Treatment for constipation in babies and toddlers

Infants

Treatments differ depending on the infant’s age and if they have been weaned. tt bottle fed, give extra water in between feeds but do NOT dilute the formula any more than is advised on the instructions. Consider the possibility of cow’s milk intolerance -your GP will be able to check for that. If breast fed, then constipation is more

unusual and the GP will examine to find a cause. If weaned, then encourage extra fluid such as water or diluted fruit juice, especially fruit with a high sorbitol cootent (apples, pears, grapes and prunes). If this fails, then the GP will prescribe laxatives.

Over 1 year

Laxatives

Parents often do not bring their children to the GP until the constipation has been present for at least 4-5 days. At that time it is likely the GP will prescribe a laxative to assist.

Laxatives for children form 2 main types:

1. Osmotic laxatives. These draw fluid into the bowel and make the poo softer. The 2 main examples are lactulose and macrogol. They come as a syrup or as a sachet of powder that needs to be mixed with water.

2. Stimulant Laxatives. These stimulate the muscles of the bowel to help push the poo out. These are usually used in addition to the osmotic laxative when it has not worked on its own. It is important not to stop the laxatives abruptly, unless advised by your GP as this may cause the constipation to recur.

Your GP may advise continuing the laxatives for a few weeks after the symptoms have got better. In some patients the laxative is required for a lot longer especially if there is impacted constipation.

Diet

It is my experience that diet alone is rarely successful in managing childhood constipation. However it is important to ensure that the child has a high fibre diet and plenty of water. This will help prevent the constipation recurring after it has been treated.

How to prevent constipation

(this applies to children older than 1 year)

Fibre

• Check the breakfast cereal and encourage the child to have one that is high in fibre. If they are unhappy then try mixing 2 breakfast cereals together.
• Ensure they child eats sufficient fruit, vegetables cereals and wholemeal bread.
• Fussy eaters can be rewarded for eating more fibre or the higher fibre foods can be mixed in with other foods.
• Powdered bran, which is tasteless, can be sprinkled on food or added to yoghurt
• Offer fruit and vegetables with every meal -perhaps try cutting them into chunks or arranging them into faces or as letter shapes
• Rather than sweets and crisps as snacks, try raisins or apricots

Fluid

Encourage older children to drink plenty of water. Squash, fizzy drinks and milk can make them feel full up so they do not eat their meals and do not take in enough fibre. Rather offer squash or fizzy drinks at the end of the meal as a reward for finishing their meal.

Toileting

• Encourage children to have regular visits to the toilet. Allow them plenty of time so they do not feel rushed.
• Star charts or rewards are often helpful for children who are stool holding.
• Keep calm and don’t worry about the problem in front of your child. They will quickly pick up on your concern around this issue and this will often make the problem worse.
• Praise your child for using the potty or toilet but please do not punish accidents as this can make the child more nervous and more prone to have an accident.