Dr. Vivek M. Rege
Pediatric Surgeon & Pediatric Urologist
B J Wadia Hospital For Children, Hurkisondas Hospital,
Wockhardt Hospital, Mumbai

In recent times, with the advent of small nuclear family, working parents and availability of fast foods in cities, this has become a very common complaint. I must be seeing at least 4 new children with constipation each month. Theoretically there are multiple causes for constipation but almost all boil down to one common cause -  improper diet of the child. The reasons for a wrong diet in a child are - excess intake of milk daily, feeding of soups and fruit juices; eating junk foods and filling the tummy with wafers, chips, biscuits etc. The wrong type of food at the wrong time in the wrong quantity leaves little for the right food in the right quantity. Inadequate fibre and low residue leads to constipation, this in turn leads to loss of appetite, hence decreased intake and further constipation. Additionally, with constipation comes passage of hard stools with painful defecation and hence the child tries to avoid passing stool and looses appetite and a vicious circle ensues. Another reason in such cases is a child of 2 years is still being fed milk through a bottle with a nipple!! This child is given 4 - 5 feeds of milk to a total of almost 1 - 11/2 litres milk daily leaving no space for eating other food. There are many things wrong in this approach ? total dependance on milk as the source for proteins, carbohydrates and fats is far below adequate in a growing 2 year old. Feeds given by bottle are bad for the child ? since the child is able to swallow the milk fast, and along with it the air is swallowed and the stomach gets filled and remains for a long period. This leaves no incentive for the child to take the effort of taking solids, putting them in the mouth manually, then chewing each many times and then swallowing it and the child likes the easy and fast way of taking meals ? bottle milk. Also, the child is used to only one type of taste, and does not like vegetables ? each having a different taste. The child goes for the axiom ? maximum satiety with minimum effort in the shortest time.The therapy for these children is of course to correct the diet under supervision of the doctor.

This does not mean other causes should not be looked for. There may be anatomical causes like a small size anal opening in the child, which makes it difficult for the child to pass stools and the child strains, and the pain is awful and hence passes little at a time to avoid prolonged pain. In some children, the anal opening is situated slightly ahead and is narrowed or stenosed giving rise to physical cause of constipation that needs correction. These conditions require a surgical intervention to make the opening in the correct position and also adequately large size for the stool to be passed easily.