Childhood, that is to say the period between birth and puberty, is characterized by a gradual increase in the growth of all the tissues and a corresponding activity of the nutritive organs. To this is added a very marked impressibility of the whole nervous system. It is not unreasonable then to devote a paragraph to the constipation of children.
“In some cases the constipation may be due to functional derangement of the liver as in jaundice, where the stools may be hard, dry and clay-colored, showing a deficiency in the secretion of bile. Deficient or too tenacious intestinal mucus is another cause; the constipation of most febrile affections is mainly due to this condition, or to augmented perspiratory, or urinary secretions. Nervous, acid children are predisposed to constipation. The nutriment, especially the amylaceous class, boiled milk, soups containing meal, rice, sago, etc., is another cause. Too slight peristaltic movement of the intestinal tube as a secondary effect in other diseases as hydrocephalus or atrophy is another causative influence. Mechanical obstructions, incarcerated hernia, intussusception, occlusions, etc., may also produce it.
“The diet of either mother or child is at fault usually. Liquid food five or six times a day will usually correct this abnormal condition, oatmeal gruel between meals with plenty of milk and water, or chocolate or cocoa-shell tea at meal is an excellent diet for mother and child.” – T. C. Duncan, M. D., Diseases of Children.
We take the following from the Homoeopathic Times, vol. viii., p. 191 : [At a clinical lecture, Professor Jacobi, of New York, called attention to a form of infantile constipation not mentioned in the books. In this affection the color of the faeces is about normal, but they are deficient in moisture. They are dry and somewhat friable. The passages of young babies are never normally like this. There is evidently here a lack of moisture which may possibly arise from an insufficient secretion on the part of the intestinal glands. It may arise from other causes, one of which is a peculiar anatomical condition occasionally occurring in the bowels of the new-born or young infants. A few anatomists have recognized that the intestinal tract is different in the young from what it is in the old. The colon is very much larger and longer in proportion in the child than in the adult, and this peculiar condition often remains up to the age of five or six years. The child may have two or even three sigmoid flexures, or the real sigmoid flexure may not be found on the left side, but on the right.
In the passages of the young, where the peristaltic action of the bowel is normal, and the colon of the usual proportion, the faeces will not be dried out; but where the flexure is long, or there are two of them, the faeces will dry out. In the foetus and the new-born the secretions of the intestines are very copious. There is a great deal of mucus and epithelium, which may become very dry and compressed – to such an amount, indeed, as to constitute actual obstruction. Dr. Jacobi stated that he has met with a number of cases in children that could not be explained in any other way than by the supposition that there were two or three sigmoid flexures, one on the top of the other, and impeding the free passage of the faeces. In the treatment of a case where such a state of things is suspected, the diet must be regulated so that there may be an abundance of water in the food. In the choice of food, oatmeal is to be given in preference to tapioca, rice, or even barley. Purgatives ought not to be given except in urgent cases. Injections are very useful and cannot be dispensed with. Another cause of constipation like this may be that there is an insufficient physiological action of the muscular layer of the intestines. This may occur in feeble children. In another class of children this constipation does not appear until from six months to one year after birth, and then, from being perfectly regular they become obstinately constipated. In this class the muscles of voluntary motion as well as those of the intestine, become diminished in power; they are rachitic children.]
Nux vomica is of service for infants where the nurse indulges to excess in the use of coffee, tea or spiced meats, and in those children who have been fed too prematurely or too freely upon animal food, it will be additionally indicated if there is at the same time anorexia, vomitings, distention of the abdomen, insomnia, oppression of breath, continual restlessness; violent and ineffectual efforts at defecation. The absence of this latter symptom, all the others being present, will be an indication for Opium. Bryonia is a remedy analogous to Nux vom. and may be alternated with it with benefit. A brownish coating on the tongue is a further indication for Bryonia.
In the occasional constipation of nervous children and especially during dentition, Chamomilla will be of service. But in nervous children with large heads, dilated pupils, subject to convulsive movements and startings during sleep, with disturbed dreams, Belladonna will be often indicated.
Calcarea will sometimes be called for in analogous circumstances. Kreosote is adapted to emaciated children during dentition.
Many physicians recommend Lycopodium as the principal remedy in the obstinate constipation of young children, when there are present the following : ineffectual efforts; alteration of features; the abuse of farinaceous, heavy, indigestible articles of diet.
[Prof. J. P. Mills, of Chicago, in a paper read before the Thirty-fifth session of the American Institute of Homoeopathy, considers Lycopodium as the remedy for infantile constipation and colic. He bases his opinion upon the well-known physiological function of the liver and the corresponding dependence of the kidneys in excreting nitrogenous substances eliminated from the blood by the liver, and the consequent renal complications which so often appear in constipation due to the absence of the proper biliary secretion. Lycopodium having these organs as fields for its action becomes a well-indicated drug for the conditions under discussion.]
Platina is useful when the evacuations take place only after violent efforts, necessitating at times manual extraction, and are composed of small, black and hard pieces.
When, with the inertia corresponding to Platina, the evacuations are dryer and paler, and the etiological conditions of a farinaceous diet mentioned under Lycopodium are present, in infants artificially nourished, Alumina will be of service.
If, in infants brought up by hand, an obstinate constipation with hard stools, which crumble on passage, of a clay color streaked with green follows a diarrhoea; if there is prolapse of the rectum, and a coexisting paleness of the skin and insomnia, Podophyllum should be consulted.
If with the same pallor of the skin, there is a yellowish coloration of the conjunctivae and an accompanying salivation, together with pale and whitish evacuations, Mercurius will be better indicated.
When after the employment of Platina and Lycopodium, the rectum alone still remains in an inactive state almost approaching a paralysis, Veratrum alb. will be serviceable. Sulphur and Alumina may also be required in some cases.
Crocus sativa has often benefited the constipation of infants associated with troubles of the vena-portal system.
Plumbum, Opium, Hydrastis, Zincum, Phytolacca, Graphites, Silicea, Nitric acid, etc., should also be consulted for infantile constipation.
The most frequent form of constipation is the paralytic. Then we have in the order of frequency, the haemorrhoidal, infantile, irritative, uterine, and hepatic. The other forms are more rarely met with in practice.
We would add that habitual, hereditary or constitutional constipation is not a serious condition and the physician should not be unnecessarily concerned in regard to it. The constipation itself of the lying-in woman is rarely serious. The same is true of the constipation which accompanies the mild form of acute diseases or which occurs in convalescents or those under a forced diet. It is different, however, if the constipation is accidental, obstinate, and accompanied with repeated vomitings, and extreme distension of the stomach, or if the accumulation of the faeces is so great is to produce symptoms of strangulation. If the patient has an old hernia, the constipation should be carefully watched. We should not forget also that in children constipation sometimes predisposes to meningitis, and constitutes at times its first symptom; do not neglect then the constipation occurring in children, no matter what may be its organic form. The solicitude of the physician should be equally great when constipation attacks plethoric persons who are subject to congestive headaches, with a marked tendency to hyperaemia of the nervous centres or who already suffer from severe lesions of the same centres; also when the concomitant symptoms give rise to the fear of organic alteration of the abdominal viscera, or the initial signs of a cachexia appear in a more or less obscure form.