Stool or “poo” is a subject that most people avoid, considering it dirty and smelly. However, parents of young children will often pay close attention to their child’s poo every day. Parents can often get very concerned about their child’s bowel habits, as they worry about constipation and toilet training.
What exactly is a normal stool? Parents may have different understandings. When taking the child for a vaccination, parents sometimes should ask a doctor to show them a stool chart. What constitutes a normal stool differs in each age group. When
the baby is younger than 6 months old and is being fed with breast milk, it is normal for the stool to be liquid or loose with curds like. Once the baby starts to eat supplement foods at 6 months old, the stool may become creamy, but still not hard.
It is not normal for a child under the age of 2 years to pass stool that resembles a very thick paste in tube shaped, like toothpaste being squeezed out of a tube. This occurs when the child resists emptying his or her bowels, causing stool impacted in the colon. It is a symptom of constipation.
What is constipation? Some children pass a soft stool every 2 days. Some children empty their bowels every day or even 2 times a day. Constipation can be classified in terms of both the characteristics and the amount of the stool.
Bowel movements in children normally take place every other day or 3 times a week. In general, 2 or fewer normal bowel movements per week is a sign of constipation. If a child passes a large volume of stool every 2 days without difficulty, it does not
mean that the child is not constipated. It is likely that stool is being impacted in the colon until the child cannot hold it back any longer. When the child empties his or her bowels in such cases, the first part is hard and then the later part is soft. When bowel movements are difficult or painful, the child will often hold off from going to the toilet for 2-3 days, causing impacted stools to collect in the colon until the child reaches a point where he or she cannot hold them in any longer. Parents should monitor their children’s bowel habits to look for signs of constipation.
If a child passes stool daily, but it is hard and only a small volume, this is also a symptom of constipation. The colon is very long and can store a large volume of stool. When the child passes stool that is hard but in small volumes, it is likely that there is still stool left inside the intestines, but it will not come out. It is like when rocks are piled on top of each other until the stack becomes too high and some, but not all, of the rocks fall.
Constipation in children is not a serious condition. In most cases, the constipation is caused by behavior problems. Nevertheless, parents should not leave it untreated. Chronic constipation can lead to mental and physical health problems. However, parents should not buy laxatives or enema device without seeking professional medical advice because there are potential side effects. Taking the child to see a doctor is the recommended course of action.
An Enema is administered when the stool is impacted in the colon, causing abdominal discomfort and vomiting as the stool backs up. Administering an appropriate and accurate dose is very important. For instance, the applicator must not be too hard for the child’s rectum. Parents who buy an enema themselves run the risk of giving their child the wrong dose. Use of enemas is often traumatic for children. Most children do not like to have a applicator inserted into their rectum and so their parents have to grab them tight, causing fear and emotional problems.
Laxatives must be used under certain conditions and for specific durations due to the possibility of side effects. Constipation can be difficult to treat which needs to tune into emotional, mental and physical symptoms. Untreated constipation requires a longer treatment period – 3 months, 6 months or even years in some children. The medications need to be adjusted or changed from time to time, so parents should not buy them over the counter, especially for young children under the age of 6 years. While pharmacists are professionals, they will not have all the necessary patient information that a doctor would have, such as duration of received medications, drug resistance, and other conditions regarding certain medications that should not be taken together due to complex interactions and toxicity.
The use of enema or laxatives is not ideal. It is better for parents to monitor their young children’s bowel habits and establish bowel training by the following methods:
Finally, I would like to add that creating a food plan for healthy bowel movements in young children is not always easy, but also not too difficult. Constipation can be prevented. A mother with young children should not leave hard stools or irregular bowel movements untreated. It is important to treat the constipation at a young age as chronic constipation requires a longer treatment period. When taking your child for a vaccination, please consult with the doctor about the appropriate amount of food and milk to be consumed. Enemas are not recommended. If the conditions of constipation appear, please consult with a doctor and don’t do the enema. Most importantly, please monitor your child’s toilet behavior.
At Samitivej, we have a toilet training program with toilet seats made especially for children and therapeutic exercises called the Balloon Exercise and the Breathing Exercise. Parents who have a child experiencing constipation can consult with our
doctor to determine the best course of action.
The Second Class Honors, M.D., Faculty of Medicine, Chulalongkorn University, 1976.