Living with a child with constipation – the mother’s perspective

By Davina Houghton, School of Nursing & Midwifery, ECU Joondalup

Despite increasing knowledge and evidence being acquired on the subject of idiopathic childhood constipation (ICC), we are no further forward in reducing the burdens for (in this case) the mother caring for a child with this common childhood condition. Research has been undertaken in WA on this subject and preliminary results are available.

ICC affects up to 32.2% of all children in the world and has been described as a “growing global public health problem”. With no underlying medical cause, ICC often goes unrecognised by the child or parent/carer, which increases the risk for chronicity if it lasts two months or more.

It can be easily diagnosed and well-managed within the primary health care setting with the aid of several evidence-based constipation guidelines (e.g. clinical guideline developed by the National Institute for Health and Care Excellence).

The aim is to investigate the range of ICC health education provided to families by primary care practitioners and the formats in which it is delivered, the aspects of the health education that families use, and what other health education and/or resources families feel might help them.

Preliminary findings

The last question of the online questionnaire invited the participants (all mothers) to share anything else in relation to their child’s constipation. The information shared included:

“We were told that she will possibly grow out of it.”

“More awareness of constipation in children and how common. I was at a total loss as to what/ how/treatment/prevention of constipation for this child.”

“She [the child] tells school she feel sick a lot, especially nausea, and then I get called to fetch her resulting in missed school and time off work a lot. I explained to them about her constipation but doesn't

Key messages

Idiopathic childhood constipation is common seem to help. I am at a loss as to how to help my daughter and it makes me very sad.”

Mothers often feel unsupported Use of evidence-based guidelines is strongly advised.

“Constipation is so tricky!!! GPs have been useless and very dismissive. I have had to guide care and interventions ourselves over many years which at times has been so distressing for the whole family. We still do not have solutions”.

“I feel very discarded when attending medical appointments regarding constipation and feel I am always told the same thing, ‘take Movicol’, ‘take up to 7 adult Movicol a day’.”

“I would like more information on how to manage constipation, prevent it from occurring again and possible causes for it. Dietary advice will be appreciated as well.”

The burdens for these mothers in caring for their child with ICC is both evident and well-documented. It appears to result from primary care practitioners being unaware of the evidence-based guidelines, lacking ICC-specific knowledge, having short consultation times, and providing irregular or short-term follow-up.

Mothers state that they feel they are not being taken seriously, their concerns are often dismissed, or that they are frequently told their child will grow out of ICC. Mothers also feel sadness and distress for their child; guilt, shame and embarrassment that may cause them to question their competence as a mother; and frustration and isolation from the perceived ‘taboo’ nature of ICC.

Furthermore, mothers experience stress from having to administer regular laxative medication, resolve conflict with partners and siblings, and from having to negotiate care needs with schoolteachers and employers. Often the arduous ICC journey lasts for years, and this diminishes the motivation to adhere to treatment regimens, which can then result in significant adverse effects for the child, their family, society, and the economy of health services.

While there is no quick-fix for curing ICC, ideally primary care practitioners would always use evidence-based constipation guidelines to:

(a) provide a timely diagnosis;

(b) initiate aggressive pharmacological treatment (laxative medication) to disimpact the child, followed by a regular maintenance dose of medication, titrated according to stool consistency as per the Bristol Stool Scale;

(c) demystify ICC through providing collaborative oral, and written non-pharmacological health education to both the child and the mother/parent/ carer, which is individualised according to the family’s educational and cultural needs;

(d) suggest evidence-based dietary and behavioural strategies for managing ICC;

(e) secure regular follow-up consultations to monitor progress, and provide on-going health education and support; and to

(f) refer children unresponsive to the treatment regimen to an expert within three months.

– References available on request

Author competing interests – the author is involved in the research quoted