CONSTIPATION IN CHILDREN

By Kleovoulos Chandanos, Paediatrician

We define constipation as a delay or difficulty of a stool movement, capable of causing significant discomfort in the child. Nursing babies can defecate from seven times a day to just once a week. Children from one to two years of age have an average of two bowel movements a day while four-year olds acquire similar habits with an adult, having from three bowel movements a day to just three in a week.

Constipation concerns from five to 10 percent of kids. In the majority of children constipation is functional, not due to any organic damage. In the first six months, constipation is usually due to the immaturity of the muscle system in the kidneys and eventually goes away. After the first six months, a painful bowel movement due to hard stool can cause constipation. This mainly happens in the transient stages of diet going from maternal milk to the milk for the first infantile stage or immediately after starting on solids.

In older children, the willful withholding of a bowel movement is the main cause of constipation.

A painful movement or the fear of toilets leads to constipation, which temporarily presents two sides: the period of toilet training and the beginning of the school age. The withholding of a movement leads to enlargement of the intestine, abdominal ache, irritability, anorexia, as well as diarrhoea stemming from an overstuffed intestine.

Confronting constipation depends on the child's age, as well as on the gravity and longevity of the symptoms. Initially, the intestine is cleaned out completely using a laxative or enema. Then, a treatment follows for several months to keep the stool soft by adopting a diet rich in fibres (legumes, fruits and vegetables) or by temporarily increasing liquid intake and attempting a bowel movement at fixed times throughout the day. The objective is to achieve a soft bowel movement every one or two days. The length of the treatment varies between two until six months.

In babies younger than a year we never use bowel stimulant drugs apart from glycerin suppositories or micro-enemas. Increasing the liquid intake (water or fruit juice) after the first two months in an infant, or fibers after the first five or six months in babies who eat solids, are usually enough to combat constipation.

The psychological encouragement of the child plays an important role in confronting constipation.

Bruxism – Part Two

By Nikos Papadakis, Dental Surgeon

Complications

Certain people can suffer with bruxism without any long-term consequences. But when complications exist, they can be varied. The damage in the teeth shows with small fractures, chipped teeth, bigger fractures or loose teeth. The grinding of teeth, which comes about gradually if it is left to develop for years, can have dramatic results in the appearance, as well as in the operational function of the jawbone system. With grinding, the teeth initially lose their sculptured chewing definition and afterwards a big part of their height. With the flattening that befalls them, the protective layer of adamantine is progressively lost, leaving the sensitive dentin exposed. This renders the teeth sensitive to cold, pressure and other stimuli. Fillings and other additive work also suffer with these excessive pressures resulting in teeth being broken or misaligned.

Inflammation develops in the gums; the teeth get loose and eventually fall out. The inside of the cheeks can be traumatized in many cases and the temples can feel pressured with the pain being reflected in the ear. Often the jawbone shifts from its correct place, and this causes various sounds while eating or talking, or makes it difficult to open the mouth.

Certain patients after some years show inflated jawbones, resulting from the body's effort to strengthen the bone mass, in order to cope with the big pressures suffered for an extended time period. Some complain that they dream about losing their teeth or suffer from insomnia and depression.

Bruxism during childhood

The children can suffer from bruxism as a result of problems they face in school. Problems of adapting, relationships, school progress and exams are subjects that can occupy them during sleep and cause stress. Teething pain or uneven teeth can also be causes of bruxism.  

Also, other health problems like colds, allergies or otitis can cause grinding.

In children, teeth grinding can be accompanied by sucking of the thumb or nail biting. With children who grind their teeth between the ages of three to 10 years of age, more than half will stop by the time they are 13, and without any apparent damage to their teeth. For some children, though, the problem will continue.

Often, parents ignore childhood teeth grinding believing that it's a normal or relatively innocent situation.

Continued next month