Control Issues in Children
By Audrey Cochran, CCCN, GCNS, BC
Anyone who has been around babies knows what tyrants they can be at times. If hungry or wearing wet or soiled diapers, they cry until someone rescues them. They need to feel they’ll be taken care of, and the world is a safe place. But when one of mine was around five years old he became constipated, and pushing out that hard fecal matter was painful He must have decided, “I’m not going to let that happen again!” That meant he got even more constipated. Our pediatrician prescribed a children's mild laxative and that took care of the problem. It was not a Freudian thing of who is in control.
I’m a firm believer of looking in the toilet. What you see is a window on how your insides are working. We can teach this to our children. Everyone knows what diarrhea or loose stool looks like, and that it can be a sign of illness. The ideal appearance is like a smooth banana, or Type 4 on the Bristol Stool Form Scale. The women in my continence rehabilitation program in a GYN office are somewhat startled when I show the Stool Scale to them, until I explain its significance. If what the toilet contains looks like little marbles (Type 1), a bunch of grapes (Type 2) or a cracked banana (Type 3), I suggest that they take a magnesium tablet with their evening meal for a week. At their next visit we discuss the results. If there remains a problem, they can take up to two tablets. I do that myself when I'm traveling because my bottom misses its familiar toilet and my gut refuses to cooperate. I recommend using plain magnesium not Milk of Magnesia. Magnesium works without the cramping or accidents of the latter and the side effect is a looser stool. When this happens, I recommend decreasing the dose of magnesium.
Children generally need smaller doses. This can be combined with a child's multivitamin/mineral combination, which you should discuss with your pediatrician. The NIH Office of Dietary Supplements (http://ods.od.nih.gov/factsheets/magnesium) suggests 110 mg. as the upper supplementary intake level for children ages 4 to 8. An alternative for children with constipation is to make cookies with lots of chopped or pureed prunes (also called dried plums) or apricots or figs. Some children develop a taste for dried fruit as a snack and it is certainly better for them than candy. If given the opportunity to eat five servings of fruit and/or vegetables a day, maybe they won’t get constipated in the first place. For an older child you could buy sugarless gum containing sorbitol, the substance in prunes, which is a mild laxative.
What if your child has been constipated for a long time and develops diarrhea but has a distended hard belly? That is most likely encopresis, where the hard stool blocks the gut which is still trying to force out the contents, but all it can push out is the still liquid stool from higher up in the gut. I once worked with a family whose developmentally delayed 13 year old had this problem. I taught the mother how to have her son lie down on the sofa, and feel the hardness in the left side of his abdomen, at which point she needed to get him to take the laxative her doctor had prescribed but which her son didn’t like to take. A blocked gut can actually be fatal, a blockage can cause the gut to become distended and rupture
Another control issue occurs when little girls hold their urine too long, or don’t completely empty their bladder and end up with one bladder infection after another. This isn’t a question of just getting them to drink more fluids though that should be tried also. Observe how they use the toilet. Do they sit perched on the edge with their panties just pushed down to their knees, and their legs held tightly together, just letting out a little urine instead of completely emptying their bladder? Apparently that feels good – but leads to a bladder which doesn’t work well. To get them out of that habit, insist they push their panties down to their ankles, and have them blow soap bubbles or blow a pinwheel. That helps to relax their pelvic floor. Some parents find if they have their girls sit facing the back of the toilet, that assures better emptying.
Have you ever wondered how parents manage in other countries, which don’t have all our high tech musical potty chairs and access to highly educated pediatricians? Watch the news on TV and you might see very young children wearing just t-shirts. You certainly won’t see diapers. They acquire toileting skills at a far younger age than our children do. Do you suppose it’s because they don’t like the feeling of urine running down their legs, and learn to squat over the toilet hole their parents use? (Many parts of the world use a toilet hole, with tiled or pottery edges, instead of the shiny porcelain “thrones” fancied by Western countries.)
One summer I had three boys, ages 3½, 2, and 6 months in diapers. Our family doctor, in response to my complaints said, “Oh, they’ll train themselves when they are ready.” But I was getting tired of all that laundry. So while hanging up the washing on the clothesline in our back yard I let our eldest play with just a t-shirt on. When he started to urinate I said, “Don’t do that on the cement. Do it in the dirt.” He thought that was fun and when he was really good at that I said, “Now see if you can hold it while you run inside to the bathroom and do it in the toilet like Daddy does.” After a couple of weeks he rarely had accidents, and the 2 year old was clamoring to play the same game. I wondered why I had waited so long.
About the Author
Audrey Cochran, CCCN, GCNS, BC, wrote her master's thesis on "How Older People Manage Loss of Bladder Control," which presented a challenge because no one wanted to talk about this problem. Since then she has worked in and OB/GYN office for 17 years using biofeedback to teach women how to contract their pelvic floor muscles, without getting their abdominal muscles into the act, and how to manage contributing problems like constipation and medications. Cochran contracted with Kern Regional Center to teach their clients, including children with autism and Down syndrome how to toilet appropriately.
