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  • Denise Scott

Treating Constipation with Diet

What exactly is constipation? Why do some babies/children get it while others do not?

Constipation constitutes hard, dry, difficult-to-pass, infrequent stools. The frequency is individualized, although constipation has been defined as fewer than three stools per week. Some babies may pass stools once or twice a week that are soft and pass without discomfort (this is not constipation); others may strain with pain and difficulty every few days. Constipation is better described by the stool characteristics and the degree of discomfort, in addition to the length of time between stools.

Young girl in discomfort trying hard to pass a stool

Babies and children with constipation tend to pass small, firm, individual pieces of stool (pebbles or turds), usually with effort and discomfort. This is considered constipation, even if passed daily. Additional signs are pain when passing stool, stomach pain, soiling (stool leakage in the underwear from backed-up stool), and/or small amounts of red blood on the stool surface when passed.

Constipation in children is a common pediatric complaint. The pediatrician will discern what is problematic, needs treatment, or indicates a health issue.

Causes of constipation are many and include:

  • Changes in diet (this can commonly occur when changing from breastmilk to formula)

  • Changes in routine, such as travel

  • Voluntary withholding - occurs when children ignore the signals of needing to stool

  • Toilet training issues - toddlers are often reluctant to use the potty, so hold their stool and can do so for a very long time!

  • Cow milk allergy - something to consider as a cause, especially once transitioned to milk from baby formula.

  • Family history - yes, this does sometimes run (or not run!) in families

  • Medications - some medicines can lead to constipation, such as extra iron (not formula with iron) or other prescription medicine.

  • Inadequate water intake

  • Excess milk intake

  • Medical conditions - this article will primarily focus on functional constipation that does not have underlying medical conditions.

Toddler drinking her milk - too much milk intake, over 2-3 cups daily, can lead to constipation

Considering the causes, children who

  • are sedentary

  • do not drink enough fluids

  • drink too much milk (more than 3 cups daily)

  • lack fiber-rich foods

  • have specific medical conditions affecting the GI tract

  • take certain medications

are at risk for constipation.

Why is this a problem?

Complications can occur from chronic constipation, making the problem much worse. These include:

  • Stool withholding due to painful stools and fear of passing them. This can lead to impaction.

  • Tears of the skin around the anus leading to bleeding.

  • Hemorrhoids - yes, even children can develop these!

  • Encopresis (leakage of stool around the impacted stool) which causes soiling.

  • Rectal prolapse from constant straining where the rectum comes out of the anus.

Any concerns regarding constipation, especially any complications, should be discussed with your child’s doctor, who can direct you to the best management. There are preventive measures you can take to avoid this problem altogether.

Ensuring your child drinks enough water can help prevent hard stools

Preventive measures include:

1. Ensure your child gets plenty of fluid, primarily water, once over 6 months. The following guidelines are helpful for daily amounts:

6-12 months ½-1 cup (4-8 ounces)

1-3 years 2-4 cups

4-8 5 cups

9-13 5-7 cups

14-18 6-8 cups

1 cup = 8 ounces.

Kids in sports should drink more.

2. Limit milk intake to 16-24 ounces or 2-3 cups daily.

3. Encourage physical activity.

4. Feed your child fiber-rich foods such as vegetables, fruit, whole grains, beans, and nuts (nuts if 4 or older).

5. Watch for signs of your child needing to go and discuss these signs with them. Have them go as soon as they are noticed.

6. Have a regular toileting routine and make it easier for them with items such as a smaller toilet seat and step stool.

7. Review any medications your child takes.

8. Encourage and support them with understanding - some of this may be beyond their control.

9. Avoid too many bananas and low fiber foods (simple or refined carbohydrates)

10. Emphasize probiotic-rich foods, such as plain yogurt, or discuss probiotics with your doctor.

In evaluating constipation, your doctor will get a careful history, perform a physical exam, may obtain an abdominal x-ray to look for backup, and may order additional tests to help determine whether the constipation is functional (no serious causes) or may be a result of a medical issue that needs further treatment. Sometimes your doctor may refer you to a pediatric gastroenterologist, but pediatricians deal with constipation frequently.

Treatment may sometimes involve using a stool softener, fiber supplement, laxative, or enemas to get things started. For these to work effectively, adequate water intake is vital. Management will often involve dietary changes with a higher fiber diet, increased water intake, and decreased milk intake. Sometimes juice can be helpful, such as apple or prune juice (constipation is one of the only conditions for which juice is recommended).

Dietary fiber from fruits, vegetables, beans, and whole grains help to keep a child regular

For infants, it is best to focus on their diet, using green vegetables and fruits that start with 'p', such as peaches, pears, plums, and prunes. These will increase fiber. Once 6 months and older, you can offer a couple of ounces of water several times daily. Some high fiber fruits include kiwi, apples (not applesauce), pears, berries, and prunes.

Babies with blood in their stool, distended abdomen, increased fussiness with stooling, or inability to pass a stool after straining for 15 minutes or more should be evaluated.

Ideally, the best medicine is prevention through dietary means. Start healthy dietary habits early to make life easier for everyone.

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