Constipation in Children

Eils Hewitt: Many parents spend a lot of time talking about poo, the color of it, the texture and the smell. But what happens if your child is constipated, it’s a little embarrassing but it’s important to find out what the problem is. With me in the studio is Dr. Su Laurent, consultant, pediatrician at Barnet Hospital and the Baby Channel Medical Advisor. Thanks very much Su for coming in today. Dr. Su Laurent: Hi. Eils Hewitt: First of all, let’s get a definition what do you mean by constipation? Dr. Su Laurent: Constipation in medical terms is the infrequent passage of painful hard stools. So, what it means is that child is not doing enough poo in order to be comfortable. Eils Hewitt: And how common is constipation in children? Dr. Su Laurent: It is extremely common, in fact, it’s something that I specialized in and I even run a clinic which will I call my poo clinic, because there were so many children who are constipated out there, starting from babies all the way through older children even to teenagers. It causes an enormous amount of consternation and I often get whole families who will come to see me because they are concerned about the one child’s constipation. Eils Hewitt: And I have got a 5 month old baby, I don’t know in terms of babies becoming constipated. I was originally told if you are breastfeeding, it was impossible for your baby to be constipated and yet he go five days and seven days without pooing and it is alarming in a baby isn’t that? Dr. Su Laurent: It is alarming and it causes lots of consternation. In babies constipation for breastfed babies is unusual for it to be a problem because usually they just thought themselves out again and usually they pass what they need to pass. But if obviously your baby is distressed and is having great difficulty doing a poo and you can see that stress that they are straining away you will think about increasing the amount of fluid that they are getting. So, in a breastfed baby, if they are feeding very well, you might need to give him mixed with water. And in a bottle-fed baby, you need to be very careful, you are actually giving the right concentration of the formula. Sometimes people like to give an extra little one scoop to the formula or heat scoops rather than flat scoops and it’s very important to get the mixture right. Eils Hewitt: As it always, you kind of go on to how can the constipation be prevented, it’s obviously that’s a intended formula actually makes me correctly. Dr. Su Laurent: Getting the conscious exactly. Sometimes health fits is very helpful at this sort of situation. They say things like little bit of orange juice sometimes, fresh orange juice and some water can be helpful or little bit of brown sugar in some water can be helpful as well. But I think just getting extra water into babies often what they need. Eils Hewitt: And there with them, Harley my little boy, he just for some reason wouldn’t take water, his poo it was just a different texture? Dr. Su Laurent: Yes, yes. Eils Hewitt: So, in the end we resorted to lying down on his back and then kind of doing a kind of cycling motion with his legs. Dr. Su Laurent: Yes. Eils Hewitt: That saves time and things moving. Dr. Su Laurent: Well, actually in older children exercise is often very helpful and is the said to children who may tend to get a bit more constipated. So, you are right getting them sort of getting them moving, getting the bowel movements often very helpful. Eils Hewitt: So, why do, lets move on to children, why do children become constipated presumably if they diet. Dr. Su Laurent: Well, it does a very very big part of it and when I see lots of doctors who trained abroad particularly in developing countries and I always say to them how much constipation do you see in Africa or in India and they say it’s very, very unusual. And it is our diet is obviously very important part of why our children become constipated. If you look at the average child’s diet, it’s very low on fibre, they don’t eat nearly enough fruit and vegetables and often children just don’t drink enough as well. So diet is probably the number one cause of constipation in children. The next thing is they do tend to be families that get constipated and I was drew out of a family tree and if you look around your family tree you might find a mother or father who is very constipated as a child or he is still is constipated or a grandmother. And you often find parents suddenly realizing of course it’s sort of dirty throughout the family Eils Hewitt: So basically it can be a genetic link? Dr. Su Laurent: They can be a genetic link as well. There is no sort of gene that’s been shown to protect the constipation but certainly I often find it’s very common in certain families. Eils Hewitt: Good constipation lead onto anything more serious. Is it connected with irritable bowel syndrome, or? Dr. Su Laurent: That’s a very good question, that’s a very good question and there is no direct link but they are certainly true that lot of children get lot of tummy ache when they have constipation and there is a saying which is little belly aches can often grow up into big belly aches and if you don’t get constipation sorted out when children are small, very often what the next thing that happens is that the child will start to soil. And soiling can be a very big problem at home and at school, extremely distressing to families and can completely disrupt the family’s life. Eils Hewitt: So when you say soiling, do you mean like a constant deposit basically in their families? Dr. Su Laurent: Yes, I mean that everyday they either produce enough poo to actually have to change their pants several times a day or at the end of day you’ll find that always got a smudge in their pants and this starts to become a problem at school where people smelling them and it also become a problem, behavioral problem with children because what happens then is that they start to hide their pants. I have had children whose pants are been in the gutters because they thrown them out of their bedroom windows or in piles under their bed so they don’t want to tell their parents. Parents were throwing away endless pairs of pants because they are so upset with what’s happening it’s a very very big problem. Eils Hewitt: So what advice would you give viewers today who realize that their children are so elegant, suddenly realize oh my child is not abnormal, this is quiet common. Dr. Su Laurent: Exactly, it is common. First of all talk about it to your doctor. It’s very important to realize there are two sides of this problem. One is there is a medical problem in other words the child has got huge big rocks sticking in their bottom which need to come out and until those big rocks, those big poos have come out, their poo wont start to pass naturally again. And at the same time if you got a big, I will say this depends if you got a big rock sitting in your bottom then you can understand how bits of poo will start to trickle around the edge and starts to come out into a child’s pants without them being any control at all. But after a while this also becomes a behavioral problem because they recognize, they need to do a poo and rather than doing a poo they clench their buttocks and they hang on and they wont do one. And they will go and hide behind a sofa, they’ll disappear. And often the parents think they are trying very hard to do a poo but actually what they are doing is trying very hard not to do a poo. Eils Hewitt: Alright. Dr. Su Laurent: So what they need to do to begin with is to clear out using laxatives. Eils Hewitt: I was going to say but all lax I mean presumably don’t use laxatives on babies. Dr. Su Laurent: It is very unusual to use laxatives in babies, very young babies know, very unusual to use laxatives. But in older and toddlers and in older children we use laxatives very commonly and there are various sorts that you can use. If you got a child to say hasn’t done a poo for ten days is soiling and you feel that tummy and you can feel the tummy absolutely full of poo, there is no amount of sort of minor laxative is going to help at all. You need to use something else really going to go down there into the poo and clear out the poo and that’s why you really need to go and see your doctor because sort of laxatives you can’t buy over-the-counter. Eils Hewitt: So are we talking oral laxatives here, I mean tablets. Dr. Su Laurent: By mouth, yes and that’s a very good question because lots of children will come to see me who have been given a very mild laxative by mouth. It just often makes the constipation worse and then have been give suppositories at their bottom. The problem with suppositories is if you got a little child who is holding on like mad and doesn’t want to do a poo and then you put a suppository in, what will happen first of all it will just fly straight out across the room the suppository. Eils Hewitt: So suppository, explain what the suppository is? Dr. Su Laurent: Suppository is just like a little bullet made of jelly and it goes in and the either it is supported to be sort of liquify inside the bottom and then help the poo ease out gradually. But the problem with if you got a very big poo sitting inside a bottom, you put little suppository and there is not much space for and the next thing you know it flies out. And also it will cause the child a huge amount of stress because if it is hurting them anyway in their bottom he will start poking things up the bottom, it will make things much worse. The best thing is to use a more powerful laxative up at the top hand and there are several good laxatives you can use with children which will help clear out their insides, help them pass the big poo and then after that follow them up with the laxatives that will help them do a poo regularly and get them back into good habits again. Eils Hewitt: And what about enemas, are they used for children? Dr. Su Laurent: Well, enemas are like bags of liquid that you put into a child’s bottom to help and adults to help them clear out. Eils Hewitt: That’s quite extreme isn’t it? Dr. Su Laurent: It’s quite extreme and those very rarely will give an enema at home for child because it has got the same problem. It’s very distressing for the family and the child and it’s nothing you would want to do to a child who is already holding back. So, what you do is you bring a child into hospital and you try your hard as to clear them out at the top hand and we have huge quantities, sometimes of laxatives that we pour down the top hand either by getting the child to drink them or by giving them a tube into their nose and just pouring something on. So if you like its clearing up hole their insides from top to the bottom. But occasionally if that doesn’t work you might give them a bit of sedatives though they are bit steeply and then using enema while they relax and they don’t mind to help really clear out their bottom from the other end. Eils Hewitt: So, we talked about those kind of laxative type treatments, are there any alternative treatments? Dr. Su Laurent: Yes, well, if you look around in complementary medicine and you say what else is there we can offer for children, everyone who does complementary medicine will have something that they have tried and they find helpful. For example, acupunctures I will say that can be very helpful. Now in the young child approaching them with needles. Eils Hewitt: That’s stressful it is exactly. Dr. Su Laurent: But sometimes they can use acupressure and that will help to relax the bowel and with an older child acupuncture often if you explain acupuncture to a child, it actually it isn’t painful. They will be very tolerant and also things like osteopathy and cranial osteopathy can be very helpful again in helping the bowel to relax instead of recognizing the sort of tensions that are going on inside a child. Probably one of the most helpful things I have ever is some type of psychotherapy and some behavioral work with the child to help them to understand that it’s very very important to recognize their body and to know when they need to do a poo and that actually doing a poo and getting that first poo out is the hardest thing and after that it will be much easier and to keep recognizing and rewarding them for doing a poo and for having clean pants at the end of the day. Eils Hewitt: So that helps them relax, I was just thinking how much of it is stress and now we talked about diet but presumably – action. Dr. Su Laurent: A lot of it, yes, exactly, exactly. Once the whole cycle starts it is a very difficult one to break, also just comfort from other parents, I mean you don’t talk about this in the playground, my child is constipated too. You might say my child has got asthma although allergic to something because that’s an okay topic. But constipation isn’t just recognizing that there are loads of other children like this, it is very helpful to parents and getting it out in the open and finding another parent you can talk to and getting tips from other parents often very helpful. Eils Hewitt: So, tell us a bit more about you poo clinic. What kind of support do you give to parents? Dr. Su Laurent: Well, I have actually for a while I did it with a social worker. And she ran alongside my clinic, she ran a support group for parents and the children were doing messy play. So they were just enjoying playing with sort of messy sand and clay and things and paint and just getting their hands dirty because lot of these children she don’t like being dirty and like sort of holding back and its all about sort of keeping things in. So getting the children to relax and to release and at the same time talking to parents and giving them a bit of support. That has been very helpful. We don’t do that at the moment anymore, but I do find that having a clinic where we just do poos, which is supported by a nurse will also see parents who talk about poos can be very helpful. Sometimes for me I must say it’s extremely draining doing nothing but poos and I like sort of splitting of poos with a bit of asthma and bit of epilepsy as well. Eils Hewitt: And you say what in terms of the parents how much of a kind of parents happens to you know if you are a new mom for example how much of is your kind of stress that you kind of pass onto the baby it’s the parenting as well. Dr. Su Laurent: Well, that’s quite an interesting one and I think that particularly for child have -- if the parents had a child to be constipated once they make every effort to make sure the child doesn’t get constipated. So the next child doesn’t. So what happens with the first one is they will sort them out eventually and they will learn to hopefully relax and understand that it is a problem that can be solved and then with the next child they stuff them full of healthy food, they get them plenty of fluids, loads of exercise and they leap in early with a little bit of laxatives if the child gets a bit constipated. Some children just do for a short time. They leap in early, clear them out and they can relax and make the sure the next one doesn’t become constipated like the first one. Eils Hewitt: So, basically, in terms of if you realize that your baby or your child is constipated, how long did you leave it before consulting a GP? Dr. Su Laurent: Well, I would say go early. I think one of the main problems is that often parents will go to the GP, they might be visual at the first time and give you little you little bit of advice about that and they will go again and get maybe a mild laxatives and sometimes by the time that I come to see them they have been constipated, seriously constipated fox six months and that means doing one poo every ten days for six months. The child is screaming every night; they are looking pale and awful. The first question dad asks when he gets home from work is, has he done a poo? It’s over and they know that they can relax if the poo is happened. But if they haven’t the child wont eat. So, if they have reached that stage seek help from your GP, and if you don’t feel that you are getting the sort of help that you need then ask if you can see a pediatrician. I think that‘s a very very important. Eils Hewitt: So, just in summary there what will be the key element, the key advice that you would give to your parents whose babies or children are suffering form constipation? Dr. Su Laurent: The first thing is really look at their diet. Are they getting five portions of fruit and vegetables every day? Are they eating the high fiber cereals, are they drinking plenty of water and fruit juice everyday. That’s the first thing really look at diet, really make sure that you are encouraging them to do a poo, they look like they need to pop them on the potty or the loo quickly. Don’t worry too much about them wanting to do poos in nappies, we haven’t addressed this yet. But some children will do wees happily into the loo or into a potty, but they always want a nappy for doing their poo. That is fine, as long as the poo comes out it doesn’t matter where it come out. Don’t worry about that and then if that isn’t working, simple things aren’t working then you can pop along get a simple laxative from a chemist, that they will sell the basic ones at the chemist and the chemist will advice you but if that’s not working go along to the GP and have a good chat. Eils Hewitt: Great and thank you very much for coming in this morning and giving us that really helpful advice. Dr. Su Laurent: Thank you.