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148 5.2 Common Nutritional Problems in Preschool Children
Obesity Chronic faecal retention desensitizes the rectum
wall, which exacerbates the problem as large stool
Obesity in children 1–4 years old is becoming volumes are then required to signal the need for a
increasingly prevalent. The prevention, bowel movement.
consequences and treatment are discussed in detail
in Chapter 7.2. Constipation may cause poor eating if a child
feels discomfort when constipated. Fibre and fluid
Constipation intake will then decrease, possibly exacerbating the
constipation.
A simple definition of constipation is ‘the difficult
passage of hard stools’ and it is often a complex Treatment
problem. Usually there is no one underlying cause
that can be identified. Infrequent passing of stools NICE (2010) recommends that treatment should
is not always indicative as normal stool habit in begin with emptying the large bowel and then
children 1–4 years old is considered to be within maintaining regular passage of soft stools with
the range of passing a stool three times per day to laxatives so that the fear of painful defecation
one stool every three days. The average is passing subsides. Parents need to be reassured that laxatives
one stool a day. are both necessary and safe. Stress in the family over
a child’s constipation, and poor compliance with
Factors exacerbating constipation include: treatment can both delay recovery. Families need
frequent support and encouragement; in difficult
●● insufficient intake of dietary fibre and/or cases involvement of the clinical psychology or child
f luid and adolescent mental health team may be essential.
Coercive potty training is to be avoided.
●● cow’s milk protein allergy – probably more
common in children with atopic disorders (e.g. Once the constipation is being treated young
eczema and asthma) children may begin to eat better and dietary changes
can be considered. In time and on an individual
●● emotional disturbances basis, slow weaning from laxative treatment can
begin as most children will eventually grow out of
●● childhood infection constipation.
●● a change in routine Dietary changes to suggest
●● an intentional or subconscious withholding of a Encourage the child to eat more foods with higher
stool after a traumatic event. fibre content, such as:
It may have begun in infancy but may begin in ●● wholegrain breakfast cereals and wholemeal
some children at around 2 years of age when potty bread
training begins.
●● fruit and vegetables
Symptoms include:
●● beans, pulses and lentils (e.g. baked beans)
●● abdominal pain
●● ground and chopped nuts.
●● bleeding from the bottom (anal fissure)
Offer 6–8 drinks per day of about 100–120 mL
●● passage of very large stools that are difficult to each. More may be required in hot weather and
flush away after physical activity.
●● stool-withholding behaviour which can be Unprocessed bran should not be given to young
misinterpreted as ‘straining’ to open bowels children as it can cause bloating and interferes with
the absorption of micronutrients, such as iron,
●● soiling (from ‘overflow’ diarrhoea) – usually a calcium and zinc.
result of chronic faecal retention in children
over 3 years old.
