Constipation is defined as the infrequent passage of hard stools. Constipation is common during childhood, occurring in up to 25% of children. Low dietary fibre intake, slow transit time, coercive toilet training, and in some children abnormal contraction of the anal sphincters and pelvic floor can all cause constipation.
Anal fissures can occur secondary to passing large hard stools and may contribute to a cycle of pain and avoidance of defecation. Medical causes such as thyroid deficiency, cow’s milk protein allergy, spinal anomalies, and anatomical anal conditions are rare.
Hirschsprung’s Disease, a rare neurological muscle abnormality, usually causes severe constipation from birth. Substance P deficiency also usually causes early constipation. Breast-fed babies are rarely constipated, although stool frequency may vary considerably. In bottle-fed babies, it is important to be sure that the formula is correctly made up, as concentrated formula may exacerbate tendency to constipation. Weaning from breastmilk and onto solid foods and the period of toilet training are times when constipation may occur. Babies should be offered increased water, prune juice, stewed prunes and steamed vegetables if weaned. Stool softening laxatives may be added for slightly older children.
Encopresis is defined as the repeated and involuntary passage of stool into the clothing after the age of four years. Encopresis occurs in 3% of 4-year-old children and 1.6% of 10- year-old children, and is 2 to 3 times more common amongst boys than girls. This faecal retention and overflow can develop as a result of prolonged constipation, physiological incoordination of the lower bowel and anus muscles, incomplete evacuation (the busy boy), or toilet avoidance. Soiling may occur as leakage of loose stool (sometimes misdiagnosed as diarrhoea), or overflow of solid stool from the distended rectum.
The developmental value of play in the early years of life is without question. Play is essential for the development of physical, social, intellectual and emotional health. Habitual physical activity in young children is also linked to a greater likelihood of skill progression, perceived physical competence, cardiovascular and musculoskeletal health, and weight management.
Promotion of activity in the early years of life predominately requires families and carers to provide time and opportunity for structured (adult guided) and unstructured physical activity (supervised, free play alone or with other children). Parents and carers are also expected to model positive practices and values to physical activity.
Developmentally appropriate activities for toddlers initially involve simple one-skill locomotive challenges such as running or jumping or manipulative activities such as throwing or hitting for distance. Toddlers learn physical activities through lots of opportunities to explore, imitate, and repeat challenges.