Constipation the Route to Regularity

The Route to Regularity

Four-year-old Kara often goes three or four days without a bowel movement. That worries her mother, who is afraid Kara is constipated. But when she does go, Kara never has a problem moving her bowels. So even though her mother is worried, Kara has no complaints. Is she constipated--or not?

''Some parents think that unless a child has a bowel movement every day, there's something wrong,'' says Kevin Ferentz, M.D., assistant professor of family medicine at the University of Maryland School of Medicine and a family physician in Baltimore. ''But regularity is a highly variable and personal thing. Even if a child has a bowel movement only twice a week, as long as there's no discomfort associated with it and the stool is relatively soft, then she's regular. She's not constipated.''

In most children with true constipation, the cause is dietary, notes Dr. Ferentz. The digestive tract is designed to function best with a bulky, high-fiber diet--that means lots of whole grains, beans, fruits and vegetables. But for many kids, those aren't necessarily the foods of choice (at least, not their choice).

Other children, especially those being toilet trained, become constipated because of the changes they're going through, rather than their dietary habits. As part of their resistance to the training process, these kids become locked in what's been called the battle of the bowels with their parents. They literally refuse to go, and as a result their stools may become impacted.

Despite all the potential roadblocks to regularity, constipation in kids can easily be corrected and prevented. (''No child ever has to be constipated,'' says Dr. Ferentz.) Here's what you can do.

For Infants

Try a slick solution. Younger children and babies can be given glycerin suppositories. ''These are very thin, bullet-shaped waxy substances that melt when they are inserted in the rectum,'' says Dr. Ferentz. ''They relieve constipation in two ways: by stimulating the rectum and by 'greasing the skids' for smooth elimination. But use them only occasionally because regular use will make a child dependent and then they won't be able to have a bowel movement without them.''

Glycerin suppositories for a child or infant can be purchased at any pharmacy, and directions for use are on the package.

Try using a thermometer. Once your infant's constipation is diagnosed by a physician, you can use a rectal thermometer approved for infant use to help her go. ''Thoroughly lubricate the thermometer with petroleum jelly,'' suggests Dr. Ferentz. ''Then stick it in the baby's rectum no farther than an inch-and-a-half and pull it out. Sometimes you'll get a 'present' along with the thermometer.''

Try this sweet formula for relief. ''For infants, a teaspoon of Karo syrup in a six-to eight-ounce bottle of formula, or ½ teaspoon in a four-ounce bottle, can soften a stool nicely,'' says Shirley Menard, R.N., a certified pediatric nurse practitioner and assistant professor at the University of Texas Health Science Center at San Antonio School of Nursing. The syrup draws water into the bowel and keeps stools soft, she says.

For Children

Give an over-the-counter laxative . . . but sparingly. If a child ten and over already has constipation, there are several over-the-counter medications that can provide relief temporarily. ''For an older child, it's okay to use over-the-counter laxatives such as milk of magnesia or mineral oil,'' says Dr. Ferentz. ''But only use them as advised by a physician. Mineral oil, in particular, shouldn't be used regularly because it interferes with the body's absorption of fat-soluble vitamins.'' Other laxatives, too, can cause problems if taken regularly. A child can become so dependent on them, she loses the natural urge to move her bowels.

''If your child has been drinking a quart of milk a day, for example, you may have found the connection right there,'' says Dr. Hogan. Consuming too many dairy products can be constipating, she says. Other constipating foods frequently found in children's diets include applesauce, bananas and white rice.

Make some high-fiber muffins. ''Dietary fiber helps keep stools soft,'' says Dr. Ferentz. ''Unfortunately, in our society we take in way too few fiber-rich foods like fruits, vegetables, whole wheat breads and bran cereals.''

You can introduce your child to fiber sources that are fun to eat. ''For example, there's no reason why a child can't eat a bran muffin every day,'' he says. To make these muffins more appealing, add lots of raisins. ''Most kidslove raisins,'' notes Dr. Ferentz.

Serve snacks fit for a rabbit. When your child is hungry between meals, try giving him some raw vegetables, like carrots and celery. ''Most kids like them because they're crunchy,'' says Dr. Ferentz. To make these snacks even more appealing, spruce them up with some add-ons. ''A piece of celery spread with a bit of peanut butter is great for preventing constipation.''

Disguise those ''disgusting'' vegetables. Maybe it's tough to get your child to eat cauliflower or broccoli--high-fiber vegetables that help the constipation situation. But you can camouflage those helpful veggies to make them more palatable, says Dr. Hogan. ''Be creative. Try cutting them into different shapes. Tell him broccoli florets are little trees. If you have to, chop up vegetables and hide them in meat loaf where he can't find them.''

Take advantage of fruit favoritism. Kids who won't eat vegetables usually will eat fruits. And many kinds of fruit are effective at getting things moving. ''Offer lots of apples, pears and peaches,'' suggests Menard. ''But hold back on bananas and applesauce, which tend to be constipating,'' she warns.

Offer liquids galore. ''Make sure your child is drinking plenty of fluids, including fruit juices, because they too can help prevent constipation,'' says Menard. This is especially important if you're introducing more bran and other high-fiber foods into your child's diet. Liquids help bulk up fiber in the gut to form soft, easy-to-pass stools.

Don't start toilet training too soon. Kids who aren't ready to use the potty may withhold stools as a way to assert control over their own bodies, says Dr. Ferentz. ''A two-year-old wants to be in control so desperately that if you tell him, ' You've got to go to the potty,' he'll actually try not to go--just to show you who's boss.''

Instead of forcing the issue, wait and watch for signs of readiness on the child's part. ''Most kids really don't express much interest in toilet training until they're close to three. That's when it's developmentally appropriate to begin,'' says Dr. Ferentz.

Turn over some control. Children engaged in a stool-withholding power struggle with parents may need to be given the freedom to make some decisions for themselves, says Dr. Ferentz.

'' You may need to look at other control issues in the child's life--for example, what clothes he wears, or what kind of sandwich he eats for lunch. If you let him have more say in these matters, he'll feel like you're starting to let go--and that's important to him,'' Dr. Ferentz suggests. ''The child may be able to relax and pass stools more freely.''