In the previous section we described the most common causes of functional constipation (a condition separated from any structural or metabolic abnormality). The problem, therefore, will have to be faced trying to remedy the causal factors just listed.
In the first weeks of life, if the evacuations are sparse but the stools maintain their soft, creamy and water-rich consistency, generally no treatment is required, even when the child is suffering in an attempt to evacuate. We have indeed seen how this suffering actually belongs to a normal growth process, during which the baby learns only a little at a time to contract only the muscles necessary to evacuate; so let's give him time to practice, without unnecessary or even harmful injuries or unnecessary care.
If the true constipation (hard feces, painful and infrequent evacuations) appears in a child fed with artificial milk, the problem can be solved by increasing the intake of fluids, for example by diluting the powder preparations in greater quantities of water. In cases of more obstinate constipation it may be useful - after obtaining the positive opinion of the pediatrician - to put a little apple, pear, white grape or plum juice in addition to bottle water.
An underlying allergy to cow's milk proteins can be evidenced by symptoms such as digestive problems, vomiting, hives, rectal inflammation and difficulty breathing (dyspnea); if the suspicion is founded, an exclusion diet lasting 2-4 weeks can be considered (eliminate the cow's milk for this period of time and see what happens, then reintroduce it to confirm whether or not the constipation and other disorders actually depend on this allergy).
The cornerstone of constipation therapy in older children is to make evacuation no longer painful, but comfortable. For preventive purposes, it is important to make the stools softer through the generous administration of fecal liquids and "softeners"; among these the healthiest and most natural is given by the dietary fiber contained in plant foods, often not appreciated by the little one. The problem can be tricked by trying to identify the foods that your child likes, even in relation to the form in which they occur. Fruit, for example, can be served with a spoonful of ice cream or whipped cream, or simply "embellished" with a little imagination (cut it into wedges to compose a flower, a sun, a smiling face). The vegetables, on the other hand, can be minced and "hidden" in the sauce or in the filling of meatballs or tortelli. In this context, the good example given by the parents is also very important; if mom and dad show that they like vegetables, it's even easier for the baby to love them. Be careful, however, to avoid conflicting situations and too rigid impositions at mealtimes, given that the child's constipation already involves an important psychological stress for the whole family. In addition to softening the feces, it is obviously necessary to treat any anal pathologies that make the evacuation painful; in this regard, remedies against constipation are useful, making stools softer and thicker; just as important is the accurate intimate hygiene and - in the most serious cases - a topical therapy based on antibacterial, analgesic and epithelizing salves.
In addition to feeding, it is very important to educate the child in the correct position during the use of the toilets. The use of the potty, for example, is much more appropriate from the postural point of view than the WC, which forces the child to an unnatural posture with his hands on the donut to avoid falling, the knees joined and the feet dangling. If you do not have a Turkish bath and the child prefers to use the WC because doing so feels "big", it is advisable to use the combined reducers and a stool to be placed at the foot of the WC, which allows the child to keep the knees apart and the soles of the feet firmly resting on this rise (for a correct positioning it is in fact necessary that the child can rest his feet on the ground or on the stool).
Another simple measure to normalize defecation in constipated children is the so-called "toilet training", which consists in inviting him to evacuate to the bathroom at home at set times of the day (late afternoon, after dinner), without hurried him too much. In this environment, in fact, he can enjoy the maximum degree of comfort, privacy and hygiene.
Only when all these precautions do not work, to resolve the child's constipation, the pediatrician can prescribe appropriate aids, such as probiotic milk enzymes, fiber preparations or faecal softeners. The latter include osmotic laxatives, such as lactitol and lactulose, and polyethylene glycol. Prolonged use of stimulant laxatives (senna, aloe juice and bisacodyl) is not recommended to resolve constipation in children; moreover, since the use of any laxative method tends to be addictive, it is important to agree with the doctor about the frequency of applications in the constipated child.
