Episode 90: Constipation in Kids: The Warning Signs Parents Shouldn't Miss

Episode 90: Constipation in Kids: The Warning Signs Parents Shouldn't Miss

Constipation is one of the most common gut health challenges I see in children, yet many of the early warning signs are often missed. In this episode, I unpack what constipation really looks like in kids, why it's about much more than simply not doing a poo, and how it can affect appetite, feeding behaviours, mood, gut health, and overall wellbeing.

As a paediatric dietitian with 25 years of experience in children's gut health, I explain why constipation is often more complex than just fibre and water. We explore the hidden causes, the role of the gut microbiome, withholding behaviours, toileting routines, and why early intervention matters.

If you're raising a picky eater or fussy eater who struggles with tummy pain, poor appetite, withholding, or irregular bowel habits, this episode will help you understand what's really going on and what practical steps you can take to support your child's health.

In This Episode

Introduction to Episode 90 & The Reality of Childhood Constipation - 00:00.084
A Holistic, Gut-First Approach Beyond "Fluid and Fiber" - 02:02.976
Hidden Warning Signs and the Vicious Cycle of Withholding - 04:25.324
Functional Constipation and the Role of Dietary Fiber - 06:51.81
The Nuances of Fiber Types and the Importance of Hydration - 09:10.754
Public Toileting Fears and the Impact of Too Much Dairy - 11:26.668
The Bidirectional Gut-Microbiome Connection - 13:44.448
Physical Activity and the Importance of Toileting Ergonomics - 16:07.436
Anxiety, Neurodivergence, and the Gut-Brain Superhighway - 18:23.958
Action Steps: Tracking Patterns and the Right Way to Use Laxatives - 20:44.76
Conclusion: Looking Holistically at Your Child's Gut Health - 23:08.93

Links:
https://nourishwithkarina.com/feedingbabies
https://nourishwithkarina.com/membership

Highlights:

Introduction: Turning the Mirror on the Feeder - 00:00.98
Moving Past Parent Guilt and Failure - 02:17.85
The Power of Perspective: A Case Study - 04:42.08
The Comparison Trap and the Toddler Transition - 06:54.34
The Feeding Ecosystem and Breaking the Cycle of Despair - 09:13.12
The Framework: Child, Environment, and Parent - 11:36.48
Reframing Wins and Recognizing Intuitive Eaters - 14:00.18
Three Essential Mindset Shifts - 16:25.88
Conclusion: Becoming a Confident Role Model - 18:47.01

Show notes

READ TRANSCRIPT

Show Notes

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Introduction to Episode 90 & The Reality of Childhood Constipation (00:00.084)
You're listening to the Easy Feed Podcast, episode number 90. Constipation in kids. The warning signs parents shouldn't miss.

Hi there, I'm Karina Savage, and with over 20 years' experience feeding children, including my own, I've learnt all the secrets that busy mums need to get their children eating better and actually enjoying healthy foods. So a huge welcome to the Easy Feed Podcast. Welcome back, it's great to have you. Today I want to talk about a very common challenge in children and adults as well, but

You know, it's a hugely common problem in children, and often it presents itself in toddlerhood and can be a real tricky time for parents, especially when they're trying to toilet train and get children out of nappies, but they're having this real challenge because the children aren't wanting to do a poo. And holding on can be a real issue and can create

Bigger problems. So I wanted to talk about this topic of constipation because I commonly have online consultations for families who have children with constipation. And I just wanted to give you a little more information about what to look for and what to do. So constipation is associated with painful or infrequent bowel actions holding on abdominal pain. So they can get really sore tummies. And this can be associated with

trying to do a poo, but also at other times, it can be a real source of stress for families, especially when you're watching your child trying to do a poo and they're going red and they're really in pain and they're upset and they're agitated and they just can't get it out. It can be really stressful for parents and for the child, of course. And something that parents really want to get on top of, but sometimes really don't know what to do. And they're told that, you know, I'll just take lax leaves, their child will grow out of it.

A Holistic, Gut-First Approach Beyond "Fluid and Fiber" (02:02.976)
Maybe try and give them a bit more water. But sometimes that just doesn't work. And parents are left feeling really powerless as to how to help their child. So that's why I wanted to record this episode today, just to give you a little more information. I'm a pediatric dietitian. I specialized in this gastroenterology space now for 25 years. I spent the first 12 years of my professional career in a children's hospital as the lead pediatric gastroenterology dietitian. And I saw lots and lots of children with all sorts of different bows.

Conditions, tricky, tricky, complex bowel conditions, and also a ton with constipation. And of course, you know, over the past 25 years in my clinic as well, my private clinic online, I see lots and lots of kids who struggle with constipation. So it's really about looking at the whole, the big picture holistically. It's not just looking at fluid and fiber, it's a lot more layered than that. And so we really need to just take a step back.

Look at everything. So when I have a consultation with parents, I I rewind right back to the beginning. I say, how were they born? Were they born at term? Were they born preterm? Were they born vaginally? Were they born via cesarean section? They've been exposed to lots of antibiotics in their life. We need to consider their gut health history first before we look at what's going on currently. So that's an important part of the picture, important part of the puzzle. And that

very much shapes how I educate parents and how I make a plan to try and help this child. It also involves what's currently happening in terms of their dietary intake, their fluid intake, their toileting routine, whether they're holding on. There is a lot to consider. We also need to look at whether the child is very active, whether the child gets stressed or anxious, whether there's neurodivergence or sensory sensitivity. So

It's it's more complex than just fluid and fiber. And sometimes just increasing fiber can actually make things worse. It can actually constipate kids more because you're just putting in something that makes more concrete when you're already in a very concrete situation, if that makes sense. So sometimes just adding fiber isn't the way to go. So your fiber supplements, yes, they can have a place. And yes, I do use them sometimes, but we also need to be very intentional.

Hidden Warning Signs and the Vicious Cycle of Withholding (04:25.324)
with our approach so that we're actually making things better, not worse. So what does constipation actually look like? Well constipation is not just not pooing. Constipation is like children can poo. So they can actually poo daily, little bits, little bits here and there, but they're not properly clearing. And this is the issue. So warning signs that parents sometimes miss is when the the poos are slightly on the firma side. They're painful and

Again, usually when your child is in pain doing a purse, especially when they're younger, parents do see that. But if they're just pulling bits but it's not fully emptying, it may be missed because it's you know, sometimes parents don't think to ask the question to the child, or the child might be too young to answer that question, especially if they're only like two and a half, for example. Sometimes children will experience tummy pain. Sometimes they'll be really bloated. It can definitely impact appetite.

And I see a lot of kids, especially fussy eaters, that are also constipated and that can impact appetite. So we need to be really mindful of that. If you think about yourself, if you've ever been constipated, it just makes you feel yuck and it really does change the food that you want to eat, how much you want to eat, and it can just make you feel really ugh. And so it's really important to understand that when a child is constipated, it is going to impact their approach and their want to eat certain foods.

Children will commonly have accidents. They might have very smelly flatulence. And it's very common in the toddler age group to have these withholding behaviors. And so sometimes a child might look or appear to be wanting to try and do a poo. You know, they might be doing a little dance. They might be, you know, tensing up their face. And the parent thinks that they're trying to do a poo, but in fact, they might be trying to hold it in.

And that is a real concern. And that's something that we don't want to miss because if children are holding on to their poo, it just gets drier and harder in their bowel, in their large bowel. And that makes it harder to push out. So the longer poo stays in the large bowel, the more water gets reabsorbed back into the body. And that it basically just makes it drier. And it's really harder to push out then. And

Functional Constipation and the Role of Dietary Fiber (06:51.81)
What can happen in children when they hold on and it just gets basically backed up in their system, then what happens is the that part of the bowel can get stretched, especially as it comes out, it can get stretched. And when that happens, you can lose some sensitivity and feedback to the brain that the child needs too. And so the longer this constipation goes on, the more problematic it can be longer term.

Another problem is when children do start to associate doing a poo with it being painful, then they want to hold on even more because they don't want to experience that pain and it just reinforces that vicious cycle. So it's important that we don't miss those early signs of constipation so that we prevent it getting to the point where they end up needing to go to hospital to get an enema or you have to go to the pharmacist desperate to

By an enema to try and clear them out because they're really just struggling to do a poo. Now, most of the time, constipation in childhood is functional, meaning there is no serious underlying disease or medical condition that is causing it. There is a small percentage of cases where there is an underlying medical cause, but the majority of time there isn't. My advice is that this is if this is going on for a very long time, then I definitely would get a doctor to review.

Your child and see a pediatric gastroenterologist if you need to, absolutely, just to rule out any other causes. But most of the time the constipation is functional, which means that there are things that we can do to help your child. So let's move on to now what causes constipation in kids. So the first thing that can contribute to constipation in children is a lower fiber intake.

Many children, we know 40% of children in Australia do not meet their dietary fiber needs. And this is a driver for constipation, especially when your child relies on white bread, white rice, pasta, crackers, plain cereal, yogurt, cheese, milk, biscuits, noodles, and packaged snacks. Because fiber helps not only bulk and soften stools, it helps.

The Nuances of Fiber Types and the Importance of Hydration (09:10.754)
Feed the beneficial gut bacteria. It helps support bowel regularity. There's many benefits to fiber to our gut, to keeping our stools soft and regular. And many fussy eaters are not getting enough fiber, which means that they're getting lower fiber intakes, lower plant diversity, less fuel for the gut microbiome, and less bulk for the poo. And less fiber that helps the stools stay healthy.

So certainly fiber intake is important to focus on. And when I talk to parents, I do go through the different types of fiber because there are different types of fiber. And some fibers, as I said, will cause cement. Some fibers will help soften the stools. So there's an important nuance and difference in terms of the types of fiber that your child eats. So we don't just want to feed them the types of fiber.

That is going to cause their pood to become even more cement-like because that's just going to reinforce the problem. So, yes, fiber is important, but also the type of fiber and the diversity of fiber is also important. Just to give you a few examples, we have insoluble fiber, we have soluble fiber, we have resistant starch. Okay, so there's different types of fiber to be aware of because you can really tailor your child's diet to increase.

specific types of dietary fiber to support their bowel health. Okay, another cause of constipation in children is inadequate fluid intake. Really, really important and often overlooked. You know, children just have their water bottles that they take with them. And sometimes it's really hard to work out how much your child is drinking because they might have a bubbler at school, they might have their water bottle,

But you just don't know how much of which they've drunk and whether it's been topped up or not. I mean, in some cases, the parents know that their child have literally had two sips of the water bottle all day and that's it. But sometimes it's important to really focus on increasing overall fluid intake, not necessarily just dairy like milk, but water to support bowel health. Because as I said, if they have a a good fiber intake but their water intake's really poor, then

Public Toileting Fears and the Impact of Too Much Dairy (11:26.668)
You're not going to get soft poo. You're going to get cement. Okay. Another cause of constipation in childhood is holding on. Okay. So withholding of their stools or their poo in their body. And this can be caused by a child not wanting to go to the toilet. This is very, very common when children start going out to places like daycare, like school.

where they don't want to do a poo in public or in a different toilet. And that can make it really tricky because they hold on, but then when they hold on, it then gets drier and then harder to poo out. And then as I said, it's just this vicious cycle. So if they're embarrassed, if they're a bit older and they don't want to use a school toilet or even if they're at daycare, like they're three year old at daycare and

They just don't want to do a poo outside of home, it can make them hold on. And that's a problem, especially if then they develop constipation as a result. If they have already associated doing a poo with pain or difficulty or they're scared, then they will hold on and they are not going to want to do a poo. They may always want to do it in the nappy, or they may just hold on and not want to do it at all. And it just gets harder and harder to push out. So it's really important to recognize constipation.

early so that your child does not develop these thoughts and fears and worries associations with doing a poo. Okay, another cause of constipation. Too much dairy. This is another very common situation with fussy eaters. They love the white diet. They love the milk, the yogurt, the cheese. Too much dairy means not enough plant foods means not enough fiber. So dairy influences things in two ways.

It displaces fiber because our children are just snacking on cheese sticks and yogurt instead of nuts and hummus and other plant-based foods, which are going to be much more nutritious for them and contain iron, by the way. This is a common thing that we talk about inside my nourish with Karina membership. We're always talking about tips and ideas to boost nutrients, to boost fiber, to boost iron in children that love the white diet. So

The Bidirectional Gut-Microbiome Connection (13:44.448)
This is an important thing to be mindful of with your child. Are they snacking on white foods all day long? And how can we move them over to more nutritious snacks? Now, dairy doesn't cause constipation in every child, but many children I see eat too much dairy and then not getting enough fiber. As I said, 40% of children. The other problem is that dairy actually can cause constipation in a group of kids.

So they have studied children who have constipation, chronic constipation. They have removed dairy from those children's diets. Those children improved significantly. The constipation went away. Then they reintroduced this dairy to the children, and then they got constipated again. So these are studies that have been done, clinical trials showing that in a subgroup of children, in a population of children, obviously not every child. So not only is dairy displacing fiber.

It actually can cause constipation in a smaller group of children. So hard to know if your child is that group, but it's something just to be mindful of. Now we know that the gut microbiome influences everything to do with our health. And it I think it's bi-directional in terms of the relationship between constipation and gut microbiome. They've found associations between, so in the research, they've found associations between.

functional constipation, so the constipation that I'm talking about and changes to the gut microbiota, but they're not sure, you know, which way it goes, whether it's b it's the fact that because you're constipated, you're not eating as well and you have a poorer gut microbiome, or is it that a poorer gut microbiome then causes the constipation? So the reviews that have found associations between functional constipation and changes to the gut microbiome have said that the relationship is complex and likely

Bidirectional. So, you know, it could be that the altered microbiome can influence constipation and then constipation influences the gut microbiome. But the the most important thing to know is that when your child does have fiber in their diet in their life, that fiber feeds the gut microbes. That produces these beautiful short chain fatty acids and supports gut movement so that your child's bowel actions are healthy.

Physical Activity and the Importance of Toileting Ergonomics (16:07.436)
And when your child doesn't get enough fiber, then you don't get this fermentation happening. You don't get all of the beautiful short chain fatty acids being produced, and you don't get the same support for gut motility. So it's just important to remember that microbiome and fiber do play a role. But of course, there's many other factors that play a role as well. So if we move on to low movement, so movement can help stimulate the bow.

So children who are less active or sit down for long periods of time may have slower bowel patterns. So this is just something to be aware of. It's not the case for most kids because most kids are active and moving around. I certainly see it in children who I've worked with with special needs who might be wheelchair bound, or children that just don't move around as much. It can impact bow motility. Okay, a couple more factors that I want to run through is.

Toilet routine and timing. Now, this is something that I also talk a lot about in my online consultations when I'm helping families fix their child's constipation and improve their child's gut health. And by the way, you can find out more information about my consults online on my website, nourishwithkarina.com. Just click on the consult tab. The toileting routine is really important and it's important to get into a good toileting routine with your child from when they are potty trained because

If you have a good toileting routine, it enables the child to empty their bowels more regularly and they're less likely to hold on at school. And it just helps everything work better day to day from a bowel health perspective. So I'd encourage you to have a think about your child's toileting routine. And obviously I can chat to you a whole lot more about that. but it it also comes down to

the toilet environment and how they're sitting on the toilet and their foot positioning and all of that because the bowel has a position that it prefers to be in to evacuate the stool and to clear out. And so that's another important factor to consider is how they're actually sitting on the toilet. And that all comes into the toileting routine. Okay. The final one I want to talk about now is stress, anxiety and neurodivergent children. Because if a child is more anxious

Anxiety, Neurodivergence, and the Gut-Brain Superhighway (18:23.958)
Is perhaps autistic or has ADHD sensory sensitivities or toileting fears, they may be more likely to withhold or avoid toilets or struggle with that feedback of when they do need to go to the toilet, or they may have restricted diets and be more fussy. And so those children may be more at risk and more prone to developing constipation. So it's important to understand these.

potential risk factors and red flags that could be contributing to constipation or the development of constipation and pick it up early so that you can support them to get their bowel health on track. Because when their bowel health is on track and they're eating better and their gut microbiome is better, that directly feeds back to their brain. The gut brain connection is huge. And if the gut health is better, the messages back to the brain are better and healthier and everything works.

Much better. We have a much more positive mindset. We have a much healthier body in general. The gut brain connection is incredibly huge. There's this super highway via the vagal nerve. It's part of the enteric nervous system that runs between the gut and the brain. At least 40% of the neurotransmitters are the same in the gut and the brain. So when you have a gut instinct or a gut feeling, that's just not an old wives thing. That's

Legitimate. That's real. Okay. So we need to make sure our children's gut are as healthy as they can be, especially for children that are anxious or neurodivergent, because we need to support that gut-brain interaction as much as possible. So picking up constipation early and addressing things early and improving their gut health, which improves their brain health and their brain function, their concentration, their mood, their focus, there's all this data and statistics around improved gut health and improved.

Improve concentration and focus and less anxiety and depression. It's incredible. So the more we can do for that group, the better. Okay, now let's talk a little bit about what you can do. If you feel like your child's gut health, a constipation is just not a hundred percent right. They might be getting a bit of tummy pain, they might be getting some skid marks in their underpants, they might be having accidents. So I would start with paying attention.

Action Steps: Tracking Patterns and the Right Way to Use Laxatives(20:44.76)
To what's happening to their daily bow routine and their daily bow health. And are they clearing out daily? Is it every few days? If they're older, you have to ask them what the consistency is. If they're younger, you'll know. But paying attention to their bowel health, their bowel routine, what's coming out, when it's coming out, how it's coming out, that's the starting point, just to make sure that it's okay, it's healthy, it's good. If it's not,

Then you need to start looking a little more closely at what's going on. You know, is it so hard that they're really getting a sore tummy and they've got really, you know, little pellet pebbles coming out? Do they need to go to the doctor? Does the doctor need to feel their tummy? And in this situation, laxatives can be supportive to restore normal gut motility and normal bowel actions, especially if it's going to help reduce.

pain, fear associated with doing a poo. Okay. If it's going to help them soften things and get it out regularly and stop withholding, then laxatives have their place. Sure, they're they're beneficial shorter term, but ideally not longer term, because typically they're a band-aid for something underlying, which is what I get to the bottom of pardon the pun in my consults with parents, because we we really need to understand what's going on, what's behind the constipation. What do we need to

fixed so that their gut health is going to be better long term for the rest of their life rather than relying on lexatives. I would start to think about your child's fluid intake. I would think about your child's fiber intake. I would start paying attention a little more to their toileting routine. How often are they going to the toilet? Where do they sit? How do they sit? These things are all really important because it's a day in, day out thing. And as I said, the bow needs to be in a certain position to clear out

Fully and properly, how do we support their microbiome? How do we get more plant diversity into them? Because at the end of the day, the more we can support their gut health, the more it's going to support their entire health and well being, mood, behavior, focus, and just they're just going to feel better. They're also likely to eat better because constipated kids will eat differently. They may not have an appetite.

Conclusion: Looking Holistically at Your Child's Gut Health (23:08.93)
They may want safe, comfort foods. So constipation will definitely impact food choice and how much they eat. They can be full of poo, so they don't want to eat. So I think from today's episode, I just want you, if you've got a child who is constipated or you're worried about their gut health and and how their bowel actions actually are day in, day out, I would do these things. I would start by tracking the pattern, as I said. I would look at their intake, I would look at their fluid.

I would look at the routine. I would start with those four things. And if you felt that you really needed support in this space, then reach out to me or look on my website, book a consultation, and we will go through everything. And I will give you a clear plan for exactly what to do to get your child's bowel health back on track. Constipation is not just a toilet problem. It is gut health. It is appetite. It is feeding. It is, you know, often much bigger than

Just sitting on the toilet and getting a poo at. So it's really important to look holistically at this for your child, for their long-term health. So as I said, reach out to me if you want to chat more. Send me an email to hello at nourishwithkarina.com or just go to my website to book a consult. My membership is currently closed. We do talk a lot about fiber. In fact, a couple of months ago, the member

Bonus for the month was the power of fiber PDF, a really powerful tool to help you boost your child's intake of all the important fibers. So my members do get a lot of support in this space as well. And again, you can find out about my membership on my nourishwithkarina.com website. I hope this has been a helpful, informative episode for you. And as always, I can't wait to chat again with you soon. Bye for now.