“Let food be thy medicine and medicine be thy food.” — Hippocrates
Aside from fever and colds, the other common ailments in children involve problems in the gut like the bowel movement.
The normal interval between bowel movement as well as the appearance of the stool in an infant or child may vary depending on the age and what they eat or drink. The formed bowel movement can be as frequent as three times a day or three times a week or every other day in infants and children.
During the first two to three weeks of life, infants usually pass soft or liquid bowel movement after every feeding, especially those who are exclusively breastfed but less frequent among formula-fed infants.
Whereas during the next three months of life, some breastfed infants may still have bowel movement after each feeding although others may have only one bowel movement per week or even once every 10 days but are rarely constipated.
Most formula-fed infants have two to three bowel movements per day depending on the type of formula given. Those who are given soy-based and cow’s milk-based formulas may have harder stools while those given partially or completely hydrolysed or hypoallergenic formulas may have loose stools.
The World Health Organization (WHO) has defined diarrhea as having loose or watery stools at least three times per day or more frequently than normal for an individual. However, other definition of diarrhea refers not just to an increase in the frequency, but also a change in the quantity (a few squirts or a cupful), color (yellow, gray, green, brown, black, bloody), and consistency (watery, runny, loose, mushy, mucoid).
The leading cause of acute diarrhea among children less than five years old worldwide is rotavirus which is responsible for about 40 percent of all hospital admissions. Its most dreaded complication is dehydration. Other causes of infectious diarrhea that can produce bloody stools are parasites like Entamoeba histolytica and Giardia lamblia and bacteria like Shigella and Enterotoxigenic Escherichia coli which may require treatment with an antiameobic or antibiotic agents.
However, you should not give any medication like antispasmodic or antiemetic in children to stop the passage of loose stools. Instead, you must allow the body to get rid of the bad virus, parasite or bacteria. Make sure that you give enough fluids to prevent dehydration. Give the appropriate oral rehydration solution and do not give power drinks that may have a low salt content and high sugar that would further cause upset in the gut. Your child must have an adequate urine output by checking if the diaper is wet with urine at least every six or eight hours or your toddler is able to urinate at least three to four times a day or more.
Treatment of childhood diarrhea would include the following:
Oral rehydration therapyZincContinue feeding (including breastfeeding) and give banana for older infantsFor formula-fed infants, dilute the feed to half the concentrationReduce the intake of spicy, oily, citrus, protein-rich, fibre-rich foods like cereals, coffee/tea
Constipation is another common gut problem in children of all ages. It is defined as having bowel movement less frequently than normal or with hard, large, difficult, and painful bowel movements.
In majority of children who are constipated, no underlying medical condition can be identified. Changes in diet, behaviour, use of home remedies and sometimes medicines can help resolve constipation.
The bowel movements of a child who is constipated appear hard or pellet-like that she cries and looks as if she is straining and causes her face to become red. Unusual habits in children with this problem can also be observed. Some babies may arch their back, tighten their buttocks and cry. Older kids may rock back and forth, cross their legs, stand on their tiptoes, wriggle, fidget, squat or assume other unusual positions aside from arching their back and tightening their buttocks and legs. Some children may even hide in a corner or go to a secret place while doing these movements which some call a “special dance.”
Constipation develops due to pain brought about by a tear in the anus with the passage of a large or hard bowel movement. Sometimes, a child may choose to delay the passage of stool in unfamiliar surroundings because she is not comfortable in the new environment, or she is busy playing and does not want to be disturbed.
Teach your child to listen to her body and that it is better to have a bowel movement when her body tells her it is time to do so rather than withhold it because it will only make the stool harder and more painful to move later.
There are three time frames when a child is likely to develop constipation. First instance occurs when your child is weaned from the milk and starts to eat solid food. The second instance happens when you begin toilet training your child. While the third one can occur once your child starts to enter school. You must try home remedies first to treat your child’s constipation.
HOME REMEDIES FOR CONSTIPATION
If the home remedies do not work or your child does not have a bowel movement within 24 hours, or if you are worried, consult your child’s doctor or nurse for medical advice.
The dietary recommendation for infants older than 6 months and toddlers are the following:
1. One hundred percent fruit juice like prune or pear juice:
Two to four ounces (60 to 120 ml) from six to eight months
Two to six ounces (60 to 180 ml) from infants ages 8 to 12 months and older children from 1 to 6 years old
2. Dark corn syrup
Add ¼ teaspoon to 1 teaspoon (1.25 to 5 ml) to four ounces (120 ml) of formula or expressed breast milk.
Start at low dose and increase the amount up to 5 ml until your baby has a daily bowel movement.
Taper the dose when the stool becomes soft and more frequent.
Resume when the stool begins to get too hard.
3. Substitute barley cereal for rice cereal
4. High-fiber fruits and vegetables or purees
ApricotBeansBroccoliPeasPearsPeachesPrunesPlumsSpinachSweet potatoes or camote
5. Enough fluids of at least 32 ounces or 960 ml per day for children older than one year (water and other non-milk fluids).
Illustration by Liz Jocano