Understanding and Managing Constipation in Children
Constipation is not just prevalent among children; it can affect us all. Statistics indicate that approximately one in ten children will experience constipation at some point.
Why does Constipation in children occur?
Constipation in children typically occurs without an underlying medical condition. Bowel habits can vary significantly among children, especially infants.
In babies, there is huge variation in what is considered “normal” . It is considered normal for babies to have a bowel movement multiple times daily or as little as a few times per week. However, as children grow older, their bowel habits often become more regular, typically around one formed bowel movements per day.
Parents often become concerned when they observe their child straining or experiencing pain during bowel movements. Bright red faces, tears, and discomfort are tell-tale signs that your child might be experiencing constipation.
Medical criteria for pediatric constipation involve hard, pellet-like bowel movements that are painful to pass and may occur less frequently. A significant concern is that children may start to hold in their bowel movements, associating them with pain, which can worsen constipation over time. It's crucial to address these behaviors early to prevent potential long-term complications.
Causes of Constipation in Children
Many factors can contribute to constipation in children:
1. Dietary Change: Introducing solids can cause constipation as the digestive system adapts to new types of food and fiber.
2. Unfamiliar Surroundings: Transitions such as starting daycare, childcare, or school can cause anxiety, making children reluctant to use unfamiliar bathrooms.
3. Toilet Training: Proper positioning during toilet training is essential to prevent constipation. Children should sit with their feet supported and knees higher than their waist for optimal bowel movement.
Fixing Constipation in children.
1. Dietary Adjustments:
Adequate fluid intake and a diet rich in fiber are crucial in managing constipation. Ensure your child drinks enough water appropriate for their age and consumes a variety of fiber-rich foods such as fruits (with skins), vegetables, oats, grains, nuts, seeds, and legumes. Specific fruits like pears, prunes, and green kiwis are known for their stool-softening properties, which can be particularly beneficial.
Dietary fibre is otherwise known as prebiotics - it is the nutrition for our gut bugs, keeping our bacterial communities in good balance - which may also help to prevent constipation
The type of fibre also plays a role in bowel health.
Insoluble fiber, found in the outer layers of grains, helps bulk up stool and move it through the gastrointestinal tract.
Soluble fiber, found in foods like fruits and vegetables, helps retain water in the stool, softening it and aiding in its passage.
Resistant starch, found in certain bananas, potatoes, and rice, acts like fiber and benefits gut health. Promoting a diet rich in a variety of plant foods ensures a balance of these fibers, supporting healthy bowel movements and a balanced gut microbiome.
2. Fluid Intake:
Ensuring your child drinks enough water is crucial. Young children should aim for around one liter of fluid daily, while school-aged children should aim for approximately 1.5 liters. Monitoring signs of dehydration, such as dry skin and lips, can help determine if they're getting enough fluids.
3. Toileting Practices:
Encouraging children to sit on the toilet after meals can help establish regular bowel habits. Make the experience relaxing by providing books or allowing screen time, and focus on rewarding the behavior of sitting rather than the act of producing a bowel movement. Make sure children have their feet supported and their knees up above waist height - this way their bowel is in the best position to do a poo!
4. Probiotics:
There's a growing body of evidence linking an imbalance in gut bacteria to gut problems, including constipation. Children with constipation often have a different gut microbiome, with lower concentrations of beneficial bacteria like lactobacillus. While probiotics may help some children, it's important to try them for a period (e.g., a month) and observe their effects.
5. Food Intolerances in children with gut issues.
When all else has been trialled, it is important to consider whether food intolerances (such as dairy and wheat) are contributing to constipation.
Dairy contains both protein and lactose, which are linked to constipation in some children. If other measures fail, consider a trial removal of dairy for a month to see if symptoms improve.
Wheat, which contains gluten and fructans, can also be a culprit. However, these dietary changes should be discussed with a professional to ensure proper guidance and nutrition.
6. Medications and Supplements.
Children may be on stool softeners like osmolax, lactulose, or movicol to manage constipation. These medications draw water into the bowel, softening the stool and making it easier to pass. They are safe for long-term use under medical supervision and can help avoid complications like bowel obstruction or the need for more invasive treatments.
Whilst they are important to use whilst a child is very constipated, medications are often a “bandaid” treatment, therefore it is good to get to the bottom of why a child may be constipated (pardon the pun!)
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