Dealing with irregularity issues in children

By Heather Greenwood Davis on June 14, 2013

If you thought the end of diapers meant the end of talking about poop, think again. Most kids experience bowel movement problems at some point. According to experts, most kids experience some form of bowel movement issues in their formative years.

Sometimes it’s an easy fix

Dr. Kevan Jacobson, acting head of Gastroenterology at British Columbia’s Children’s Hospital, says many children are lacking key components in their diet that could make things easier. He says, “We generally don’t take in enough fibre. The recommended amount of daily fibre (in grams) for a healthy diet is the equivalent of your age plus five. A 10-year-old, for example, needs about 15 grams of fibre a day – about three bowls of bran cereal.” He acknowledges that getting enough fibre is difficult. Hence the tummy troubles. The good news is that while some symptoms warrant immediate action (blood in the stool for example) others are par for the course and can be easily handled at home. The trick is knowing the difference.

We asked Dr. Jacobson and University of Western Ontario pediatric gastroenterologist Dr. John Howard for tips to help us all figure it out.

For younger children with constipation

RULE OF THUMB: Relax. This is a common problem.

Dr. Howard says that there are two times in life when constipation goes with the territory:

  • When babies change from breast milk to normal foods
  • When children are about age four

The cause for the age four group? Listening to their parents! “That’s when parents sometimes ask kids to hold back, and they do it too well. The longer the child holds the stool in, the dryer, bigger and harder it gets. The end result can be painful – sometimes even tearing the inner lining of the anus on the way out. They’ll have a painful stool, which causes them to hold back, which causes a bigger stool, which causes a painful stool, which causes them to hold back.”

What to watch for: 'The poop dance’ – often a child will stiffen up, they’ll walk funny and they’ll position in a funny way, just to try to hold things back. And crying with stooling is certainly a warning sign.”

First steps: Try adding phylum or ground flaxseed to meals to encourage softer stools. Milk of Magnesia can also do wonders.

Seek help: See a doctor if, after a week, the pain persists.

For younger children with diarrhea

RULE OF THUMB: Don’t worry about definitions. Trust your judgment.

“The most common cause of diarrhea is something called toddler’s diarrhea,” Dr. Howard says. “Some kids will have diarrhea three to five times a day but otherwise their growth is completely healthy.”

What to watch for: Diarrhea is defined as too many stools or stools that are too loose compared to what is normal for the child. Look at both your child and what’s in the bowl. If you don’t like what you’re seeing in either place, chances are something is off.

First steps: Take note of hydration. Make sure your child is getting adequate amounts of liquid. Also consider the possibility they may have caught a bug. Either way, most kids will be fine in three to five days.

Seek help: If the diarrhea seems connected to something the child is eating or exposed to, consider seeing your doctor. “Kids with lactose intolerance present at this time,” says Dr. Jacobson. “The usual signs are abdominal pain and either loose or frequent bowel movements.”

For older children with abdominal pain

RULE OF THUMB: Pay close attention.

It turns out that the constant tummy aches that children aged eight to 12 claim to experience aren’t necessarily a figment of their imagination. “It’s a pain pattern about one out of six kids get,” says Dr. Howard. He equates the aches with the gripe in babies, menstrual cramps in teenage girls and backaches in adults. It’s a pain pattern that occurs commonly and normally.

What to watch for: The recurrent pain that causes a child to moan and groan is usually harmless, but the discomfort is real. “Recurrent abdominal pain tends to be around the belly button, any time of day. Nothing makes it worse and nothing makes it better. It’s like a headache in your tummy.” In younger children, it can be particularly tough for a parent to deal with. “It also can be difficult to define if the child is not able to verbalize,” says Dr. Jacobson. “If they have symptoms, but it’s not associated with clinical consequences, it will probably not be clinically significant.”

First steps: Comfort. Clinically there’s not much you can do. You treat it with “understanding and watchful waiting,” says Dr. Howard. “It is real pain just like any other pain.”

Seek help: If you suspect a connection between the pain and an activity or bodily function (eating, urinating, bowel movements), see a doctor, particularly if it seems related to poor weight gain or growth. Waking up in the middle of the night with the pain is also unusual for the “tummy headache,” notes Dr. Howard. The fact that it is recurrent on its own, however, doesn’t mean there’s a bigger problem. Sudden pain, rather than recurrent ache, is a different story. “If it’s a pain that comes on suddenly, we have to watch that fairly carefully.”

The non-complainers

Sometimes kids become too old to confide in a parent. Maybe they’re embarrassed about talking about their bodies and their bathroom habits. Or maybe you’ve got a full plate and aren’t as aware of their bathroom breaks as you were when they were babies. Here are a few things to watch for:

  • Frequent trips to the toilet
  • Spending long periods of time in the bathroom
  • Night waking
  • Constant discomfort (fidgets and wiggles)

For more information visit: - The Hospital for Sick Children’s Health Site: quick answers to common questions. - Dr. Howard’s site for kids with stomach ailments big and small.

By Heather Greenwood Davis| June 14, 2013

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