your child's diet to prevent weight loss and to cut down on roughage.
IBD is a chronic illness that can require treatment in a hospital. The complications of IBD can be serious, and sometimes surgery is necessary. But it helps to remember that between one and two million Americans are now living with IBD, and many are able to control their symptoms for long periods (even years) without a flare-up.
Blood with a bowel movement: Blood with a bowel movement can have many causes. It can come from hemorrhoids or from an anal fissure (a small tear in the wall of the anus caused by passing large, hard stools). It can also come from a serious intestinal infection, from inflammatory bowel disease, and from other causes.
Dietary fiber: Good sources of dietary fiber include fresh fruits, vegetables, bran, and whole grains. Try using whole-grain breads instead of white and brown rice instead of white. Offer fruits or bran cookies as snacks.
Introduce new sources of fiber gradually, over a period of days or weeks - not all at once. This prevents cramps, gas, or diarrhea.
Complications of IBD: The large bowel can bleed or perforate, stop moving normally, or become distended or obstructed.
Other parts of the body may be affected, creating the following:
- Arthritis.
- Skin problems.
- Kidney stones, gallstones.
- Eye inflammation.
- Delayed growth in children
In the long term, ulcerative colitis may increase risk of colon cancer.
OTHER MEDICAL ILLNESSES
Besides dietary problems, some other reasons for constipation in children include:
- Anal fissure: A small tear in the anus makes bowel movements painful.
- Infection: Fever, sweating, vomiting, and not drinking enough fluids can make a child's body low on water. Bowel movements become dry and hard to pass.
- Hirschsprung's disease: In this disorder, parts of the bowel lack nerve cells needed for normal bowel function.
- Thyroid deficiency.
- Spinal cord abnormalities.
- Certain inherited metabolic disorders.
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