CONSTIPATION IN CHILDREN: TREATMENT OPTIONS

CONSTIPATION IN CHILDREN: TREATMENT OPTIONS

Constipation is defined as abnormally delayed or difficulty in defecation (bowel opening). If your child continues to have symptoms despite changing the diet, modifying the lifestyle and increasing fluid intake (see previous article Constipation in Children – What Is It?), then your child may need treatment.

Treatment of childhood constipation

Around 97% of cases of constipations are functional which can be managed using the by modifying their diet or with medication if required as directed by your doctor. Rare causes of constipation due to structural gut abnormalities such as anal stenosis or imperforate anus, anal tear (fissure) or Hirschprung’s disease require surgical intervention by a paediatric surgeon. Neurological disease such as spinal bifida or cerebral palsy can also cause constipation.

Medication options

  1. Faecal softeners such as DUPHALAC, LACTUL & FORLAX work by drawing fluid into the faeces making it soft to pass out. Take the medication as directed by your doctor or pharmacist.

Duphalac

Lactul

Forlax

  1. Suppository such as DULCOLAX works by softening impacted stool at the rectum. Take the medication as directed by your doctor or pharmacist.

Dulcolax

Maintenance

Once the cycle of constipation is treated successfully, you still need to encourage your child to change the habit and lifestyle to prevent recurrence by following these principles:

  • Increase fluid intake
  • Increase dietary fibre and avoid fatty, sugary or starchy foods
  • Avoid sweet drinks before meals
  • Encourage your child to exercise (avoid being sedentary)
  • Develop a regular meal schedule
  • Get the child to have regular bathroom breaks
  • Encourage your child not to be frighten of going to the toilet

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CONSTIPATION IN CHILDREN: WHAT IS IT?

CONSTIPATION IN CHILDREN: WHAT IS IT?

Constipation occurs when a child does not go to toilet to defecate regularly resulting in difficult or painful bowel opening (pooping). The peak incidence of constipation is between 2-4 years of age when parents start to toilet train their children.  Around half the kids experience constipation at least once during childhood!

The frequency of defecation depends on the child’s age; beginning with around 4 times a day during neonatal and infant period but gradually decreasing to twice daily during early years of age and once daily by the age of 4 years when children are able to achieve anal sphincter control.

Symptoms of constipation

  • difficulty or pain in defecation
  • hard dry stools (see stool chart below)
  • irregular bowel movements
  • abdominal pain or distention (bloated)
  • bleeding when it causes an anal tear or fissure
  • pain during defecation causes the child to withhold the stool even more thereby setting up a vicious cycle of stool retention

Stool Consistency is best described using the Bristol Stool Chart

Source: Wikipedia

Contributory factors to constipation

  • Low fibre diet (not enough fruits and vegetables)
  • Insufficient fluid intake (see below)
  • Poor quality diet (too much junk food)
  • Being overweight
  • Sedentary lifestyle (not enough exercise)
  • Psychological factors (such as stress or anxiety)
  • Family history
  • Organic bowel disorder

Prevention

Image Source: YMCA Harrisburg

Prevention is the best option and you can follow the following principles:

  • Increase fluid intake
  • Increase dietary fibre and avoid fatty, sugary or starchy foods
  • Increase sorbitol in the diet (apple, prune or pear juice)
  • Encourage your child to exercise (avoid being sedentary)
  • Develop a regular meal schedule
  • Get the child to have regular bathroom breaks

Recommended fluid intake (including fluid in food and drinks)

The table below is just a guide and more may be required if the child is active and sweats a lot.

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WHY VACCINATE YOUR CHILD?

WHY VACCINATE YOUR CHILD?

Vaccines work by introducing a weakened or dead form of either the bacteria or virus (known as the antigen). This vaccine encourages the body to create antibodies against this antigen so that when the person is exposed to the infection, the body is able to fight the infection quickly without being affected too severely by the illness. In short, vaccines prepares the body to fight the disease in case the person gets infected in the future.

Source: M Klingensmith

Although there may be some side effects during the vaccination, the benefits outweigh them. In 2018, it was reported that in Malaysia, there were:

  • 6 deaths from measles (none of them receive vaccination)
  • 5 deaths from diphtheria (4 of them did not receive vaccination)
  • 22 deaths from pertussis (19 of them did not receive vaccination)

Reference: Star News Malaysia 22 Jan 2019

Do read the link below on how a lecturer had ‘wished his parents had him vaccinated’ as a baby but instead contracted polio at the age of 18 months and lost his ability to walk properly since then.

https://www.thestar.com.my/news/nation/2019/01/23/lecturer-how-i-wish-there-was-polio-vaccine-then/

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DIET FOR PATIENTS WITH KIDNEY DISORDERS

DIET FOR PATIENTS WITH KIDNEY DISORDERS

Most kidney disorders are caused by patients with poorly controlled diabetes or hypertension.  As such, it is important to eat a healthy diet which is low in salt and fat (to reduce the risk of high blood pressure) and low in sugar (to reduce risk of diabetes).

Do also refer to our health articles on Diet for Hypertension and Diet for Diabetes if you also have hypertension or diabetes.

When you have kidney damage or on dialysis, the kidneys will have difficulty removing waste and fluid from your body. A good diet will help provide energy for your daily tasks, maintain a healthy weight, prevent muscle-mass loss and slow down the progression of kidney disease.

Image Source: Live Strong

A kidney-friendly diet refers to eating the right amount of protein, phosphorous, calcium and potassium as well as drinking appropriate amount of fluids to control the build-up of waste and fluids in your body. You need to discuss with your doctor or dietitian on how to limit the amount of:

  • sodium in foods and drinks
  • protein in your diet
  • high-phosphorus foods
  • canned foods or fruits (best to avoid)
  • liquid to prevent fluid build-up in your body which cause ankle swelling

Vitamins

Image Source: Whatwolf (Freepik)

When you have kidney disease, you may not be getting enough minerals or vitamins in the food groups you are eating.  Vitamins which are useful for patients with kidney disorders include:

a) Vitamin B Complex. Vitamin B6, B12 and folic acid work together with iron to prevent anaemia. The other vitamin B components such as thiamine, riboflavin, pantothenic acid and niacin help your body convert foods into energy more efficiently.

b) Iron. Iron works with Vitamin B complex to prevent anaemia.

c) Vitamin D & Calcium. Vitamin D and Calcium help to maintain bone density and bone strength.

Phosphorus

Phosphorus is a mineral which works together with calcium and vitamin D for the development and maintenance of your bones.  Excess phosphorus in the blood results in calcium being pulled out of your bones making them weak and susceptible to fractures.  The normal phosphorus level in adults should be between 2.5 to 4.5 mg/dl.

Image Source: Huffpost Australia

Phosphorus is naturally found in protein rich foods such as meat, fish, poultry, dairy products, fish, legumes and nuts. Phosphorus found in animal foods is absorbed more easily by our body compared to those found in plant foods. Besides that, phosphorus is also used as additives in processed foods, canned foods and beverages. Phosphorus from food additives is completely absorbed by our body hence avoiding it can help lower your intake of phosphorus. It is usually listed on the food packaging at the ingredient labels as ‘phosphorus’ or you may look for words with ‘PHOS’.

Potassium

Potassium is a mineral which is essential in maintaining regular heart beat and muscle function. Abnormal potassium levels can cause irregular heart beat or even heart attack and muscle cramps. The recommended intake for normal adults is between 3,500 to 4,500 mg per day. A potassium restricted diet is around 2,000 mg per day. 

What is a safe potassium level in the blood?

Potassium in foods

Listed below are some good practices to help reduce potassium in your diet:

  • Chopping & slicing foods into smaller pieces, soaking them in a large volume of water for a 1 – 2 hours in several changes of water and straining the vegetables to discard the water before cooking, can leach potassium into water.
  • When using canned vegetables or fruits, drain away the brine or syrup
  • Peel off the skin from fruits
  • Do not take the gravy from vegetable dishes or soup
  • Use whole spices rather than ground spices
  • Avoid herbal and traditional remedies (ginseng roots, banana stem, akar kayu and others)

Haemodialysis patients

If you are on haemodialysis, do discuss with your doctor or dietician because you may also need to:

  • add protein to your diet because hemodialysis removes protein
  • choose foods with the right amount of potassium
  • take vitamins made for people with kidney failure
  • find healthy ways to add calories to your diet because you may experience reduced appetite

Source: www.kidney.org

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VACCINATION FOR CHILDREN (MALAYSIA)

VACCINATION FOR CHILDREN (MALAYSIA)

This is the recommended vaccination schedule for children in Malaysia. Do share this article with your friends with young children to keep as reference and useful reminder.

Explanation Notes

  • Bacillus Calmette–Guérin (BCG), vaccine that gives protection against tuberculosis
  • DTaP is the combination of diphtheria(D), tetanus(T) and accelullar pertussis (aP)
  • DT is a booster dose which protects against diphtheria (D) and tetanus (T)
  • Hib is Haemophilus Influenza type B
  • MMR is the combination of Measles(M), Mumps(M) and Rubella(R)
  • MR vaccine provides protection against Measles (M) and Rubella (R). MR Dose 2 at 7 years old
  • JE is vaccine against Japanese Encephalitis (This vaccine is only provided in Sarawak)
  • HPV is Human Papilloma This vaccine is provided only for girls aged 13 years. Dose 2 is given 6 months after dose 1

This an additional list of vaccines which you can discuss with your doctor about the suitability for your child:

Reference: myhealth.gov.my

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