SingaporeMotherhood | Baby & Toddler

April 2022

Over 1 in 2 Singaporean Toddlers have Constipation — Does Yours?

Earlier this year, the Friso #ReallyKnowPoop Constipation Survey polled 1,000 Singaporean parents to better understand the constipation woes of their toddlers aged 12 to 26 months. 18 per cent say their toddlers experience constipation every few days, and 34 per cent every few weeks. These numbers reflect how common constipation is among toddlers here.

Another finding from the survey was that 40 per cent of parents scour the internet for tips on how to deal with constipation. To help you out, we ask Dr Christina Ong, Senior Consultant Paediatrician & Paediatric Gastroenterologist at the SOG Christina Ong Clinic for Children and Gastroenterology, to shed some light on the sticky issue.

(See also: Does your Child have Good Poop?)

How can I tell if my toddler is constipated?

Toddler constipation is a common issue in Singapore, but catching the signs early can help. Classic signs or symptoms that suggest that a toddler may have constipation include:

  • Not passing stools for a few days
  • Avoiding the bathroom to escape discomfort
  • Passing hard, dry stools
  • Cries or screams during bowel movements
  • Feeling bloated and/or has tummy pain
  • Trying to hold stool in, such as clenching teeth, crossing legs, squeezing buttocks together, turning red in the face

It is important to watch out for these signs as constipation can turn into a vicious cycle if left untreated. Early and holistic treatment can prevent chronic issues.

Bristol Stool Chart indicates constipation
Cabot Health, Bristol Stool Chart, CC BY-SA 3.0, via Wikimedia Commons

The Bristol Stool Chart is an assessment tool that can help characterise a toddler’s stool based on its consistency and stool type. Generally, Type 1 and 2 stools on the Bristol Stool Chart indicate constipation.

Observing toilet habits and poop colour is a great way to spot signs of constipation and health issues early. Good colours (green, brown, yellow) indicate a healthy gut, whereas bad colours (black, red, white) might signal gut issues.

Melissa Wong, head of marketing at FrieslandCampina Singapore

What are common causes of constipation in toddlers?

In the survey, parents largely attributed toddler constipation to factors such as ‘not eating enough fibre’ (54%) or ‘not drinking enough water’ (53%). Aside from dietary factors, the survey also found that different milestones experienced in growing up may be associated with an increased risk of constipation. These include weaning, toilet training, and transitions to kindergarten/school, among others.

(See also: Primary 1: How is it Different from Preschool?)

Painful experience with passing stools

One painful experience with passing stools may be all it takes, explains Dr Ong. Now associating passing motion with pain, the child starts withholding stools in order to avoid it. Over a period of time, constipation develops. Left unchecked, it may lead to a vicious circle of painful defaecation, stool withholding, and worsening of constipation.

Occasionally, anal tears may occur from the passage of large calibre or hard stools. Also known as anal fissures, this may lead to further reluctance of passing stools and escalation of stool withholding behaviour.

New or unfamiliar environment

A child who is starting a new kindergarten or school may avoid passing stools as they are unfamiliar with the surroundings. They may have anxiety using the bathroom, or simply asking to go. Occasionally, they may be busy with their activities and delay opening the bowels, hence leading to constipation.

Fruit and vegetable meal for toddler

Dietary factors

Diets high in processed food and insufficient fluid intake are commonly associated with constipation. Children should be encouraged to have a balanced diet that includes fruits, vegetables, and fibre.

(See also: A Mum’s Guide to Successful Baby-Led Weaning (BLW))

What are some more serious conditions that might cause constipation in toddlers?

According to Dr Ong, constipation is a common digestive problem among children not just in Singapore but also in other countries. The prevalence of childhood constipation is estimated at up to 3 to 10 per cent worldwide. Yet medical conditions account for less than 5 per cent of constipation in children.

Some of the known medical problems include anatomical irregularities in the anus or rectum. Problems with absorption or medications may also lead to constipation.

In persistent cases of constipation, parents should consult their doctor, Dr Ong advises. After careful history taking and physical examination to exclude underlying medical causes, the doctor may prescribe stool softeners or order further tests as indicated.

(See also: Ins and Outs of Gastroenteritis in Babies and Children)

How can I help prevent constipation in my toddler?

Melissa Wong, head of marketing at FrieslandCampina Singapore, shares more findings: “In the survey, we found that 53% of parents would ‘wait and see’ before seeking medical attention. Most prefer using home remedies such as dietary changes (71%) and medicated oil (51%).”

Friso #ReallyKnowPoop Constipation Survey infographic

“However,” she adds, “a holistic and early intervention approach is key to managing constipation in toddlers. Having good nutrition and regular exercise should also be a part of a toddler’s daily lifestyle and should not be a solution only when constipation occurs.”

Dr Ong offers these suggestions:

Include more high-fibre foods and avoid ‘nasties’

High-fibre foods such as fruits, vegetables, beans, and whole-grain bread will help form soft stools and stimulate bowel movements. Tiny tummies can easily recognise natural, whole foods. Whereas processed foods often contain preservatives and unwanted additives. These complicate digestion and disrupt healthy bacteria in the digestive system.

(See also: Help your Toddler Eat Well and Grow Better with these TCM Tips)

Drink plenty of fluids

Drinking enough water and other fluids promotes good digestion and regular bowel movements by keeping stools soft. Soft stools move more easily through and out of the digestive tract.

Stay active through regular exercise

Keeping healthy with exercise speeds up the time it takes food to move through the large intestine. Exercise promotes digestion, and helps the intestine to push the digested food forward, aiding in bowel movement. As parents or caregivers, you can set a good example by exercising together with your little ones.

Toddler hugging teddy bear

Are there any tips I can use to help my toddler ‘go’?

Dr Ong recommends providing your child with plenty of fluids. Drinking sufficient water can help soften stools and reduce the discomfort associated with constipation.

To encourage toilet training in a child, have them sit on the toilet for approximately 5 to 10 minutes once or twice per day after meals. They are more likely to have a bowel movement after eating. Do praise your child for making the effort of sitting on the toilet even if there is no bowel movement.

(See also: Potty Training: Go Slow and Steady)

On the other hand, if your child develops constipation or phobia during toilet training, they are probably not ready for it. Consider pausing the training for two to three months before resuming. Remember that toilet training should be done in a reassuring manner, with plenty of praise and positive reinforcement.

Sleep and gut health are also interconnected. A good sleeping schedule improves the performance of the gut microbiome that facilitates metabolic and digestive processes. Conversely, 95% of our bodies’ serotonin — an important hormone that regulates sleep — is found in the gut.

Camilleri, M., 2009. Serotonin in the gastrointestinal tract. Current Opinion in Endocrinology, Diabetes and Obesity, 16(1), pp.53-59.

Ms Wong hopes that by helping parents to better understand the signs and science of constipation, that they would be able to successfully identify and manage toddler constipation with confidence.

That’s why, on World Sleep Day 2022, Friso collaborated with homegrown kidswear label, Maison Q, to launch the Friso x Maison Q Limited Edition Reversible Bedding. The hope? To inspire more bedtime conversations about the importance of gut health. Get it free with a minimum of $250 spent on participating Friso Gold products till 30 April 2022, while stocks last. Five lucky families also stand to win a 3D2N Friso Family Poopcation at Shangri-la Singapore. More details in the IG post below or click here to find out more.

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Over 1 in 2 Singaporean Toddlers have Constipation — Does Yours?