The best remedy for chronic constipation in children ( young ) is parenting skills.
This is the scenario:
A kid is determined not to have a bowel movement for the rest of his life because it hurts so much.
The best doctor in the world who can give the best medical advice but there are ten other patients waiting outside, so he can only spare five minutes to talk about constipation in children which actually needs one year to sort out. Besides, insurance doesn't pay the doctor the necessary time needed to guide the parents with all the details - after all the doctor needs to earn a living.
Therefore the bulk of curing the constipation in children falls on worried parents who have tried everything they know to convince the kid that withholding stools is bad for his health. Of course, this web page is not intended for folks who can afford to hire round the clock medical professionals.
Depending on their luck, there are three types of battles faced by parents:
Battle of the wits - The kid is cooperative so the main thing the parents need to do is to absorb new information on how to help him.
Battle of the will - A dominant kid who spits out the liquid paraffin his parents thoughtfully mixed with fruit juice. He runs round and round the house when it's "potty time". Before learning how to help the kid to poo, the parents have to learn how to be "the boss at home".
Battle of the will and wits - A dominant kid, with whom "nothing works". Nightmare.
Even if there were a magic pill, coaxing a dominant kid to swallow is still a formidable challenge. Can you see now why being a qualified parent is so important ?
A wise parent does not need a magic pill. A wise parent sees the comprehensive approach rather than applying a remedy rigidly. Comprehensive approach will succeed where conventional method has failed.
Now we can talk about the principles concerning handling constipation in children :
Stool management - Parents have to find ways to make the stools softer and evacuate them.
Pint-size children demonstrate the colon's impressive capacity to accommodate stools bigger than adults'. At times, if they withhold long enough parents get to see stools that can hardly go down the pipe and some have to be broken up before flushing.
I am impressed by kids in this situation who are still willing to subject themselves to enema. Their other counterparts would cringe at the idea of a needle-like instrument inserted into the same opening which is already hurting from squeezing out a gigantic stool. Even I would rather skip enema and choose to soak in warm baths and/or laxatives.
In the event Encopresis develops, the already jammed and very-stretched colon goes a step further. Somehow, loose stools can still seep through the blockage and parents end up dealing with soiled pants. This usually occurs when the child is given constipation remedy for an extended period, for the purpose of softening and adding bulk to the stool. Doctor Stoll suggests testing out first the maximum dosage of mineral oil, this happens when oil is floating on water after a ( reluctant ) bowel movement then reduce the dosage by 10% and subsequently add psyllium husk to the regime. I personally think his approach works on principle that each case of constipation in children is different, therefore parents must use discretion to work out the effective quantity of mineral oil first and then the effective quantity of psyllium husk. Simply giving the child a teaspoon of mineral oil before bed faithfully every night will never work if this is not the sufficient quantity to soften the child's stool.
Stoll's method also emphasizes the importance of combining both mineral oil and psyllium husk. If I don't have extra money to spend on taming a kid's stools, I certainly don't mind giving his suggestion a try. It's cheap and both ingredients are not laxatives such as Miralax which I shall only grudgingly implement when the kid absolutely cannot swallow mineral oil.
Sigh...choosing laxative means more work as I would have to see a professional health care provider regularly to watch out for dependency, fluid and electrolyte imbalances and improper absorption of nutrients.
Pain management - To minimize pain until the child no longer fears having a bowel movement. This entails parents to be consistent and persistent in pursuing whatever combination remedial actions they have chosen to ensure the child does not have another painful bowel movement again ...if possible. In some cases, the remedies and/or monitoring have to be ongoing for 6 months to a year. Remember, one recurrence of painful stooling can jump start stool withholding and constipation in children again.
Habit management - Toilet training and diet. Schedule time for children to sit on the toilet preferably after breakfast. Don't wait for them to tell you when they need to go. It is you the parent who tell them when to go whether they have the urge or not. Anyways in the case of constipation in children, I certainly can't trust the child's urge to poo because his/her colon has become too extended to feel the sensation. The darn stool had sat there for a hundred years until I applied fleet enema, warm baths, vaseline to take it out. That darn stool is going to drag its stay again. So darling, I have to train you to be tough with the big bad stool. You only need to sit on the nice toilet bowl for 5 minutes and I will shower you with hugs, kisses along with the shiniest sticker later.
I know this is easier said than done: find creative and tasty ways to incorporate more fiber into the child's diet. It's not the American diet that should take all the blame. It's the globalization of diet culture that is eliminating FRESH food. You have to work very hard to obtain fresh food i.e. wake up early to do marketing when the meat, vegetables and fruits are fresh. You have to look out for stalls that sell quality products. You have to replenish your fridge regularly. You have to know the right cooking time so you don't end up killing the nutrients. You have to do a lot of chopping and cutting and chewing. You have to be willing to accept new food. If you don't do these - and children discern what we do more than what we say - you children would most probably refuse to cooperate.
If I have to deal with constipation in children, I would feed the kid enzyme drinks after cleaning out the stools. I don't want to worry about working out the maximum dosage of mineral oils or fighting a kid saying "yuck!" or monitoring laxatives. I would rather pay some extra money to avoid killing my brain cells. As a woman who tries to spend minimum time planning wholesome menu, this is irresistible option.
5%-30% of children are affected by idiopathic constipation in which symptoms include: faecal soiling, irregular bowel movements, abdominal pain and poor appetite. An organization in UK called Education and Resources for Improving Childhood Continence or ERIC offers help. Personally I find some of their products practical like pants and swimsuits designed to prevent "accidental leakage", musical trainer potty LOL and protection for beds. If you have had great experience with ERIC, please let me know.