Constipation is a common complaint among pediatricians’ offices. Most children experience brief periods of constipation over time that usually resolve on their own. Symptoms that warrant medical attention include recurrent, prolonged constipation, bleeding, pain, excessive straining or fear of passing stool. Many children who have previously experienced painful bowel movements instinctively begin to withhold their stool, causing a vicious cycle of even harder-to-pass stool that may lead to impaction.
This article discusses common causes of constipation, prevention strategies and treatment. This article is not intended to diagnose, treat or replace the advice of a medical provider. Please share your concerns with your child’s doctor if he or she struggles with constipation. Routine well-child visits are important for ruling out metabolic, neurologic and endocrine causes for these symptoms.
Initiating solid foods or introducing cow’s milk to the diet may lead to constipation as it is easier to offset the correct ratio of fiber and water required to make soft, easy-to-pass stool. Cow’s milk slows intestinal movement and can satiate the child’s appetite, making it less likely they will drink water or eat fiber-rich foods.
Dysbiosis of our microflora can cause a multitude of symptoms, many of them gastrointestinal. Stool testing can help identify if the child is missing important probiotic bacteria in their gut- facilitating a more customized treatment plan. A different approach is to test for food allergies- another condition that can cause a wide variety of symptoms. Food allergy testing can be completed using a simple finger stick- no blood draw is needed.
Starting school can be a significant transition for children; they must learn to navigate new schedules, locations and classmates. A change in routine may interrupt a child’s natural bowel movement pattern- leading to withholding or a reluctance to use the restroom at school.
Stress is another common cause of disordered bowel habits. During times of stress, it is harder for a child to sense (and act) when their body is ready to have a bowel movement. Toilet training, travel and the arrival of a new sibling are all very common times when children may experience brief interruptions in their body’s natural routines.
Below are some general tips for avoiding constipation. Ultimately, evaluation and treatment by a medical professional is always recommended for a more personalized approach.
Routine: if a child is toilet trained, encourage they spend time on the toilet after every meal. If the child has struggles using an adult-sized toilet, start with a portable children’s toilet or use a stool to raise their feet so their knees are flexed. If the child is at school for a portion of the day, encourage time on the toilet before and after school.
Water: encourage 16-32 ounces of non-milk fluids per day. If the child is reluctant, you may add a small splash of juice or herbal tea to add natural flavor to the water. If the child drinks milk, lightly diluting the milk with a small amount of water can encourage adequate hydration while offsetting the constipating effects of dairy.
Fiber: a great starting point for calculating children’s optimal fiber intake is:
child’s age + 5-10 grams = total fiber intake per day.
For example: a 3-year old’s optimal intake is 8-13 grams of fiber per day (for a 6-year old child it’s 11-16 grams, etc.) Specific foods that can help treat constipation include prunes, pears, apples, chia seeds and flax seeds.
Below this article you’ll find some charts with the average fiber content of various fruits, vegetables and cereals. A nutritionist or dietician familiar with children’s nutrition is also a fantastic resource and can teach you and your family how to eat for all stages of life.
Below are general treatment guidelines for mild-moderate constipation. For severe or chronic constipation, more aggressive treatment is warranted and must be supervised by a physician.
For mild constipation, a conventional doctor may prescribe laxatives like Miralax or lactulose in weight-specific doses. As a naturopathic physician, I may consider starting with magnesium that helps draw more water into the stool and thus make them easier to pass.
Severe constipation and/or stool impaction involve both oral as well as rectal medications. This treatment usually involves a bowel “clean out” to start, then is followed by supplementation of stool softeners to prevent recurrence. A clinician may recommend daily laxative use for several weeks, then taper down the dose very slowly once the child returns to normal bowel tone.
Water, diet and fiber will also be a part of a holistic treatment strategy.
The Bottom Line (get it?): Prevention is the best cure for constipation. Fiber, fruits, vegetables, water and regular physical activity create a recipe for lifelong healthy bowel function. Intervene at the first sight of constipation- prolonged pain with bowel movements will cause the child to withhold stool and can trigger fear of going to the bathroom. Stool withholding leads to even worse constipation and often will require a “bowel clean-out” if the constipation becomes severe or prolonged.
Oh, and lastly….. have you heard of that movie called Constipation?
You haven’t?? That’s probably because it hasn’t come out yet!
Table 1: Fiber content of fruits, vegetables and cereals.
References and Resources:
UpToDate: Prevention and treatment of acute constipation in infants and children
Dr. Val Manning sees patients from infancy into adulthood, focusing on preventive strategies when possible and creating sustainable, integrative treatment plans that fit the whole family. She is credentialed with various insurance companies and is currently accepting new patients.
If you want to find out more about nutrition and how it affects the topic discussed in this blog you might be interested in seeing our Registered Dietitian Nutritionist. Call the clinic to learn more or schedule an appointment.
Carly Kellogg Knowles, MS, RDN, LD
Carly has a Master of Science degree in Nutrition and is a certified Registered Dietitian Nutritionist. She is the owner of Vibrant Nutrition & Health – An Integrative and Functional Nutrition Practice in NW Portland, OR.
She specializes in medical nutrition therapy for:
-Chronic disease (anemia, autoimmune disease, cancer, pre-diabetes/diabetes, gallbladder disease, heart disease, high blood pressure, inflammation, osteoarthritis, weight management)
-Eating disorder recovery
-Fertility, pregnancy, postpartum, and breastfeeding
-Intuitive eating and wellness
She is credentialed with various insurance companies and is currently accepting new patients.