Laxatives Laxatives are medicines that speed up the movement of faeces through the bowel. There are several types that work in different ways. Some are not suitable for children; your doctor should decide on which, if any, is suitable for your child. Never give your child a laxative unless it has been prescribed or suggested by your doctor.

Does your child have either of the following?

• Pain when defecating

Has your child just started toilet training, or is he or she only recently trained?

Is your child taking any medicines?

Has your child's diet or day-to-day routine changed recently?

Consult your doctor if you are unable to make a diagnosis from this chart.

Possible cause and action Your child may be stool-holding (resisting the urge to defecate). This may be a sign of anxiety about toilet training. If your child is aged less than 18 months, it may be preferable to postpone training until he or she is at least 2 years old. If your child has not passed faeces for 4 days, you should see your doctor within 24 hours.

Possible cause and action Constipation can be a side effect of some drugs, including over-the-counter cough remedies. Stop giving your child over-the-counter drugs, but do not stop giving him or her any prescribed drugs. If the problem persists, consult your doctor.

Possible cause and action A change in diet can cause minor irregularities in bowel habits. Constipation can be a problem when a child starts school if he or she is reluctant to use the toilets there or ask permission to go to the toilet. No treatment is necessary if your child is generally well. Make sure he or she eats a healthy diet (see Avoiding constipation in children, right). Bowel habits should return to normal within a few weeks.

Possible cause and action An anal fissure (a tear or split inside the anus) is a possible cause. A tear makes defecation painful, which may lead to your child being afraid to open his or her bowels for fear of further pain. Consult your doctor, who will probably prescribe stool-softeners for your child. These will reduce the pain associated with opening the bowels. You should also take steps to prevent constipation from recurring (see Avoiding constipation in children, below).

self-help Avoiding constipation in children

Constipation in children aged over 6 months is often a result of a lack of sufficient fluids or fibre in the diet. Make sure your child drinks plenty of fluids throughout the day. Gradually increase the amount of fibre-rich foods in your child's diet; these include fruits, vegetables, wholegrain cereals, beans and pulses, and wholegrain bread. Try to give your child one or more of these foods at every meal. Encourage your child to go to the toilet after meals and allow plenty of time so that he or she does not feel rushed.

Healthy snacks

A piece of fruit, such as a banana or an unpeeled apple, makes an enjoyable, fibre-rich snack for a cl)ild of any age.

l42 Abnormal-looking faeces

For hard or pellet-like faeces, see chart 41, Constipation (p.124). For runny faeces in a child under 1 year, see chart 5, Diarrhoea in babies (p.58); for a child over 1 year, see chart 40, Diarrhoea in children (p.122). It is normal for faeces to vary slightly in their colour, smell, or consistency. Consult this chart only if there is a marked change in the appearance of your child's faeces. Sudden differences are almost always caused by something your child has eaten, and the change should only last a few days. However, there may be an underlying disorder causing the problem. If the faeces still look abnormal in 48 hours or if they are accompanied by other symptoms such as abdominal pain, you should consult your doctor, taking a sample of the faeces in a clean container for him or her to examine.

Has your child passed red, jelly-like matter, and is he or she unwell?

Is your child under 1 year old, and are his or her faeces green?

yes no

Are your child's faeces very pale?

Possible causes and action Green faeces are normal in breast-fed babies and are not a cause for concern (see Babies' faeces, p.59). However, in bottle-fed babies, green faeces may indicate gastroenteritis, especially if they are watery. Call your doctor.

Is the blood in small streaks on the faeces?

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