Have you ever found yourself wondering: why is my kid (or my student, or my patient) so grumpy lately?
I learned early on from my incontinence patients and their families that constipated kids can sometimes be irritable kids. They have outbursts, they refuse to participate in activities, they just want to sit around.
Time after time, I advise families to do a clean-out (after checking with their doctor, which I always recommend), and they come back gushing: “she’s eating so much more!” “He’s running around and playing instead of just moping!”
It makes sense, right? I won’t make assumptions about you, dear reader, but I know that I can get quite grumpy when my GI tract is off. And, for me, that means just mild constipation that lasts a day or two. I can imagine that months or even years of a back-up of poop feels pretty terrible.
One patient really hit it home for me, though, and she wasn’t even an incontinence patient. This child had cerebral palsy, and when she was around four years old I was helping her learn to walk. “Jane” was non-verbal, but she certainly was expressive. And for several sessions in a row, this happy, beautiful kid was as grumpy as I’d ever seen her. Her mom and I tried to puzzle out the cause for her shift in mood when little Jane passed gas in the middle of a therapy session. A light bulb went off and I asked her mom about her BMs.
Turns out, Jane had really been struggling, and her parents had only been advised to give her a little bit of MiraLax every now and then. I asked mom to contact her doctor to ask about giving her daughter a daily dose. I also taught her mom some positions that often help nonmobile kids have a BM (prone on an exercise ball is a great one!). The next week, Jane was back to her old self.
I now know that most kids with CP need fairly aggressive constipation management early in life to prevent a lot of hardship later on. But Jane’s story isn’t just enlightening to those of us who love kids with CP. Many, many typically developing kids are unable to express why they are grumpy, and most wouldn’t link irritability with the fact that they haven’t pooped in a few days.
The challenge with kids with chronic constipation is that they don't register that their bellies are full of poop. I liken it to getting your ears pierced: you felt it at the time, and you were aware of the new piercings for a couple of weeks, maybe, but eventually you don’t think about your earlobes all the time. The same goes for a back-up of stool in the colon, except that constipation affects how we feel far more than earrings do.
Once you connect a child's irritability to their constipation, managing both conditions becomes slightly easier. Irritability becomes a clue that the child is getting backed up again.
Go through the secret signs of constipation and the Rome criteria (available on my resources page) to determine if your child is constipated. If they are, read The Constipation Game Plan and implement the steps outlined in the book. Your child will be on their way to feeling - and behaving - better soon!