Constipation

A PDF version of Constipation Pathway Guidance for Parents & Carers (of children over 1 month of age) is available - If you would like to print out the Pathway information please do so from this document.

What is normal?

We are all different, having a poo; anything from 3 times a day to 3 times a week is ‘normal’.

It can be difficult or embarrassing for many children (and adults) to talk about going to the toilet, this chart is often used to help understand what the normal poo looks like! Types 3 and 4 are considered the ‘normal’; types 1 and 2 are typically associated with constipation and types 5 to 7 with diarrhoea.

You may find it useful to use this chart when you talk to your child about going to the toilet, as they may be able to point out what it looks like now, and over a period of time, see how it improves.

Fibre & Fluid

  • 6-8 glasses of water every day
  • Regular meals
  • You could gradually include more fibre at each meal and snack, for example:
  • Fruit and vegetables - try to have a variety and aim to eat 5 “me sized” servings every day
  • High fibre breakfast cereals – at breakfast time or as a snack e.g. porridge, high fibre cereals
  • Wholemeal, granary or high fibre white bread
  • Don’t forget the old favourite baked beans
  • For further ideas and further information visit www.nhs.uk and search “5 a day” and “change 4 life”.

Lifestyle & Routine

Don’t be afraid to talk to your child about going to the toilet - after all we all do it!

Routine – Make time for a toilet routine, the urge to poo occurs naturally after eating - get into the habit of going to the toilet 20-30 minutes after meals, exercise regular.

Don’t rush children who need to sit for a little longer.

Position - Be comfortable and relaxed - use a child  seat if necessary. Feet on floor, stool or a step and hands free. If your child needs some encouragement use a windmill or bubbles and keep these just for the toilet – they occupy the hands, act as a distraction and relax the muscles.

Exercise - Children should aim for a minimum of 60 active minutes every day, for ideas see www.nhs.uk/change4life

Is my child constipated?

  • It can be difficult for children of any age to tell someone they are constipated. The signs to look for are:
  • Less than 3 poos a week
  • Tummy ache/cramps
  • Pain or straining when passing poo
  • Passing dry hard poo
  • Avoiding the toilet
  • Not feeling the need to poo
  • Feeling that the poo is not finished
  • Sore bottom
  • Unpleasant smelling wind
  • Soiling or watery poo

People I can turn to for help

Friends and Family may be able to give advice.

The key professionals trained to help children with constipation are health visitors, school nurses and GP.

They all work together as the core team to look after children with constipation and are experts at helping families.

If a child is seen by an out of hours doctor, a hospital consultant or by the Accident and Emergency department they will always link you and your child back into the core team.

What the team will do

With you they will reach a clear understanding of your child’s needs by:

  • Listening to your concerns
  • Taking a history
  • Carrying out a physical examination

Following this they will agree a plan with you based on National Guidance (NICE)†

The plan will depend on:

  • If there are any underlying medical conditions*
  • If the poo is impacted (large, dry, hard poo which is stuck)
  • Other related issues

† NICE – National Institute of health and Clinical Excellence www.nice.org.uk

* The most common type of constipation is called idiopathic which means it has no underlying cause.

The Plan

For constipation - Life style advice and medication such as lactulose/senna is available from your pharmacy.

Some children may require treatment for impaction*.

The plan must include:

  • Medicines.
  • Diet, drink, and exercise.
  • Toilet routine and behaviour

In cases where impaction is diagnosed paediatric macrogol** will be used but you may also be given other medication such as lactulose/senna.

You will always receive:

  • A copy of the Health Builders Advice leaflet incorporating your child’s plan; and
  • A copy of this constipation pathway

* Impaction is a large, dry, hard poo which is stuck

**Only available on prescription

Support

A member of the core team will be in regular contact. Contact will initially be every 2-3 weeks.

If your child is impacted a member of the team will see them within a week of treatment starting.

After 8 weeks if no progress has been made, advice may be sought from a clinician.

The clinician will provide advice through the core team. Typically a child only needs to see a specialist once.

The core team will keep you up to date and regularly review progress with you.

How will I know my child is better?

They will have a soft comfortable poo

They will be less likely to become constipated again

Remember if your child becomes constipated then do not hesitate to contact your core team