One of the most common gastrointestinal disorders in children, functional constipation (FC) is defined as difficulty passing stool for reasons other than organic causes.
According to Dr Simon Foo Hee Wei, paediatric gastroenterologist and hepatologist at a medical centre in Sunway Velocity, Kuala Lumpur, the condition has a worldwide prevalence of 9.5% and accounts for 95% of cases of constipation in healthy children aged one year and older.
While constipation might seem like a minor issue, untreated FC can lead to serious gastrointestinal complications such as tears in the colon and urinary tract infections. These can significantly impact a child’s development and quality of life.
Occasional constipation is common and usually not a cause for concern, but parents should be alert to the warning signs of FC, such as persistent abdominal pain and bloating, changes in appetite, weight loss, or inability to control their bladder.
What causes it?
While many factors contribute to FC, children are particularly prone to developing it during their key life stages, such as the introduction of solid foods (six months to one year old), during the start of toilet training (2-3 years old), and even when beginning pre-school (3-5 years old).
These developmental milestones can be critical periods; for example, a child may develop FC during toilet training owing to the stress and pressure of learning new routines.
Psychological factors like stress, anxiety or trauma can also trigger FC. For instance, the anxiety that comes with unclean school restrooms can lead a child to avoid using the toilet, resulting in stool withholding. This can create a cycle of increasing pain and worsening constipation.
Constipation can also result from a lack of fibre and fluids in the diet, or an intolerance to cow’s milk. Transitioning from breast to cow’s milk can cause FC in some infants, leading to anal fissures owing to the passage of large, hard stools.
Prevention and management
Understanding FC and its underlying causes is the first step for parents to manage this condition in their children effectively. While specifics may vary case by case, Foo suggests a general guideline of ensuring the child has a defecation frequency of at least three times a week, without experiencing painful, large, or hard bowel movements.
Meanwhile, dietician Jillian Tan Foong Yin emphasises the role of a balanced diet in promoting good bowel movements and overall gut health.
“Fibre-rich foods like bananas, papayas, and steamed carrots or potatoes not only promote regular bowel movements but also improve gut health,” she said. Adequate hydration is equally important.
Tan, however, cautions against the misconception that introducing fibre-rich foods can alleviate FC symptoms immediately. “It should be introduced gradually to not only give your child’s digestive system some time to adapt, but also help gauge their tolerance and prevent issues like gas or bloating.”
Balancing a child’s diet with occasional snacks is also key to maintaining a healthy approach and fostering a positive relationship with food. This balance ensures children receive essential nutrients from their regular meals while being able to enjoy occasional treats.
Parents are further encouraged to instil positive lifestyle habits in their kids from young, including consistent physical activity like walking, swimming, or playing sports.
The role of potty training
Potty training, a developmental milestone, is essential not only for instilling a sense of good hygiene and independence in children but also for potentially preventing FC.
According to Foo, the recommended age to start potty training is around four years, when children can walk on their own, stay dry for a few hours, and can understand and follow simple instructions.
If children start too early, they may associate going to the toilet with negative emotions, which could lead to stool withholding and, eventually, FC.
To ease them into it, parents should ensure their child is comfortable throughout the process. Small steps, such as dressing children in easy-to-manage clothing, can help in case of accidents.
Setting a fixed time in their daily routine for using the toilet with a potty chair or ring can help build initial habits. And introducing a reward system, such as small incentives when they go to the toilet on their own within the set timeframe, can create a positive relationship with the process.
Patience is key to successful potty training. “Parents should not pressure their children, and give them constant encouragement without getting too upset if toilet accidents occur. Being a source of support during this time makes them feel secure as they learn to use the toilet independently,” Foo explained.
Patience is also crucial for managing FC in general: mums and dads should not feel discouraged, and instead seek open conversations with trusted paediatricians for professional advice. Sharing experiences and struggles with other parents can also help provide support and relief.