A very small child may have constipation, as his bowel movements may not be set. Usually if a child passes very hard stools or passes stool only 2 or 3 times in a week, he is said to be constipated. Due to constipation, a child can have abdominal pain and rigidity, particularly lower abdomen. There can be associated abdominal bloating, flatulence, nausea and or vomiting. He may have loss of appetite due to the bowels not being emptied. Not eating enough can further aggravate the constipation, Due to abdominal pain or pain over the rectum, he may avoid passing stools, thus further augmenting the problem. At times, there may be passing of some blood from the rectum, due to pressure caused by hard stools on the veins of rectum. The skin around anus may become rough, fissured and painful due to the constant pressure, thus making defecation more painful. In a very small child, light massaging over the lower abdomen can help augment bowel movements. Use of glycerine suppositories is also helpful. As soon as a baby is able to take other foods than milk, he or she can be introduced to take vegetables, particularly green ones and fruits. These can be given in a soft liquid or semiliquid form, whichever is easy for the baby to take. These provide fiber, which is necessary for regular bowel movements. An older child should be encouraged to take fiber rich food. He should also e encouraged to take at least 1 liter of water everyday. In case of not passing stools for 2, 3, days, mild laxatives can be given in night. It is also good to toilette train a growing child so that he does not get constipated. This involves making him sit in the toilette and trying to pass stool at a fixed day, every morning. Thus gradually his bowels will be adapted to function regularly. Children of affluent families these days are mostly hooked to electronic entertainment and level of physical activity has decreased. This also contributes to constipation. Hence the child should be encouraged to play outdoors or do some physical activity regularly. At times, a child may be constipated due to some anatomic defects in bowel causing occlusion or worm infestation or some other disease of the bowel. Therefore if the constipation is persistent, child should be investigated for a disease condition. Dr Rachna Pande is specialist internal medicine, Butaro Hospital
