Stress and infant bowel health

Many of us will have noticed how stress can give a sense of unease and discomfort in the stomach. Infants and young children can experience the same thing but may not be able to articulate what they are feeling and explain to their parents, carers or teachers what the problem is.

Stress can play havoc with bowel health

Bowel health is delicate and times of stress can cause bowel discomfort because stress and anxiety upset the balance of digestion. In both adults and little ones, stress can slow down digestion causing bloating, pain and constipation. In others, it can speed up digestion causing diarrhoea and frequent trips to the loo. Infants and young children, like adults, can lose their appetite completely if they experience too much stress.

Constipation is stressful

If an infant or young child develops constipation both the little one and parents are subject to even more stress and discomfort. Constipation is miserable for little ones and anyone who cares for them. It is very common it, affecting up to 30% of children[1]. In the first year of childhood, up to 4 in 10 children are likely to develop constipation at least once. That means in the UK, an estimated 270,000 cases of constipation occur in infants (under 12 months of age) each year.

Parents find it hard

According to research by Typharm[2], makers of Docusol Paediatric, a well-known product used for many years for constipation, mums find it hard to know how to recognise and manage symptoms of constipation in their young children. This is likely to be even more difficult when stress is key contributor and the main bowel symptom in the early stages may be general discomfort in the stomach.

In fact the Typharm research showed that mums often feel unsure what to do for their baby who is clearly not themselves and/or suffering from a variety of symptoms including discomfort, pain, irritability, sweating and poor appetite. Mums may feel guilty thinking they could have done something to prevent it, and then powerless thinking there is “not much I can do.” Again, these feelings may be increased if the little one is stressed, parents are stressed and the whole household is stressed.

It is vital to recognise these symptoms and treat them immediately. Bowel health and bowel movements are a sensitive subject but mums who identify symptoms of discomfort and pain in their young child should think “bowel health” and possibly constipation.

The Bristol Stool Scale

The Bristol Stool Scale is incredibly useful for detecting constipation. ERIC, the children’s bowel and bladder charity, provides details of the Bristol Stool Scale with a “poo diary” to monitor a child’s bowel movements. See: https://www.eric.org.uk/pdf-poo-diary Based on science and developed from findings a study involving 2000 participants[3], this scale is an indicator of how and why different types of poops look or feel a certain way. The Scale consists of seven categories and it makes poop knowledge basic and easy to understand. If the poop is smooth and soft and shaped like a sausage and the infant or young child is passing it easily at least 4 times a week, he or she is unlikely to be constipated. But if the poop is sausage shaped and looks like corn on the cob or a bunch of grapes or the child is passing hard lumps like rabbit droppings and the poop is difficult to pass, he or she is likely to be constipated.

Other symptoms help recognition

Other signs of constipation in young children include a fear of going to the loo and passing poo because it has become too painful. The poop is hard and dry and difficult to pass. The child may cry and strain. They may also poo in their pants. Large, hard, dry poop can get stuck in the bowel, small bits of poop break off and leak round the hard large mass. If a young child is stressed, it is also important to look out for stomach distension and bloating, a painful bottom, unhappy, angry or irritable mood, poor appetite and lack of energy. Sometimes it may be hard to tell stress and poor bowel health apart, but the frequency and look of the poop is a very important part. Always refer to the Bristol Stool Scale and monitor the appearance and frequency of the child’s poo.

The importance of treating immediately

Constipation can worsen rapidly if not treated immediately. The child will suffer more pain and discomfort. Worse still, if constipation is not recognised and treated quickly it can become chronic with the risk that the child has to be admitted to hospital. In fact, more than one third of children with constipation go on to develop chronic constipation. Approximately 35 under 18s are admitted to hospital every day due to constipation.

What to do: how to treat

• Consult a pharmacist. Write down all the child’s symptoms first so you can describe them accurately. The pharmacist will be able to advise if something more serious is a possibility and will refer you to your GP.

• OTC remedies are available but not all are available for over the counter sale in young children. Following a review by the MHRA, stimulant laxatives such as senna and bisacodyl are not available OTC without the advice of a doctor for children under the age of 12 years

• Docusol Paediatric liquid is very safe for infants and children and is available OTC for little ones from the age of 6 months. It contains docusate which is a well-established stool softener. In other words, it moistens the stool (poop). It has a gentle action working by increasing the amount of water the stool absorbs in the gut, making the stool softer and easier to pass. It is also convenient and easy for the child to take

Tips on managing stress and bowel health in little ones

• Try to keep mealtimes happy and relaxed (as challenging as this can be).

• Make plenty of time for infants and young children to enjoy their food in a relaxed manner.

• As an adult, try to manage your own stress levels and try to remain relaxed around your young children as much as much as you possibly can. In the context of a busy life this can be incredibly hard, if not impossible. So, try to make some time for yourself, get as much exercise as you can and talk to your friends and family. Find activities you enjoy and people you want to be with who can help you to de-stress. This will pay dividends for your children’s stress

• Avoid arguing with each other at the dinner table. This creates stress for both children and adults

• Get your child into a good toilet routine. It’s time consuming for a busy mum but pays dividends for your child’s bowel health and your mind.

• Encourage your child to get comfortable on the toilet. If a child’s feet cannot touch the floor when they are sitting down, use a small stool or step to raise their knees above hip level. Sitting in this position makes it easier to poo.

• Don’t worry about accidents. Whilst a child is learning to listen to their bowels accidents can happen. Don’t make a big thing of it. It can increase your child’s stress levels even more.

• Stay calm and reassuring. This is important so that a child does not see pooing as stressful but as a normal part of life. Check whether the child feels worried about using the toilet. Some children are frightened to use the toilet in the pre-school nursery for example. If a child is stressed by going to the toilet, a health visitor can often help.

• Aim to get your child eating a balance diet with plenty of fruit and vegetables but avoid unprocessed bran as that can cause bowel blockage

• Encourage your child to drink plenty of fluid. NICE produces guidelines for fluid intake in children and youngsters. See https://www.nice.org.uk/guidance/cg99/chapter/1-guidance

In summary

Stress is a common cause of constipation in infants and children. It is important to look out for signs and symptoms of pain, distension, bloating, anxiety, irritability, difficulty in sleeping and poor appetite. The appearance and frequency of the poop can be monitored using the Bristol Stool Scale.

Constipation in infants and young children should be recognised and managed swiftly otherwise it can become chronic. The pharmacist should be consulted immediately with a full description of the child’s symptoms.

Docusol Paediatric is an effective solution for infant and child constipation. It:

• Is available without prescription

• Is licensed for children from 6 months

• Is not included in the latest laxative MHRA guidance

• Is efficacious and gentle

• Is fast acting with few side effects

• Is sugar free and strawberry flavoured

• Can be mixed with drinks, not changing their consistency (e.g. water, juice, milk etc)

• Is easy to take