Time to talk

Too often not discussed out of a sense of embarrassment, the subject of childhood constipation is an important one. We get some expert thoughts

Time to talk

Doctor Nikhil Thapar, honorary consultant in paediatric gastroenterology at Great Ormond Street Hospital (GOSH), outlines for Time Out Kids the most common misconceptions parents can have about constipation in children, an important topic that needs to be talked about.

Misconception #1:
Only my child has this problem

This is probably a more common issue than parents realise and, in fact, one quarter of all school-age children will get constipation. But sometimes parents feel very isolated thinking their child has a problem that no-one else has.

Misconception #2:
It’s a behavioural problem

People can think of it as ‘bad behaviour’, but it’s important for parents to understand that constipation can often arise when the children are afraid of passing stool. Older children, for example, may avoid the school toilets, which is why it’s important for schools to have the right facilities. A lot of children who have constipation may soil or are incontinent and it’s often hard for families to understand why. It can lead parents to think their child is purposely ignoring it. In reality, the brain can switch off to this sensation so the child does not even feel they are doing it. It’s about working with the children and not being punitive about it because often that will make things worse. It’s important to have a real understanding of what the issue is.

Misconception #3:
Laxatives should be used as a last resort

A lot of parents are very hesitant about treating children with laxatives. There is a lot of misinformation that they can make your bowel lazy, but this isn’t true. If you do want to effectively treat a child with constipation, you need to make sure a reasonable amount of fibre and fluid is given in the diet so they’re not becoming dehydrated. However, this alone is not going to change things. They need to have laxative treatment, which should be given under the guidance of a paediatrician. If we step in early enough, then the child will be adequately treated and able to come off these medications early. If it’s not treated early, it just takes longer to treat.

Misconception #4:
Treatment is quick
50-60 percent of children will respond to treatment within six months to a year. However, quite often you will get the children to respond well on laxatives and the natural inclination is to think they’re cured and to stop the treatment immediately. However, as children can be a little bit sensitive about the discomfort, if treatment abruptly ends, the child can go back to square one and the whole process will start again. Sometimes it’s about doing a little bit more, and a little bit more after that. Weaning down the medication a bit and seeing how they go when the stool gets firmer. Are they still okay? Following up on these children is important for physicians; they cannot just let go at this point as otherwise they might slip back through to problems with constipation.

Misconception #5:
It only has a physical impact on the child

There is considerable physical impact for a child including: pain, stress, not being able to go, swollen and uncomfortable tummy, loss of appetite and heart burn. However, it also has a considerable knock-on effect on psychological wellbeing too. I often say happy gut equals happy mind and often kids with constipation do not have a happy mind. Behaviour may deteriorate and it can affect their progress at school as they are not able to concentrate or focus. It’s vital for parents and schools to understand the impact a condition like this can have on a child.

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