As parents, we seem to always have something to worry about. Sometimes it’s about our child’s future.
Other times it’s if they’re eating or sleeping enough. Even their bowel movements can keep us up at night!
Is it too hard? Or too soft? Too frequent or too irregular?
Today, we have Dr. Ng Yi Ki, Paediatrician from Baby and Beyond Child Specialist Clinic and ABC Child Specialist Clinic to bring us the scoop about poop—what’s normal, what’s not, and what we can do to help.
Q1. What causes constipation and loose stools?
Dr. Yi Ki: Constipation happens when your stool gets hard and dry. And this can be caused by a few things, the most common being our diet. For a child, this can happen when there is a transition from breastmilk to formula milk.
It can also happen when a baby starts solids for the first time and it takes their tummies just a little while to adjust to their new diet.
Constipation can also happen when the diet is low in fibre or the child has too much processed foods as well as not drinking enough water.
The second reason could be because of lack of activity. Exercise is really important as it helps move the digested food along the intestines.
Children who don’t get enough physical activity are at higher risk of constipation. When kids are just sitting at home watching television and not moving, the gut does not move very well and that leads to constipation.
So, the next reason is something that parents may not think about frequently and that is psycho-social issues.
Children learn to hold their bowel movements when they are stressed, like when they don’t want to go to a public toilet, or there is difficulty in toilet training and even being in a different environment.
These can cause some bowel movement change to happen, and the next thing is, it becomes a learned behaviour.
This happens when children don’t or can’t go even when they feel the need to. For example, when they are too busy with an activity or there is a new school timetable and that changes their daily bowel habit routine.
Loose stools, on the other hand, happen when your stool is watery. This is most commonly caused by an infection in the gut, but it can also be caused by food sensitivities or intolerances and even medication such as antibiotics.
Q2. What is a normal bowel movement?
Dr. Yi Ki: There is a wide range of normal bowel movements and it can really vary between kids and of course, according to their ages.
A newborn who is breastfed can poop after each feed or even just once in five days and that is absolutely normal. Bowel openings become less frequent when formula milk and solids are introduced.
In older children, some may go two to three times a day, while others may go on alternate days. What is more important than the frequency is that the stool continues to be well-formed and passes easily.
So, if you ask me what constitutes signs of constipation, I would say, a rough guide would be:
- having fewer than three bowel movements a week
- passing stools that are hard and sometimes large and bulky. The child may show they need to strain and it can be painful at times as well
- a child may also have a feeling of tummy bloatedness
- smearing on the underwear with liquid stools
On the other hand, diarrhoea means the increased frequency of bowel movements compared to the usual and stools are looser in consistency as well. Also, the child would often have trouble controlling their bowels.
Q3. When should I worry about my child’s bowel movements?
Dr. Yi Ki: It is normal for kids not to poop every single day as long as the consistency of the poop is fine. But we shouldn’t let constipation be a long-standing problem as it can lead to a few complications such as:
- Tearing of the lining of the anus resulting in passing fresh blood
- Faecal impaction is a pile-up of stools in the rectum which can be very difficult and painful to evacuate
If this is not tackled, it becomes a vicious cycle. Imagine with me, when a child doesn’t poo and the stools become harder, then poo-ing becomes more difficult and painful. Then, this will cause the child to refuse to poo because it is painful.
And when this happens the bulk of stools becomes worse causing bowel movements to become even more difficult. So, as you can see, it does not stop and it perpetuates the problem even more.
And if it is left for a long time, the rectum, which is the end part of the large intestines becomes overstretched, and they overstore the large bulk of impacted stools.
In the long run, this causes the child to start to lose the urge to poo, making the whole situation even worse.
So, when this happens seepage of liquid stools from further up the intestines can cause smearing of the underwear without the child knowing.
As you can imagine, this can be extremely embarrassing for the child. Especially when this happens to older children.
Diarrhoea, on the other hand, is often acute and so, the main complication to look out for is dehydration, especially when the child is passing large amounts of watery stools and not having enough fluid intake.
Some of the signs that your child is dehydrated are:
- Passing no or little urine. For younger babies, you will notice no wet diaper in three or more hours.
- A dry mouth and tongue
- Crying but without any tears
- Eyes are slightly more sunken than usual
- The child may be inactive or irritable
- The child is drowsy or unresponsive
We should not wait until we see those signs as these are very late signs. So, it’s important to try to catch it as soon as possible.
Here are some symptoms to look out for in the case of diarrhoea that would help you decide to take your child to a doctor earlier rather than later:
- If your child is younger than 6 months old. They can get dehydrated much quicker.
- If your child is unable to drink enough fluids, especially when your child is also vomiting at the same time.
- If your child is passing four to five large amounts of loose stools in six to eight hours or if they have bloody stools.
- If your child is old enough, he or she may be able to tell you that he has tummy pain and it is a significant tummy pain.
- If the diarrhoea has persisted for more than three days.
- If your child has signs of dehydration.
Q4. How do I encourage healthy bowel habits for my child?
Dr. Yi Ki: Some ways to encourage good healthy bowel habits for your child includes having a good healthy diet, leading an active lifestyle and practising regular toileting.
A healthy diet for good bowel movements is one that has adequate fibre.
Ideally, have your child eat four to five servings of fruit and vegetables a day for smoother bowel habits, although I know it can be challenging for many children. As a guide, one serving is equivalent to your child’s one handful, not an adult’s handful.
It is also important to reduce the consumption of processed foods and ensure that your child has enough liquids throughout the day!
An active lifestyle also helps to keep the bowels moving. Encourage your child to move and play throughout the day.
It can be as simple as walking around the block, riding a bike or just playing in the field or playground.
We can also take this opportunity to exercise along and spend quality time with them as we know, children get motivated easily when we do it along with them.
Besides that, help your child to practice regular toileting. Their body itself has a natural urge to have bowel movements after a meal; we call this the gastrocolic reflex.
So take advantage of this reflex and take five minutes after a meal to just sit on the toilet bowl. This can be done when your child is ready to sit on a toilet bowl, usually around the age of 18 months and above.
You can encourage your child to poo if he or she feels the urge, but you don’t need to pressure; that is not the goal of the exercise. Just sit and distract by having a conversation or even read a book, if you need to.
Then after five minutes, poo or no poo, your child can then get off the toilet seat. Do this daily to instil regular toileting habits.
Sometimes, a reward chart may help to give them a sense of purpose for the whole exercise and motivate him or her to cooperate with you to just sit there.
Q5. Can the right nutrition help with bowel movements?
Dr. Yi Ki: The right nutrition is definitely key to a healthy gut. And it comes in the form of having good amounts of vegetables and fruits.
So, effort needs to be put in to encourage our children to take more of them and more often or not, we have to model it as well.
Consuming probiotics and prebiotics, or synbiotics which have a mixture of both probiotics and prebiotics can also be helpful in maintaining a healthy gut.
Foods such as kimchi, and our very own pegaga are rich in them, but they may not be suitable for young kids.
So, in that sense, probiotic and prebiotic supplements can be good, too. However, we now know from studies that different strains have different functions, so do discuss this with your paediatrician.
As parents, we always want to ensure our children grow healthily. BiO-LiFE A.B. Junior Pre & Pro contains synbiotics to help boost gut health, improve bowel movements and increase nutrient absorption for the growing child.
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It is suitable for all growing children especially those who have:
- poor digestion and appetite
- poor health
- poor bowel movement
Get BiO-LiFE A.B. Junior Pre & Pro here and keep watch for more insights on your kid’s health in our next episode of AskMeDoctor!
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