Vihaan (8) often complained of a stomach ache. A dietary history showed his breakfast was just milk and biscuits. Barring home–cooked dal and rice, his eating habits comprised fried and refined food, junk food and bakery products. His intake of vegetables and fruits was rare.

Vihaan was diagnosed with chronic constipation due to wrong dietary habits, less intake of water and poor physical activity. Doctors in the city said there is a perceptible rise in cases wherein children complain of stomach ache due to chronic constipation.

"It is surprising to see the rise in the number of paediatric constipation cases recently. Poor eating habits, less water intake, wrong bowel habits and less physical activity are the reasons why children suffer from constipation at a young age. Parents must take it seriously else their children will have poor food habits and constipation later on in life," said colo–proctosurgeon Ashwin Porwal, an expert in treating the condition and its related complications.

Porwal sees at least 1–2 new patients in the 4 to 10 age group who come with complaints of constipation. "They present symptoms like hard stools and excessive straining during defecation. Not passing stools daily is a common symptom. It's a very alarming situation and needs to be prevented at the earliest," he said.

He recalled treating an 11–year–old boy who had episodes of constipation (not passing stools for 3–4 days) and stool incontinence together.

"The child was using a diaper. He was admitted last year to a leading hospital in Pune for manual impaction of stools, but his problem remained unresolved. He began to lose self–confidence, stayed at home all day and kept to himself," Porwal said

The child underwent MRI defecography that showed no structural defect of the rectum. "A month ago, we planned his treatment with medicines, nutrition, physiotherapy and herbal oil therapy for three months. He is showing results he passes stools daily, his incontinence has reduced and his diet has improved. The diaper use has gone and he has taken to sports," he added.

Paediatric gastroenterologist Vishnu Biradar said, "There is a rise in cases of paediatric constipation across all cities including Pune. I see 5–10 children with refractory constipation every day where constipation is stubborn and chronic and difficult to treat with conventional medicines."

If a child has passage of hard stools more than three times a week it is a case of paediatric constipation. Parents can be watchful as there are clear indicators, doctors said. "If a child is straining while passing stools or has frequent hard stools three times a week, then parents must consult a doctor immediately," Biradar said.

If these initial symptoms are ignored, the child may have serious symptoms like bleeding per rectum or stool incontinence or pass stool in a standing position by straining, he added.

"Wrong dietary practices include starting top milk before one year of age or bottle feeding, giving more than 200 ml of milk daily along with bakery items like biscuits or bread, use of readymade food, chocolates, use of fast food and lot of juices which are low on fibre," Biradar said.

So when a child complains of indigestion, parents indulge in self–medication when they hear their child straining or complain of stomach ache. "Home–made medicine like ginger and ajwain are among the common practices. Parents only seek medical help when the problem becomes chronic," said senior clinical nutritionist Geeta Dharmatti, president of Indian Dietetic Association, Pune chapter.

There is a growing tendency to use more ready–to–eat food items in homes. Besides, early morning school makes it difficult for the child to eat breakfast properly, she added.

Nutritionist Dhanashree Karmarkar said nutrition works wonders for young children if they are guided well. "In my practice, I have noticed that 8 out of 10 children do not eat good amount of vegetables and fruits as they are not introduced to them at a young age. It is important for parents to understand when top feeding is introduced to the baby, introduction of vegetable and fruit juices is very crucial so that the child gets adapted to the taste and has no problem later on."

High–fibre diet including a lot of bananas, raw salads and good intake of water is a must. Good amount of fat is also necessary for relieving constipation. Children like it best when a variety of foods with fresh colors are included, she added.