It’s highly likely that at some point you have had a conversation with a parent or child about the dietary changes that a child needs to make if they have constipation. This discussion is fraught with difficulties. Hands up if you’ve ever heard any of the following:
Although macrogol laxatives may be an essential part of the solution, dietary change is still important since management of idiopathic childhood constipation is a game of two halves.
So, why is it so difficult to address the lifestyle changes that are so key to success? There are several reasons.
The first issue is to do with what is normal. Parents and children alike only have themselves and those close to them as a reference for what is normal. It’s hardly an ideal sample, especially when by definition at least one of the people in the reference set has constipation. Similarly, they will look around themselves when asking themselves what is a normal diet. As a comparison, ask yourself “What is the normal number of cars for a family of five to have?” If you look at the globally statistical answer, the answer is zero cars. Most of us would think about the families in our street or social sphere, not considering the bigger picture.
That’s fine though, because we’re not asking people to feed their child normally, we’re asking them to give their child a healthy diet. That’s right isn’t it? It’s technically true, but I think that practically and socially, it is the wrong message.
This is because the second difficulty is that the diet discussion is liable to provoke negative feelings. As soon as you talk about healthy eating, people become defensive. They may not vocalise it but that is how they are likely to feel. There are really only two possibilities. The first possibility is that they believe that the diet offered to the child is already healthy enough. The message that the child's diet is not healthy is likely to be perceived as critical, which in turn will sabotage the impact of the message. The second possibility is that they already know that they are giving an unhealthy diet to the child. Talking about healthy eating is probably going to ignite feeling of guilt and inadequacy, also getting in the way of the ability to move forward.
Getting the language that we use in this important part of the consultation has the potential to radically alter patient and parent buy-in to what you are recommending. I would suggest that you try changing just one word. Instead of talking about eating healthily, talk about eating differently. I usually explain that no matter what a child’s diet is like, there are always changes that can be made that will help them stay free of constipation. Let’s think about what changes you could make, since constipation is such a horrible problem that every change that has an effect is great progress.
Here are some things that you could look at with the next constipated child you see:
Achievable changes
Edward Snelson
Definitely different
@sailordoctor
Disclaimer: I have to admit that my kids never got a second crack at their food because I always ate it if they wouldn't. I'm sure that's fine. It is fine isn't it?
Reference
- My child eats healthily.
- Are you saying that I don’t give my child healthy food?
- I can’t make him eat anything?
- My child is just a fussy eater.
Although macrogol laxatives may be an essential part of the solution, dietary change is still important since management of idiopathic childhood constipation is a game of two halves.
So, why is it so difficult to address the lifestyle changes that are so key to success? There are several reasons.
The first issue is to do with what is normal. Parents and children alike only have themselves and those close to them as a reference for what is normal. It’s hardly an ideal sample, especially when by definition at least one of the people in the reference set has constipation. Similarly, they will look around themselves when asking themselves what is a normal diet. As a comparison, ask yourself “What is the normal number of cars for a family of five to have?” If you look at the globally statistical answer, the answer is zero cars. Most of us would think about the families in our street or social sphere, not considering the bigger picture.
That’s fine though, because we’re not asking people to feed their child normally, we’re asking them to give their child a healthy diet. That’s right isn’t it? It’s technically true, but I think that practically and socially, it is the wrong message.
This is because the second difficulty is that the diet discussion is liable to provoke negative feelings. As soon as you talk about healthy eating, people become defensive. They may not vocalise it but that is how they are likely to feel. There are really only two possibilities. The first possibility is that they believe that the diet offered to the child is already healthy enough. The message that the child's diet is not healthy is likely to be perceived as critical, which in turn will sabotage the impact of the message. The second possibility is that they already know that they are giving an unhealthy diet to the child. Talking about healthy eating is probably going to ignite feeling of guilt and inadequacy, also getting in the way of the ability to move forward.
Getting the language that we use in this important part of the consultation has the potential to radically alter patient and parent buy-in to what you are recommending. I would suggest that you try changing just one word. Instead of talking about eating healthily, talk about eating differently. I usually explain that no matter what a child’s diet is like, there are always changes that can be made that will help them stay free of constipation. Let’s think about what changes you could make, since constipation is such a horrible problem that every change that has an effect is great progress.
Here are some things that you could look at with the next constipated child you see:
Achievable changes
- Cutting out sugary drinks
- Reducing sweet snacks and starchy snacks (chips and crisps)
- Change breakfast cereal to something high fibre
- Ask school to allow a water bottle at all times and a permissive approach to toilet access
- Don't use sweet and starchy snacks as a reward or treat, even for eating healthy food
- Don't have the constipation food in the house at all. Instead have fruit out and permanently available
- Give parents permission to not feed the child. If the child has been offered a healthy meal and they refuse it, don't offer them an alternative. Take the food away and let them know that they can have it back if they change their mind.
- Tell the family that everyone finds it hard to make changes. Because constipation is a long term problem, every small change can have a big effect.
Edward Snelson
Definitely different
@sailordoctor
Disclaimer: I have to admit that my kids never got a second crack at their food because I always ate it if they wouldn't. I'm sure that's fine. It is fine isn't it?
