Toddlers and Constipation
Dear readers,
I hope you all enjoyed the happy holiday of Purim. I must first and foremost thank all my patients for visiting me and my family in their colorful, flamboyant and very original Purim costumes. We look forward to share many more Purim days with you – in Yerushalyim, in good health Be-ezrat Hashem.
The reason for specifying the toddler age in this week’s title is that infants have there own, unique patterns of bowel movements. I will discuss them separately in a future article b”h in order not to confuse my readers.
“Mother of All Illnesses”
My father frequently reminded me that constipation is the “Mother of all illnesses”. I think the first time he mentioned it was when I was a teenager. Back then, I thought he was kidding, because he also insisted that walking around barefoot could kill you (that was a quote from my late grandfather David Sasson Simai Ob”m).
It was not until my second year at SUNY Downstate Medical School when a pathology professor explained that constipation is a major cause of colon cancer, which is a one of the top killers in the US. Now, the last thing I wish is to generate anxious parents, so let me clarify this statement (please pardon me for mentioning the scary “C” word).
Transient constipation, lasting a few days or weeks will absolutely NOT cause any cancer!!! It takes years of constipation to have a significant risk. However, what constipation causes is an accelerated demise of the lining of our intestines. As you may know, in order to regenerate tissues in our body, we must divide and replicate our cells. By definition, cancer disease initiates from faulty replication of our cells. Therefore, the more cycles of replication we go through, the higher the risk of cancer. So if we keep our intestinal linings clean and smooth, we could prevent a deadly disease.
Other common conditions affected by constipation include:
Urinary Tract Infections
Hemorrhoids
Intestinal obstructions.
Lastly, constipation will worsen all abdominal and inguinal (upper thighs) hernias in children and adults alike.
Establish the “Norm”
According to the Webster Dictionary constipation means: “abnormally delayed or infrequent passage of usually dry hardened feces”. Notice that the definition starts with the adjective abnormal. This leads me to the take home message this week.
Many parents bring their children to my office with the chief complaint of abdominal pains. My nurses are instructed by me to ask the parents a series of questions at every visit. The questions include obtaining any history of diarrhea, nausea, vomiting or constipation. When I read the triage note prior to entering the room, I frequently see that note states “no nausea, vomiting, diarrhea or constipation”. But when I walk into the in and delve into the matter, I make sure to ask the child what their recent bowel movements looked and felt like. This is often an embarrassing question that makes many children and parents blush at once, but you would be shocked to discover how many times this simple question solved the mystery behind the stomach aches.
Most parents do not know their kids normal bowel patterns until the question is asked at the doctor’s office. If a parent does not know what the normal bowels look like, how would they know if the bowel movements have changed???
So the take home message this week is: try and ask your children periodically about their bowel habits. Again, I do not want to add any obsessive behaviors to any readers. I do not ask my kids about their bowel habits every day, but I do ask this question on occasion and especially if they complain about any stomach aches. I go a step further, and ask my toddlers to show me their bowel movements before flushing on those days that they have belly pains.
Treatment of Constipation
There are many natural and medicinal remedies used to treat constipated kids. I can not recommend any specific remedy because each child has to have a clear plan of action when it comes to constipation. I try to custom tailor a treatment plan to each child.
Prevention of Constipation
Prevention is instrumental when it comes to constipation, and here is another quote from my father. My father practiced as an OB/GYN in three countries: in France - as a fellow at “Hôpital du Paris”, in Iran in his own private practice, and in Jerusalem at Misgav Ladach Birthing Center. My father treated patients from Western Europe and the Middle East. He once told me that his Middle Eastern patients had better vision and were less constipated then the Europeans because they had a healthy, daily intake of…......olive oil.
I just took a few moments to validate this information tonight. I Googled “olive oil & constipation” and got 400,000 results supporting this statement. A similar search for “olive oil & good vision” yielded 4 million web pages!!!
Of course, olive oil is definitely not enough to prevent constipation. As a parent, you should try to be very conscious of the foods that enter your house. Avoid bringing home foods rich in carbohydrates. Pay extra attention to the food labels when you go shopping. Try your best to increase your children’s fiber intake.
In my opinion, the big 3 foods that contribute to constipation in children are:
Pasta
Pastries
White Bread
Encourage your kids to eat fresh fruits and vegetables and to snack on whole wheat crackers, fresh fruits, nuts and figs. Make sure that they drink plenty of water, and a teaspoon or two of olive oil daily will definitely help……
Last but not least, remember that inactivity or sedentary lifestyles cause constipation. As the weather is warming up, try your best to spend more time outdoors with your children.
Wishing you a healthy and enjoyable spring (oh, it took so long to be able to write that wonderful, cheerful word).
David Elazar Simai M.D.