Bowel Health: Babies and Children

All parents know there is nothing quite like the first nappy change. Dr Joe Kosterich talks about what kind of bowel movements to expect from babies, differences in breastfed and formula-fed baby bowel movements, bowel movements and tummy pains in children, and when to take your child to the doctor.

All the parents out there will know there’s nothing quite like the first nappy change. Hi, I’m Doctor Joe. Bowels and kids is something that does exercise the mind of just about every parent. What’s normal, what to expect, when is there a problem, and when should I be doing something about it, are questions we all have.

Pretty much from day one, as soon as the baby is eating, not surprisingly, something should be coming out the other end. Most of the time, this will be a number of times a day and nappy changes may be as often as three or four or five times a day for a bowel motion – through to once every couple of days. After a period of a few weeks, usually most children will start to settle into some sort of regular pattern and much like an adult, babies also get into a pattern with their bowels.

What goes out will be a function of what goes in, so children, who are on breast milk as against a bottle, may have a slightly different bowel pattern and often parents do find if they change formulas, that again, there can be a change in bowel pattern.

There is no absolute right or wrong with babies and bowel motions. As I say, usually it’ll start to get into a pattern of once or twice a day for most. Some babies may go a number of days without a bowel motion coming through. Generally this is not a big problem in the earlier stages of life, but again, sometimes worth looking at changing formulas if you have them on one. If a baby’s on the breast, nine and a half if not more times out of ten, the bowels will chug along quite happily but again, if they’re a bit slower compared to other children, it’s neither here nor there.

Once children are getting a little bit older, of course, like the rest of us, what is happening with the bowels will be a function of what they eat. So it’s good to get healthy habits started early in your children and get them eating some vegetables and fruits from an early age. Making sure they’re getting some water and other liquids in their diet is really important, especially in summer time as you don’t want babies or children getting dehydrated. Water is important for the bowels because it allows the bowel matter not to be as solidified. We don’t want children passing little sheep pellets!

One of the most common things that I see in general practice in children is gripey tummy pains and that’s always a good reason to get your kids checked at the doctor.  The most common reason for children to have gripey tummy pains – and this is confirmed by pediatric surgeons as well – is that the bowels are not working effectively. What then happens is that the gut is contracting – keeping in mind that the bowel has a muscle tube around it – and trying to get stuff out the back door. In this situation, often when we’re talking to parents we’ll find out that the child is going once every second or maybe third day. This means the bowel is not working efficiently and effectively.

Same as in adults, the bowel’s role is to get rid of material that the body doesn’t need. If that isn’t happening, then the body’s going to try harder. The way it does that is by the muscle within the gut contracting, trying to push stuff along. The harder the material gets, the more the gut has to work and eventually this will manifest as stomach cramps or pains.

So what do we need to do to keep bowels healthy in children? The two most important things that the bowel needs for healthy functioning are water and fiber. Now water sounds obvious, again making sure your children are drinking enough of it – and you sometimes need to be a little bit on their backs about this – is really, really important. The other is that they do get enough fiber. The best sources of this are fruits and vegetables. Whole grains are helpful as well. Products where it says they’ve added fiber, I wouldn’t rely on those because generally the only reason they’ve added it is that it’s been taken away in the first place. Just eating bread is probably not the best thing to rely on and neither is relying on breakfast cereals.

If we think about it historically, what did humans eat? – Generally stuff that could be gathered or that they could catch, like nuts, grains, seeds and berries, fruits and vegetables. So these are the sorts of foods that the bowel wants and needs. It doesn’t mean you can’t give your kids other foods but those are important.

How do you know if they’re getting enough fiber and water? They’re getting enough if they’re going to the toilet everyday and they’re not having to push or strain. If you’re in the kitchen and you hear screams from the toilet because it’s hurting your child, pretty much that’s telling you that they’re having to push harder than they should.

So to summarize this topic that I think everybody is interested in but that we don’t like to talk about much, when keeping bowels healthy in children the principles are very much if not exactly the same as in adults. Little bowels are the same as big bowels and need water and fiber. It’s not complicated, it’s not difficult. If you give the bowels what they need, they will continue to work effectively for you and they’ll get rid of the stuff that the body doesn’t want or need. Subtly, when bowels start working better, people often feel less tired, a little bit less sluggish, and have a little bit more energy through the day. In the end, you’ll know how things are going when you’re kid is on the thrown.