Thursday, May 16, 2013

Constipation



Please see the updated version of this post  August 2015
Believe it or not, one day your kids will be completely out of diapers. Then the day will come when they no longer want you to wipe their butt's even after a poop. (That age tends to vary greatly from child to child).
The years pass and you at one point you may lose track of your child's bowel movements completely. That being said, it is the rare parent that gets a completely free pass.
If you are a patient of Noe Valley pediatrics I am betting that at some point before your child goes off to college, you are going to have a conversation with me about you child's BMs.

It is quite common for kids to occasionally complain about tummy aches. In my experience a full 90% of these are from constipation. Of course we never want to ignore other possibilities. Abdominal pain could be all sorts of other things that need attention.
Tummy aches that come from constipation tend to be very sharp, but also intermittent.

If I have a patient with a complaint of a tummy ache, I am going to want to know the frequency and consistency of the stools. Here is the tricky part. If your kid is really backed up (and it is unbelievable how much poop they can have inside of them) sometimes the solid poop can't get through. What they will pass is some very liquidy substance that is getting around the solid mass of impacted stool. Because of this, your first thought might be that your child has diarrhea.
Sorry kids, but the parents now need to know way more than you might be comfortable sharing. When was the most recent poop, was it normal size? Smaller than usual? How often are they pooping? Are they sitting for a long time trying to get it to come out? Are the stools coming out in little hard pieces?

I have a theory that many children don't like to poop at school. If they happen to get off schedule and the urge hits them at an inconvenient time, they will often hold it until the urge passes. Some kids become very adept at this and can hold onto a remarkable amount of stool. They may pass a tiny little hard pellet every day or do. If you ask them if they pooped, the answer will be "yes".

I like to do a little 'Nurse Judy poop math' ( this can't possibly surprise any of my followers)
Figure out how large your child's average size stool might be. Lets say it is the size of a hot dog. Assume your child doesn't have a BM for 3 days. For the next 6 days after that, they pass only 1/2 of a hot dog size poop. Within 9 days, just a bit over a week, they now have poop in there the size of 6 hot dogs.
No wonder they are having a tummy ache!
It is time to sit and talk to your child about a very important rule.
There are many choices that we will face in our lives with very few incontrovertible truths, but this is one of them THE POOP HAS TO COME OUT.
Have your younger kid play with some play dough and a toilet paper tube. Only a certain amount can fit through before something rips.
Not pooping is not an option.

These kids need to be cleared out. Massage, a warm bath and sometimes a pedialax will help. (some kids actually maybe able to pass the stool while in the tub because they are relaxed. I know it sounds gross, but if you are ever in this situation, you will be happy to see them poop anyway that you can make it happen)
Once you get some of the hard stool out, we will need to concentrate on getting them onto a more comfortable poop schedule as well as focus on diet.

Alas, the favorite foods are often the starchy breads, cheese and pasta that do nothing but block them up even more. Until they are having softer stools, you will likely have to make some adaptations to the diet.
Some kids seem to have a much easier time if you eliminate milk.
Try it for a week and see if that helps. (If you do this, make sure they are getting enough calcium)

Fruits and veggies are great. Smoothies might be useful if they won't eat them raw.
Make sure they are drinking plenty of healthy fluids. Pineapple, figs and raw crunchy red peppers might be especially helpful
See if you can somehow hide some Molasses and flax seed oil in some oatmeal or baked goods.
Do a daily probiotic. These help keep a good balance of healthy bacteria in the gut which is good for digestion.

If being on a good diet doesn't seem to be doing the trick, talk to your doctor about getting your child on Miralax.
Miralax is an over the counter fiber that is heavily used by pediatric GI specialists to deal with constipation. It is considered quite safe. It doesn't get absorbed into their system. What it does is pull the fluids into the intestine to make sure the stools are softer.
We have some patients who are on it for an extended period of time with no ill effects.
That being said, I never want anybody on medication that they don't need.
If your child has been give a dosage for a course of Miralax, I am perfectly happy doing a daily adjustment of the dose depending on that day's stool. If it feels like you are already achieving softer stool, it is okay to decrease the dose and perhaps skip a few days. The minute the poops become less frequent or more solid it will be time to bump back up the dose.

If you have a young child, check out the book itsy bitsy yoga
Some of the stretching positions might help move things along.

If you are pretty sure you child is not constipated and they have an abdominal pain that is more steady than intermittent, they need to be evaluated!




2 comments:

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