How to treat and prevent constipation in children

Dear doctor,
My two-year-old has been going for two or three days without passing stool, which was not the case before. Kindly advise.
Monica

Dear Monica,
It is normal to pass stool from three times a day to once every two or three days. In case it takes longer than three days to pass stool, or the stool is hard, or it is challenging to push out, then this is called constipation.
Toddlers tend to be picky about what they eat, and this could have contributed to the change in bowel habits.

Constipation can develop from not taking enough fluids or enough fibre, which is found in vegetables, fruits, grains and cereals. If the child has some medical conditions, or is taking some medications, this can also cause constipation.
With toddlers, the change in bowel habits is also likely to be due to ignoring the urge to poop, either because they do not want to interrupt what they are doing, or because they’re anxious or embarrassed about learning how to use the toilet, or they are not ready for toilet training.
Since he had regular bowel movements before, and he is able to pass stool every two to three days, you can try to manage the symptoms at home. Increase vegetables and fruits in his diet; increase his water intake (for instance by getting him an exciting water bottle that he can sip from every 30 minutes or so); and create a routine of going to the toilet, especially after eating. You can also develop a way of rewarding him every time he uses the toilet correctly and/or when he passes stool. If you feel that the toilet training might be causing him too much anxiety, you can pause it and resume a bit later when he is more ready. If he develops abdominal pain, nausea and vomiting, fever, or there is pain and bleeding when passing stool, then the child needs to be seen by a doctor urgently.

Encouraging your child to eat more fiber-rich fruits and vegetables, drink more water and engage in physical activity can go a long way toward alleviating constipation.

Dear doctor,
I am 52 years old. I have noticed that one or two of my teeth are a bit loose, and part of my gum looks red and swollen. My mum and eldest sibling have lost several teeth in their older age, and I am afraid that I’ll end up like them. Is there a way to prevent it?

Dear reader,
You seem to be experiencing gum disease, otherwise called periodontal disease. The gums are the tissues around your teeth that hold them in their right place.

Gum disease refers to inflammation of these tissues.
Gum disease begins with the build-up of bacteria and food particles around the teeth. The bacteria and food materials form a sticky material called plaque that attaches itself on the teeth. After some time, plaque hardens and forms tartar, which makes it difficult to clean the teeth well.

Acids released from the accumulating plaque wear out the outer layer of the tooth (the enamel) and begin to cause tooth decay. With time, this build-up irritates the gum and causes inflammation, which may be seen as red and swollen gums, also known as gingivitis. This is the earliest stage of gum disease and the easiest to treat.
If left untreated, the damage to the gum tissue continues, with spread of bacteria to inner layers and the effect of the immune system that is fighting the infection. This results in the wearing away of the soft tissue and bone, which creates spaces or pockets between the tooth and the remaining gum. These spaces encourage further build-up of food and bacteria, which causes tissue damage, more erosion of the bone and connective tissue and deepening of these spaces.

Eventually, there is minimal tissue holding the teeth in place, and they become loose and tooth loss occurs.
Gum disease may cause the gums to look reddish or purple; they may be sore and may bleed; you may notice bad breath and/or have an unpleasant taste in the mouth; there may be pain when chewing, and you may notice pus in the gum. In later stages, gum recession may be obvious – this is where the gums have pulled away from the teeth. The teeth may become loose and there may be a difference in how the teeth fit together.
The risk of developing gum disease is higher if you do no brush and floss your teeth regularly; if you smoke; if you have some chronic illnesses which increase your risk of getting infections; or if you are taking long-term medications that reduce saliva production. Some hormonal changes may make the gums more sensitive and at higher risk of inflammation such as during pregnancy, menopause or puberty. There is a higher risk of developing gum disease if you have close relatives who have it. For some people, there is no identifiable cause of the gum disease.
Gum disease should be diagnosed and treated by the dentist.

Early gum disease can be treated with dental cleaning and improving how you take care of your teeth. Additional treatments may include scaling and root planning. Moderate and severe gum disease may require surgical interventions.
You can lower the risk of developing (or worsening) gum disease by brushing your teeth properly twice or thrice a day; flossing your teeth daily using an antibacterial mouth wash; stopping use of any forms of tobacco and visiting the dentist regularly, at least twice a year.

Hello doctor,
How can I get rid of stretch marks? 

Dear reader,
Stretch marks occur as a result of damage to the dermis, which is the deeper layer of the skin, and this leads to tissue inflammation and scar formation. This damage tends to occur when the skin stretches too much too fast, for example during times of fast growth like in puberty, during pregnancy, or at any time there is fast weight gain.

Long term use of steroid medication can make it easier to develop stretch marks There are some genetic disorders that also make it easier to get stretch marks.
Stretch marks tend to be found in the softer parts of the body like the abdomen, the thighs, the lower back, among others. They are generally painless, though occasionally itchiness may develop.

Many times, the stretch marks fade with time, but rarely will they disappear. There is no known sure way of removing stretch marks. Some treatments that may reduce stretch marks include Vitamin E preparations, glycolic acid, hyaluronic acid and tretinoin cream. Procedures that may be done by a skin specialist to reduce stretch marks include ultrasound treatment, laser and micro-derma abrasion.

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