Constipation can affect all aspects of a child’s life

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school childProf (Dr) Suhail N Sheikh 

ABTRACT: To understand the basic of childhood constipation & indications of Homoeopathic remedies.

Definition
The North American Society of Gastroenterology, Hepatology, and Nutrition (NASPGHAN) define constipation as “a delay or difficulty in defecation, present for 2 weeks or more, and sufficient to cause significant distress to the patient.”

The Paris Consensus on Childhood Constipation Terminology (PACCT) defines constipation as “a period of 8 weeks with at least 2 of the following symptoms: defecation frequency less than 3 times per week, fecal incontinence frequency greater than once per week, passage of large stools that clog the toilet, palpable abdominal or rectal fecal mass, stool withholding behavior, or painful defecation.

Functional constipation has been defined by the ROME III classification  as 2 or more of the following features in a child with a developmental age of at least 4 years and occurring at least once per week for at least 2 months before diagnosis (with insufficient criteria for diagnosis of irritable bowel syndrome).

  • 2 or fewer defaecations in the toilet per week
  • At least 1 episode of faecal incontinence per week
  • History of retentive posturing or excessive volitional stool retention
  • History of painful or hard bowel movements
  • Presence of a large faecal mass in the rectum
  • History of large diameter stools that may obstruct the toilet


Introduction:
Constipation is a very common problem among Children .In fact, more children than adults are suffering from constipation to some extent or the other. Nipping constipation in the bud is very important, because as the child grows, it might compound to several complicated forms.. A child is considered constipated when he or she has fewer than three bowel movements in a week; has difficulty having a bowel movement; or when the stools are hard, dry, and unusually large. Regular soiling (often mistaken for runny diarrhoea) may indicate that a child has bad constipation with impaction (a blockage of stools/faeces).

Normal Bowel Habit in Children
Considerable variation in ‘normal’ bowel habit in children is accepted. In study of children (1-4 years of age), 96% of the children passed bowel motions between 3 times a day to alternate daily [4]. Stool frequency is also age-dependent. In babies a peak frequency of 4.4 per day at 5 days of age], and may be as high as 13 per day in breast fed infants. Although a difference in stool frequency may exist between breast and bottle fed babies, time to first stool after passage of meconium remains the same in both groups.

Types of constipation in children and babies

Idiopathic constipation. This is common. The word idiopathic means of unknown cause. Various factors may be involved (discussed later), but many children become constipated for no known reason.   Understanding the trigger for constipation in children is important. This may occur secondary to inadequate evacuation as a result of rushing to school in the morning, quick use of the school toilet, the child withholding stools as they may be occupied by something of greater interest. Occasionally children may have had a hard stool due to decreased fluid intake after a febrile illness or during a holiday trip.

Short bouts of constipation. It is common for children and babies to have a bout of mild constipation for a day or so. This may settle quickly, often without the need for medical treatment.

Long-term constipation. In about 1 in 3 children who become constipated, the problem becomes more long-term (persistent). This is also called chronic idiopathic constipation.

Idiopathic constipation with impaction. Impaction means that the bowel is, in effect, blocked by a large amount of hard stool. Idiopathic constipation with impaction most commonly develops in children between the ages of 2 and 4 years, but older or younger children can be affected.

Constipation due to an underlying disease or condition. This is uncommon. The constipation is said to be secondary to this other problem. Some examples of conditions and problems that can cause constipation are:

  • Some neurological conditions.
  • Hypothyroidism (an underactive thyroid gland).
  • Cystic fibrosis.
  • Rare diseases with abnormal development of the bowel, such as Hirschsprung’s disease.
  • As a side-effect of certain medications that a child has to take for another condition.


Constipation in Children – Causes

The following are some of the main causes why constipation occurs in children:-

The most prominent cause for constipation in children is holding back bowel motions. They have to do this often in their school hours.Some Children tend to avoid going to the bathroom, even when they really have the urge to go. They might ignore internal urges because they don’t want to stop playing a fun game, use a restroom away from home, or have to ask an adult to be excused to go to the bathroom. When they ignore the urge to go, it’s harder to go later on. This often also occurs after a child has had a large, hard and painful bowel movement, which can occasionally occur in anyone. After this, because he may associate having a bowel movement with pain, he will try to hold his stools. This creates a viscous cycle, where bowel movements are painful, so he holds them in, causing his stools to be even larger and harder, which causes more pain when it finally does pass.

Changes of climate and diet, especially when traveling or on a holiday can cause constipation.

Children also eat a lot of wrong foods. Foods that are too oily and spicy – typically those that are classified as ‘junk foods’ – can cause constipation in children.

Some infections in the alimentary tract can commonly occur in children. This can cause constipation.

Children can get constipated when they’re anxious about something, like starting at a new school or problems at home.

Most of the time, constipation is due to a diet that doesn’t include enough water and dietary fiber, which both help the bowels move properly. Kids who eat a typical fast-food diet — rich in fats (burgers, fries, milkshakes) and processed sugars (candy, cookies, sugary soft drinks) — may find that they’re constipated more often. or having a diet high in constipating foods (whole milk, cheese, bananas, etc.) or Delicate children, products of artificial baby foods.

Another factor that can contribute to constipation and infrequent stooling is having a bad experience with potty training.

Constipation in Children – Symptoms

Children commonly show the following symptoms when they suffer from constipation:-

  • Difficulty in passing stools or infrequent bowel motions
  • Pain and discomfort when passing stools
  • A heated sensation in the stomach, generally after eating a meal
  • An uncomfortable feeling of fullness in the stomach after having meals
  • Lethargy and wanting to lie down on the bed for a long time, even after just having woken up for the morning

It is important that the parents read these signs and symptoms in their children. Children themselves will not know what is happening with them. Parents must keep track of the bowel motions of their kids by inculcating a daily habit. If there is anything amiss, a doctor must be notified, who will then look for further treatment requirements.

Education of children by parents:

Studies has shown that education about constipation and toilet training, the use of a bowel habit diary (with a reward system for younger children are important for success treatment of constipation in children & preventing its recurrance.  Encourage children to attempt defecation daily after each meal for five minutes.

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NICE recommend optimising fibre intake .Children with normal defaecation patterns in comparison to children with constipation have better fibre intake. In children with strong family history of cow’s milk protein intolerance, give a trial of cow’s milk protein-free diet, and in infants, a hydrolysed formula. A trial of cow’s milk protein-free diet in those with a suggestive of family history for milk protein intolerance, increased fluid intake is recommended, but excessively restricting calorie intake in younger children is not to be done.

Conclusion: Childhood constipation is common and often associated with faecal incontinence. An essential aim is to prevent the complication & chronicity of this disease. Chronicity can be debilitating and has behavioural and social consequences. The role of homoeopathic treatment indicates that childhood constipation can be treated completely by homoeopathic medicines, with no complications & given a healthy life.

HOMOEOPATHIC MEDICINES:

Alumina
It is useful in delicate children, products of artificial baby foods.  Abnormal craving; for coarse food, chalk, charcoal, dry food, clean white rags, tea or coffee grounds, fruits vegetables, dry rice and indigestible things .  Aversion to potato, to meat, which disagrees.
CONSTIPATION FOR MANY DAYS, with SOFT STOOL.
No urging, have to aid with fingers. Rectum seems paralyzed.  Perspiration from straining at stool. Inac
tive rectum, even a soft stool is passed with difficulty, hard stools cause severe cutting. – Can only pass stool when standing. Rectum seems paralyzed.

RUBRICS

  • RECTUM – CONSTIPATION – children, in
  • RECTUM – CONSTIPATION – children, in – bottle fed, artificial food
  • RECTUM – CONSTIPATION – children, in – nursing
  • RECTUM – CONSTIPATION – children, in – obstinate
  • RECTUM – CONSTIPATION – dryness of rectum, from
  • RECTUM – CONSTIPATION – standing passes stool easier when
  • RECTUM – CONSTIPATION – stool – has to be removed mechanically
  • RECTUM – CONSTIPATION – stool – recedes
  • RECTUM – CONSTIPATION – stool – remains long in rectum with – urging, no
  • RECTUM – CONSTIPATION – difficult stool
  • RECTUM – CONSTIPATION – difficult stool – urination, can pass stool only during
  • RECTUM – CONSTIPATION – difficult stool – soft stool
  • RECTUM – CONSTIPATION – ineffectual urging and straining
  • RECTUM – CONSTIPATION – insufficient, incomplete, unsatisfactory stools
  • RECTUM – CONSTIPATION – urging – absent
  • GENERALITIES – FOOD and drinks – artificial agg.
  • GENERALITIES – FOOD and drinks – artificial agg. – baby food
  • GENERALITIES – FOOD and drinks – coal, charcoal, desires
  • GENERALITIES – FOOD and drinks – potatoes – desires
  • GENERALITIES – FOOD and drinks – potatoes – desires – fried
  • GENERALITIES – FOOD and drinks – rags, clean, desires
  • GENERALITIES – FOOD and drinks – raw food – desires

 

OPIUM
Opium contains about eighteen alkaloids, of which Apomorphine, Morphine and Codeine are well known. Paralysis; painless; of brain, tongue, bowels etc. Incarcerated umbilical or inguinal hernia. Obstinate constipation. – – Stools of hard black balls.- Bloody mucus oozes from open anus.- Retention of stools from ileus.- Stools involuntary; after fright.- Violent pain in rectum as if pressed asunder.- Difficult emission of flatus.- Intestinal spasms, child cries day and night.-  Stool insufficient   – stool remains long in the rectum with no urging.

RUBRICS:

  • RECTUM – CONSTIPATION – children, in
  • RECTUM – CONSTIPATION – children, in – bottle fed, artificial food
  • RECTUM – CONSTIPATION – children, in – newborn
  • RECTUM – CONSTIPATION – children, in – nursing
  • RECTUM – CONSTIPATION – children, in – nursing
  • RECTUM – CONSTIPATION – chronic
  • RECTUM – CONSTIPATION – difficult stool
  • RECTUM – CONSTIPATION – insufficient, incomplete, unsatisfactory stools
  • RECTUM – CONSTIPATION – urging – absent
  •  RECTUM – CONSTRICTION, closure, contraction
  • RECTUM – CONSTRICTION, closure, contraction – convulsive, spasmodic

 

BRY ALBA
Very irritable and ugly in behaviour. – Determined.
Children ask for things that are difficult to find, immediately throw it away (Cham).  Mucous membranes become dry, hence discharges are scanty and adherent. Dryness everywhere, of mouth, throat etc. THIRST, FOR LARGE QUANTITY OF COLD WATER; also for warm drinks which amel. Stools; LARGE DRY, VERY HARD, as if burnt; loose, painless, undigested, involuntary, during sleep.- Constipation. Burning in anus, with stools.

  • RECTUM – CONSTIPATION – children, in
  • RECTUM – CONSTIPATION – children, in – nursing
  • RECTUM – CONSTIPATION – dentition, during
  • RECTUM – CONSTIPATION – stool – has to be removed mechanically
  • RECTUM – CONSTIPATION – stool – remains long in rectum with – urging, no
  • RECTUM – CONSTIPATION – difficult stool
  • RECTUM – CONSTIPATION – ineffectual urging and straining
  • RECTUM – CONSTIPATION – insufficient, incomplete, unsatisfactory stools
  • RECTUM – CONSTIPATION – urging – absent

 

MAG MUR
A   mental condition arising from lack of love, affection and recognition, esp. in childhood. Rejected   children, orphans. .A liver remedy with pronounced characteristic constipation. Especially adapted to children who cannot digest milk. Constipation of infants during dentition; only passing small quantity; STOOLS KNOTTY, like sheep’s dung, CRUMBLING AT VERGE OF ANUS. Painful smarting hemorrhoids.  Constipation with liver affections; Stools like sheep dung, crumbling at verge of anus. All the magneseium remedies have pain as all the ‘Murs’  have constipation like ‘Ammonium Mur’ and ‘Natrum Mur’. They get very disturbed by violence. They hate quarrels as quarrels tend to break relationships.

  • RECTUM – CONSTIPATION – children, in
  • RECTUM – CONSTIPATION – dentition, during
  • RECTUM – CONSTIPATION – stool – recedes
  • RECTUM – CONSTIPATION – difficult stool
  • RECTUM – CONSTIPATION – ineffectual urging and straining
  • RECTUM – CONSTIPATION – insufficient, incomplete, unsatisfactory stools
  • STOOL – MILK – agg.
  • STOOL – BALLS, like

 

NITRICUM ACIDUM (nit-ac.)
Rectum, – Constipation. Painful.  Ineffectual urging (Nux-v). – Hemorrhoids.  Violent stitching pains for hours after stool (Paeon, Rat). – Fissures. Fistulas. – Stools tear the anus, even thought soft.- Prolonged pain after stools; walks in agony.- Rectum feels torn; fissures in rectum. Alldischarges very offensive, especially urine, faeces, and perspiration.

  • RECTUM – CONSTRICTION – stool – preventing
  • RECTUM – CONSTRICTION – stool – during
  • RECTUM – CONSTRICTION – stool – after
  • RECTUM – CONSTIPATION – painful
  • RECTUM – CONSTIPATION – children, in
  • RECTUM – CONSTIPATION – periodical – day agg.; alternate
  • RECTUM – CONSTIPATION – ineffectual urging and straining
  • STOOL – ACRID
  • STOOL – BALLS, like
  • STOOL – BLACK
  • STOOL – BLOODY
  • STOOL – BLOODY – streaks, in
  • STOOL – DRY
  • STOOL – HARD

 

NAT M
Children talk late; cross, irritable, cry from slightest cause.

Emaciation even while living well.
CHILDREN: Well-behaved. Responsible.
Mature beyond his years.

  • RECTUM – CONSTIPATION – children; in
  • RECTUM – CONSTIPATION – difficult stool
  • RECTUM – CONSTIPATION – difficult stool – recedes; stool
  • RECTUM – CONSTIPATION – dryness of rectum, from
  • RECTUM – CONSTIPATION – ineffectual urging and straining
  • RECTUM – CONSTIPATION – insufficient
  • RECTUM – CONSTIPATION – stool – remains long in the rectum with no urging
  • STOOL – CRUMBLING
  • STOOL – BALLS, like
  • STOOL – DRY
  • RECTUM – PAIN – stool – after
  • RECTUM – PAIN – stool – before
  • RECTUM – PAIN – stool – during
  • RECTUM – PAIN – burning – stool – after – hard stool
  • RECTUM – PAIN – tearing – stool – after
  • RECTUM – PAIN – tearing – stool – during

 

References:

  1. Italian journal of paediatrics:  [Constipation in children, Nadeem A Afzal
  2. Childhood constipation: NICE guideline DRAFT (October 2009)
  3. Synthesis Repertory
  4. Weaver LT, Steiner H: The bowel habit of young children.

 

Prof (Dr) Suhail N. Sheikh, B.H.M.S
Professor   & H.O.D, Department Of Repertory,
Motiwala Homoeopathic Medical College, Nasik City
drsuhailsheikh@gmail.com