Chronic functional constipation is the most common type of constipation in young children. There is nothing wrong with the child’s hormones or intestinal system. It is a socio-psychological problem related to parenting. It is becoming common as mothers have to work outside the house and children are placed in nurseries at an early age. Constipation is also seldom seen in families where children eat properly.
The traditional West Indian diet of legumes, ground provisions, vegetables and fruits is full of fibre, which enables bowel movements. Children who drink water and eat food with fibre after playing in their backyard seldom become constipated.
“He holds it in!”
“He goes off by himself in a corner and holds it in”. “Sometimes she breaks out in a cold sweat”. These are typical statements of parents whose children are constipated for long periods. Most of these children are about two or three years old, and all of them would have appeared to be normal, healthy kids until they began to be potty-trained. Parents start training them because they have to put them into a nursery, and the nursery insists that the children be potty-trained. They are not ready, physiologically or emotionally, for this.
A large proportion develops constipation. This is not unexpected. Children react strongly to being pressured. Initially, they may try to please their parents and may even appear to be in control of their bowels. After all, it’s quite possible to teach a parrot to talk. In the same way, it’s possible to teach a one-year-old or two-year-old to sit on a potty and defecate. It’s a new game, a new way of playing. The children have no understanding of what they are doing. At first, it’s fun, and everybody is pleased. The child is repeatedly congratulated, rewarded even. Big mistake.
Trouble soon sets in. After the first flush of victory, the child realises that there is no more fun in this new game. Everyone expects her to continue doing this thing at their request. Since this is the classical age of independence and selfishness, the child reacts by holding on to its stools, refusing to do what everyone wants it to do. A couple of days go by; everyone in the household is pressuring the child to be “nice” and “do tu-tu”. Too much attention is focused on the child, who steadfastly refuses to go off. After a week of this, the water has been absorbed, and a hard stool is passed with great difficulty and discomfort. A vicious cycle is set up: refusal … hard stools … discomfort … refusal etc. This even has a name: “defecation anxiety”! Anxiety is the enemy of defecation. One needs to be relaxed while sitting on the toilet. The longer this cycle persists, the more difficult it becomes to undo. The solution is to leave the child alone, use a stool softener for some months, make sure the diet is bowel-friendly, and allow the child to run around outside and let nature take its course.
Poor diet is the second major cause of constipation. Humans need water and roughage or fibre to have regular bowel movements. Children should be encouraged to drink water from six months of age. Fibre is essential for normal bowel movements. It adds bulk to the stool and helps it retain water. This softens the stool and speeds up its passage through the intestines.
It is strange, living in a country where traditional foods rich in fibre, like beans and dhal, callaloo and bhagi, sweet potato, corn, yams and eddoes, used to be the national diet, and fruits like mango, Portugal, orange, sapodilla, tamarind and guava were common, that any child could be constipated.
Excess milk is another common cause of constipation, especially the habit of mixing processed cereal in the milk to make it “tick”, in an attempt to make the child “go off”. Milk and commercial cereal have little fibre and contribute to obesity.
Decreased exercise is also an important cause of constipation. Today’s child spends too much time sitting down in front of screens. It is not the fault of the children. It is ours because of the lifestyle we have chosen. We have little time to play with our children. We have allowed criminals and their lesser brethren, the bad drivers with attitude, into our neighbourhoods, so the roads are no longer safe for children to play cricket or ride their bicycles. And we have allowed developers and their associates, politicians, to get away with building housing developments with no parks or squares for children to meet and play.
Too early training, poor diet and lack of exercise explain the majority of cases of chronic constipation in children.
