Constipation in children usually encompasses difficulty or straining in passing stools and/or accompanied by pain while defecating. Infrequent bowel movements (less than every alternate day or lesser) also suggest constipation in toddlers. Various factors such as diet, medication, family history, changes in routine, milk allergy can cause constipation. Toddlers often resist the urge to poop as they do not want to take a break from their play or they fear pain while passing stool. This results in accumulation of stool in the rectum. High fibre diet and plenty of fluids are a natural way to ensure that they pass stools routinely. More often it gets pertinent to administer some laxatives in addition to a proper diet.
Being a mother of a toddler and a researcher, I have been very curious as well as cautious about the medications administered to them right from the moment they are born. A few months before my child was about to complete his second birthday, he exhibited symptoms of erratic passing of stools. It started off as an alternate affair, then gradually once in 3 days and so on. I noticed this habit developed because he did not like breaks from his play time and anything that interfered this period would be dismissed off as unimportant by him. Before this became a routine, I consulted his paediatrician who suggested administering a Movicol sachet (comprised of polyethylene glycol, potassium chloride, sodium bicarbonate and sodium chloride) per day for a month. It then extended for another month followed by once every alternate day. With toddlers who can barely express properly and also fussy about taste (be it normal food, snacks or even medicine), it can get very difficult to make them take medicines. Often the doctors do not even bother to suggest how we make them take their medicines. I realised that masking it with fruit juice was a good option. However, I was perturbed with the idea of giving him any form of medication for such a prolonged period. His desire to pass stool was improving as it probably eased out the pain as well. With time it looked like all was set. However, despite following the routine, there were a few moments of missed stool, and then it again became an alternate affair. I consulted the paediatrician and she asked me to restart the medication again. This is where I absolutely disagreed with her, and therefore, I decided to take charge on finding alternative ways to overcome and sort the issue. Soon I realised that change in diet led to this interrupted stool pattern and with time he got used to the new diet changes and his stool pattern improved.
The second phase of signs of constipation started when we travelled to Shillong, a small town nestled in the hills of the North Eastern Part of India. The weather is mostly dry and it starts getting chilly from October onwards. I ensured that I give my son the diet that he usually takes; there was no change except that I introduced fresh cow milk which was being delivered every morning. 3 days of no stool and then one with a lot of pain made me realise that my son must have developed some sort of milk allergy resulting in this constipation. I was sill hesitant to start the medication. I was faced with two problems; the elders of the family (mostly his grandparents) had a big reservation for not giving the child his milk on a daily basis. Another was convincing them about the ‘alternate food’ to ensure his nutrition remains intact. We cannot evade the essence of milk as a wholesome food for the toddlers, but at the same time how do we ensure that they get all the nutrients in their diet and also ensure that they do not constipated?
Ayurveda is an ancient form of traditional medical practise in India which is focused on health promotion, disease prevention, early diagnosis and personalised treatment [1https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4230501/]. According to ayurveda, ‘Ghee’ or ‘clarified butter’ is considered to be an essential component not only in our diet, but it is also used as a healing substance when used appropriately. Henceforth, the term ghee will refer to the one derived from cow’s milk. It is a safe and versatile remedy for good health and immunity in children. It helps in strengthening immunity, brain development and bone strengthening in children and is also a great powerhouse of vitamins and other bioactive components. Furthermore, cow milk derived ghee contains ‘butyric acid’ that aids in reliving constipation in toddlers. Although the principles of ayurveda may be valid till date, it still needs the scientific validation to catch pace with the constantly evolving contemporary field of science, research and medicine which are evidence based. Therefore, bridging the gap between science and ayurveda still has a long way to go.
Butyric Acid – the wonder molecule
Butyric acid is a short chain fatty acid with tremendous therapeutic potential particularly in the gastrointestinal tract. It is a major source of energy for colonocytes and is found in some foods and in the human body. It can also be produced by microbial fermentation in the large intestine by intestinalkacteria. It is primarily associated with reduction in pain and inflammation in the gut and thereby smoothens the passing of stool. In addition, butyrate plays a vital role in maintaining gut health. Sometimes the production of butyrate is reduced and therefore supplementation is necessary. However, the main drawback of supplementing butyrate is limited owing to its volatile nature, rancid smell and rapid absorption in the upper gastrointestinal tract [2 https://www.sciencedirect.com/science/article/pii/S2405654517301397].
Ghee can reduce most of the symptoms of constipation and inflammation in the gastrointestinal tract. However, research on ghee is limited and most of the PubMed citations on ghee revolve on aspects other than constipation. Nonetheless it is known that ghee contains butyric acid which in turn elevates most of the symptoms associated with constipation. A lot of ayurvedic texts swear by the therapeutic properties of ghee in constipation. In addition to containing the wonder molecule, ghee can also be used as a delivery vehicle. Butyric acid in ghee (cow ghee) is only 1.7%. Therefore, it is yet to be explored if ghee could be used as an effective vehicle for delivery of butyric acid without affecting its inherent butyric acid composition?
Since ghee is an essential part of almost every Indians diet and our parents and grandparents swear by it, I decided to introduce ghee in my child’s diet in a different way. Although I give it to him along with his lentils or rice for lunch, I decided to administer it along with his nutritional health drink. There are of course a few drawbacks of using this health drink, the primary being sugar content, nonetheless, it has almost all the nutrients necessary for the growth and development of a child. So the benefits far outweighed the negative aspect. So I realised that a scoop or two with warm water would be fine. I started mixing very little ghee (approx 1/3rd or less of a teaspoon) along with the health drink. Although it is prescribed that ghee be administered with warm water or milk before bedtime, I decided on administering it in the morning before his breakfast. This ensured that ghee is easily digested during the day. To my surprise, the pain associated with constipation as well his frequency of passing stool improved a lot. I tried this for almost 10 days, and he skipped pooping only once and that too it happened after he pooped twice the previous day. During this period I ensured that there was barely any change in his overall diet plan. This was just a preliminary trial and extensive experiments are required before introducing ghee for relieving constipation.