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Constipation in children

Medicine, nutrition – and a lot of patience

Aus unserer Serie »English Lesson«: Constipation can torment sufferers immensely. The constant squeezing during the rarely successful sessions also promotes the leakage of haemorrhoidal cushions and can lead to anal fissures. If you imagine this in children, it is even worse. That is why it is so important to identify and treat the problem early.
Marta Campbell
24.11.2022  13:30 Uhr

A normal stool frequency is between one and three times a day to once every two days, at least for children and adults. Breastfed babies empty their bowels between four and five times a day or less frequently, which is also normal. Children suffering from constipation excrete hard stools that they can only produce with pain and often with great effort (head red, child not infrequently sweaty and exhausted afterwards). The pressure and constipation lead to small, extremely painful tears at the anus. Often, not all of the stool comes out, but the children describe that they could not squeeze it all out. This can make the whole day miserable for those affected, and running around and playing are sometimes almost impossible. The first thing parents should not do is scold. It is absolutely not the child's fault that he or she is suffering.

Then parents should observe whether it is a one-time event or whether the constipation occurs again and again. Do not wait too long before going to the doctor, because constipation can become chronic after only two months. Then a vicious circle develops: children avoid going to the toilet because they know the severe pain that awaits them. This in turn promotes constipation and so on. Over time, the intestines can even dilate and the children lose the urge to go to the toilet. Sometimes, as a result, small amounts of stool repeatedly empty into the pants. This is both unpleasant and embarrassing for the affected children. Under no circumstances should parents reproach their children for this.

Back to normal

For all these reasons, the first goal must be to quickly normalise bowel movements so that children can once again experience that the “number two” no longer hurts. This builds new confidence in the function of their own body at this point, wounds can heal, the child can begin to relax.

If you have managed constipation yourself as an adult more often, you can do so on your own if the symptoms recur and do not last too long. If children suffer from constipation, however, the doctor is always called upon. Only a doctor can determine whether there is a serious illness or organic malformation behind the symptoms or, for example, a congenital allergy to cow's milk protein. Should the doctor rule this out, the German Society for Paediatrics and Adolescent Medicine (DGKJ) describes the further procedure as follows.

Treating wounds

In babies and young toddlers, the bottom and anus need care to get rid of inflammation. Usually, the child is also given a medicine to soften the stool. From the age of six months, a macrogol is usually used for this purpose. Its long-term use does not cause any problems either.

According to the DGKJ, a change in diet is just as important for long-term normal bowel movements. Fruit, diluted juices and whole grain products naturally ensure well-formed stools of normal consistency. In infants, an intolerance to cow's milk protein can cause the constipation, according to the DGKJ. If this is suspected, an omission test will help. Allergy tests are too inaccurate to rule out this cause.

In acute and severe cases of constipation, glycerine suppositories or mini enemas bring quick relief. However, parents may only use these aids if the child does not resist and if the child's bottom is not acutely inflamed.

Explain the therapy

Kindergarten and school children can already be told in simple terms what is wrong with their digestion. Here, too, paediatricians and adolescent doctors often start with macrogol to quickly break the vicious circle of holding back the stool and constipation. Because the urge to go to the toilet occurs mainly after main meals, parents should remind their children to go to the toilet after every big meal. The child should be able to sit comfortably on the toilet, for example with a stool or child seat, and may also look at a book while doing so. Time pressure, on the other hand, is harmful. The DGKJ writes that words of praise after having successfully defecated are helpful.

Enemas and clysters usually do not bring success. On the contrary, the agonising procedures increase the children's anxiety and worsen the problem. Older children and adolescents should also be fed a diet rich in fibre, fruit juice (for example, a glass of diluted apple or pear juice before breakfast) fruit and raw vegetables. An absolute no to chocolate - known as a stuffing food - does not have to be. Here too, the dose makes the poison.

The DGKJ puts it in a nutshell: children who suffer from constipation need, in addition to the medical measures and diet mentioned, above all this: patience and understanding from their parents.

Deutsch/German Englisch/English
Abführmittel laxative
After anus
Anus anus
Analfissur anal fissure
Darm bowel, intestine
Einlauf enema
Entspannung relaxation
Geduld patience
Großes Geschäft defecate, »number two«
Hämorrhoide haemorrhoide
Heilen heal
Kinderaufsatz children’s attachment
Milcheiweiß milk protein
Po butt
Pressen press
Schemel stool
Schimpfen scold
Teufelskreis vicious circle
Toilettengang toilet visit
Verstopfung constipation
Wunde wound, sore

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