Episode 14: Constipation in Kids

Episode 14: Constipation in Kids

In today's episode, we will be discussing a topic that affects around one in ten children at some point in their lives: constipation. We will explore the various reasons behind it in children and infants, focusing on important developmental milestones that can trigger this issue.

To access additional resources and dive deeper into this crucial topic, check out my Nourishing Kids membership at nourishwithkarina.com/membership. Don't forget to leave a review and send me a DM on Instagram with any topics you'd like me to cover in future episodes.

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Links
https://nourishwithkarina.com/feedingbabies
https://nourishwithkarina.com/3-week-feeding-kids-reset

Highlights:

Introduction (00:00.078)
Constipation in Children: An Overview (02:15.886)
Childhood Constipation and Its Causes (04:38.638)
Constipation in Children: A Parental Perspective (06:55.15)
Toileting Practices in Children (09:18.222)
Supporting Children's Bowel Health and Constipation (11:42.638)
Understanding Bowel Health and Fiber (14:06.926)
Gut Microbiome and Probiotics for Healthy Bowel Health (16:25.774)
Probiotics and Constipation in Children (18:41.774)
Constipation and Food Intolerance in Children: Dairy and Wheat (21:05.23)
Childhood Constipation Management: A Guide (23:26.51)

Show notes

READ TRANSCRIPT

Show Notes

We will discuss the impact of factors such as introducing solid foods, unfamiliar surroundings like daycare or school toilets, and how these can affect your child's bowel health.

Here are five crucial points we'll be covering:

1. Normal Bowel Habits: I'll shed light on the variations in bowel habits in children, from babies to toddlers, and what signs indicate constipation. Understanding what's normal is the first step in identifying potential issues.

2. Toilet Training Techniques: I'll provide insights into the importance of good positioning during toilet training. Whether in nappies or using a potty, the right position can significantly impact their ability to have a comfortable bowel movement.

3. Dietary Strategies: We'll discuss the role of fluid and fibre intake in preventing and managing constipation. From the right amount of water for different age groups to fibre-rich plant foods and their impact on gut health, we'll explore dietary approaches to support your child's bowel health.

4. Probiotics and Gut Health: I'll share information on how the balance of gut bacteria, specifically lactobacillus, can play a role in constipation. We'll discuss the potential benefits of probiotics and how they might contribute to maintaining a healthy gut microbiome.

5. Food Intolerances and Medications: We'll touch upon the possibility of food intolerances, especially regarding dairy and gluten, and how a systematic trial can help identify and manage constipation. Additionally, I'll address the use of stool softeners and their role in maintaining bowel regularity.

If you want to equip yourself with valuable insights into managing childhood constipation, join me in this episode of The Easy Feed Podcast. Remember, you're not alone in facing these challenges, and there is help available. Tune in for practical tips and expert advice.

For more in-depth discussions on parenting and child health, listen to the full episode on your favourite podcast platform. If you want to learn more and stay connected, remember to subscribe and share your thoughts with us. Here's to happy and healthy little ones!

Learn more about my membership program, head over to: https://nourishwithkarina.com/membership

Introduction (00:00.078)
You're listening to the Easy Feed Podcast, episode number 14, constipation in kids. 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 so good to have you here. Today I'm going to be taking a dive into a very common issue for many of us, not just for children, but it's constipation. And constipation is very common in children and infants. The stats tell us that it's roughly about one in 10 children will suffer constipation at some point.
seems to be even higher in little ones and infants can also struggle with constipation. So it's something that many of us will face at some point, if not in our children, in ourselves. So I'm here today to dive a little bit deeper into what are the causes and what we can do about it. Most of the time, constipation in young children occurs without any underlying medical cause.
Bow habits really vary significantly. Look, in babies, normal can be a poo every day, up to four times a day, even up to once a week can still be normal for a baby, which I still struggle to get my head around a little because I think if my daughter or son was only pooing once a week, I would probably feel a little concerned, but...
Look, there is a huge range, especially in babies, as to what is normal for bowel health and for pooing. And then as children get a little older, it does tend to normalise a little more closely to about the age of two, three. Typically children will have approximately one to two formed bowel actions or poos per day. And usually the poo is a patty -like consistency because usually
Constipation in Children: An Overview (02:15.886)
Let's be honest, it's squashed into the nappy. So it's formed, but it's not too hard. It's when the poo is small, hard, pellety, pebbly, and super hard to push out. That's when parents get worried when they're looking at their child trying to do a poo and their face goes bright red and they're really straining or upset and crying. That's when parents start to get really worried and, and the concern that their child may have constipation.
So look, there is set criteria in the pediatric gastroenterology world as to what constipation is. And there's all these criteria and you have to basically tick off two of the criteria to qualify. But really at the end of the day, constipation children usually have very hard pellet -like bowel actions and they're often painful to pass. They may become less frequent. So children who were previously pooing once a day.
may only poo once every three or four days. And as I said, they can become quite distressed doing a poo. Sometimes children, and this often happens in the toddler age group, they start to hold on because they start to associate doing a poo with straining or possible pain. And so this is something that we really need to be mindful of because...
holding on behaviors can lead to worsening of constipation. And look, I've been working in this field for 21 years and I've worked with pediatric gastroenterologists all my career and I've seen thousands and thousands of constipated kids and it does get worse and kids can end up having to go to hospital by the age of, you know, eight or nine if the holding on continues and the constipation worsens. So look, I'm not here to freak you out, but...
It can get worse and that's why picking up holding on behaviors early is so important because it means you can get on top of it, set up some strategies, get them pooing better and get them feeling happier about pooing. Because really at the end of the day, if they're scared to do a poo or they're worried about the pain of doing a poo, then they will continue to hold on. And that's when the poo sits in their bowel and it becomes harder because basically,
Child's Constipation and Its Causes (04:38.638)
The body, the bowel reabsorbs the water from the poo and just becomes harder and dry and more like concrete. So holding on behaviors is important to be aware of. And look, children may have different holding on behaviors. They may have their knees up to their chest. They may rock back and forth. They actually may stiffen their whole lower body straight out. They may stand on their tiptoes. They may go into a corner and do a little fidgety dance.
You know, there's all different signs of children holding on and there's also very different behaviours when children are actually trying to do a poo. So sometimes it's impossible to work out what's going on with your child's actually trying to do a poo or hold on. But I will say this, if it seems like they are trying to hold it in and they are consistently not pooing.
then I would really try to, we'll try some of the strategies that I'm going to talk about today because the more we can get them pooing regularly and feeling happy to do a poo, the better it's going to be for their bowel health long -term. Some key milestones of a child's development when constipation may arise or may develop is first of all, introducing solids.
When this happens, when you're introducing a whole new world of food, of fibers to the gut, the gut has to adapt. And sometimes this can cause constipation. This is a very normal time when constipation can develop and it's nothing to be alarmed with or worried about. It's just going, okay, this is a very common time and let's, you know, put some strategies in place to support your little one to get through this time.
unfamiliar surroundings can also be a cause of constipation. So perhaps when your child starts daycare, childcare, or even school, when they have to start going to the toilet and doing a poo somewhere else apart from home, that can actually cause them to feel unsure or anxious about doing a poo in those new surroundings. And for this reason, they may choose not to do a poo.
Constipation in Children: A Parental Perspective (06:55.15)
And therefore hold on all day. And by the time they get home, they might, may not necessarily need to do a poo. So that poo just stays in there and gets harder and drier. And then this story continues on and on every time they go out or have to, you know, go to the toilet outside of their usual familiar surroundings. So unfamiliar surroundings can trigger a constipation or a child being, I guess, introduced to a new routine with unfamiliar surroundings can.
Yeah, can cause constipation. So just something to be mindful of. Look, sometimes school toilets aren't set up well for children to be able to relax and do a poo. There may not be enough privacy for that child and, and they don't want to do a poo in the school toilet. And again, so that means they hold on and this vicious cycle can start. So it's just good to be mindful of these time points in a child's life that can exacerbate.
the development of constipation. When you are looking to toilet train your little one, it is important that they are in a good position. And this goes for any child that's doing a poo. We need to make sure that when they're sitting, their feet are supported and their knees are upright above the height of their waist. So if you think back to caveman days, really the squat position is a great position for the bowel and the
the lower bowel and the rectum to be in to do a poo. So if your child is in squat position or, and you might find that, you know, if your child's in nappies, they like to do a poo in squat position, because that is the best position for them to be in to do a poo. So if they are positioned with their feet supported, their knees up above their waist height, this is a good position for them to be in. Whether they are...
potty training and you're trying to get them in this position at the age of say two and a half or three, which is I think a reasonable age to consider potty training. Or whether you've got a five or six year old sitting on the toilet with their feet on a stool and their knees up above their waist. That is a really good position for an older child to be in because positioning will influence their ability to do a poo.
Toileting Practices in Children (09:18.222)
And we want to obviously give them the best chance of getting it out as easily as possible because again, once they realise that it doesn't hurt and it feels good to get it out, then they're more likely to be more confident and want to go back on the toilet or on the potty. Timing and consistency are also important to enable children to develop regular bowel habits. And the recommendation that I have for you there, especially in a child that is already potentially constipated,
is to set up a really healthy routine of sitting them on the toilet after breakfast and after dinner for about 10 minutes each time in a relaxed, calm state. So give them a book. If they're older and they just won't, older and they just won't sit there with a book or, you know, if they're really young, you can sit with them. But if they're older, then you may throw a screen at them and just get them to relax on the toilet for 10 minutes.
after breakfast and after dinner. Again, make sure their feet are supported, knees are up, but giving them that time to relax on the toilet, it doesn't actually matter. Say to them, it doesn't matter whether a poo comes out or not. You actually just want to reward the behaviour of sitting there. You don't want to reward whether anything came out or not. So you don't want to reward a poo coming out with a couple of little, you know, &Ms or something like that, because you don't want them to then...
think that they have to try and push something out, you reward the fact that they sat there for 10 minutes and relax on the toilet just to see whether anything came out. So that's the approach that I would take. Make sure that the positioning is good and set up a routine where they're sitting on the toilet after breakfast and after dinner, 10 minutes relaxed, feet supported, knees up and just say to them, look, just sit on there. It doesn't matter if anything comes out. Don't push, don't strain. Just see what happens. And that's a really good approach. So you would reward.
them for sitting on the toilet, not whether anything came out. So you might give them a little sticker and once they've got so many stickers, they get a little prize, a reward. So a sticker reward chart can work really well there, especially if they're younger, just trying to find a way to encourage them to sit there, relax and not push and not strain. So aside from routine and positioning on the toilet, what else can we do from a dietary perspective?
Supporting Children's Bowel Health and Constipation (11:42.638)
to support our children's bowel health and constipation? Well, poor fluid intake and low fibre intake can both independently influence constipation risk and the development of constipation, and then the reversal of constipation. So in terms of fluid, we'll start with fluid. Children with constipation do need to make sure that they are getting their
regular fluid requirements. The research doesn't support them having extra fluid if they're already good water drinkers. So if they already meet their fluid needs, they're not necessarily going to benefit from significantly increasing the fluid intake above what they normally drink. But if they're poor fluid drinkers, so if they would only drink maybe a cup or two of water a day and they're six, then increasing that water intake is like
to potentially help their constipation. So looking at their age, a young child, a toddler, we want to be aiming for at least one litre of fluid, mainly water, per day. And that's separate to the fluid in food, like for example, custard or yoghurt. And for a school -aged child, we want to be aiming, and I mean primary school, so like a six, seven, eight year old.
We want to be aiming for around 1 .5 litres of fluid a day, mainly water, and that's aside from food. So I would be checking your child's fluid intake to make sure that they're meeting most of their fluid requirements. And if they're not trying to increase that, cause that may help with their bowel health and keeping their poos softer. Now, every child, just like every adult is going to have different fluid needs. If you're a big, heavy sweater,
you're likely to have higher fluid requirements than your friend sitting next to you that may not be a big sweater. So even though I've given you some rough, you know, numbers to aim for, sometimes kids get away with less, sometimes kids need more. It really depends on how much fluid they lose. In hot, humid conditions, children are going to need more fluid. And just simply looking at their skin, is their skin dry, are their lips dry, can also give you an indication of whether they're meeting their fluid requirements.
Understanding Bowel Health and Fibre (14:06.926)
Another way to check is to look at the colour of their wee. If the urine is very yellow and smelly, then they're absolutely heading towards dehydration and they need more water. Whereas if they're weeing regularly or in their nappy is regularly full, so you know, having at least four or five wet nappies per 24 hours and it's a very light pale yellow colour, then chances are they are hydrated and they're getting enough fluid. In terms of fibre,
Fibre definitely influences our bowel health and our stool or our poo consistency. There are different types of fibre. We have insoluble fibre, which tends to be present in the outside of the grain. So the bran, the husk, and that's where you find a lot of insoluble fibre. So for example, wheat bran. And insoluble fibre helps to bulk up the poo and it helps to move it through the bowel.
the gastrointestinal tract and come out the other end. Soluble fibre on the other hand helps to keep water in the poo, helps to soften the poo and also helps to move it through the gastrointestinal tract. Then there's resistant starch which acts like a fibre and that's also good for bowel health and that's found in things like bananas and potatoes that have been cooked and cooled. Same with rice.
that's been cooked and cooled. So resistant starch is another fibre that can benefit our gut health. At the end of the day, we really just want to be making sure that we're giving our children more plant foods so they're getting more fibre to support their bowel health and reduce the risk of constipation. The fibre in these plant foods is also known as prebiotics. I told you I'd get a bit gut geeky. The prebiotics is the food that feeds our gut bugs. So...
If we're feeding our gut bugs good, healthy, fiber rich foods, then our gut bugs are going to be thriving and we're going to have really good, healthy populations of the good bacteria to balance out the bad bacteria. So we'll have a healthy balance of good and bad bugs in our gut. So the fiber rich foods or fiber, which is prebiotics, is what the gut bugs feed off. So again, giving our children fiber rich foods is going to support.
Gut Microbiome and Probiotics for Healthy Bowel Health (16:25.774)
a healthy gut microbiome as well as healthy poo consistency and helping it to move through the bowel. So foods such as fruits, preferably with the skin on, same with vegetables, preferably with the skin on, don't peel your carrots, don't pull your potatoes, leave the skin on. Oats, grains, nut butters, seeds, legumes, they're all really good sources of fibre, mainly soluble fibre for our bowel health.
Some foods that will specifically act as stool softeners, foods such as pear, prune, and kiwi. Green kiwi has also been studied and has shown to have natural laxative effects. There is no evidence for additional fiber supplements in the management of childhood constipation if your child is already having fiber -rich foods.
So just a little more on the gut microbiome and the probiotics. There is some evidence supporting the link between an imbalance of the gut bacteria and gut problems. So in simple terms, that means that if the balance of the healthy bugs and the bad bugs are out of whack, so if there's more bad bugs than good bugs, then we can start to see more.
functional gut disorders and constipation can be one of those. So the studies have shown that young children with constipation do have a different balance of microbes in their gut and they have a lower concentration of the healthy bacteria that we do want to have good amounts of, called lactobacillus. And if you look at probiotic supplements in the pharmacy, you will see that a lot of those ones for children and for adults,
do contain lots of lactobacillus and that's because this is a bacteria that we do want in our bowel. So probiotics aren't going to work for everybody, but they're certainly worth a try if you feel that your child may have had a bit of a rough trot with their gut health, they may have had lots of antibiotic exposure, maybe they were really colicky as a child, as a baby I should say, or maybe they're still colicky as a child.
Probiotics and Constipation in Children (18:41.774)
irritable behavior. But look, I think at the end of the day, they're worth a try, but there's not significant evidence in the literature to say that yes, definitely probiotic supplementation has got to stop constipation, but it's certainly worth a try and I would try them for a month. See if it makes a difference to the bowels and you could then stop them and then see what happens or keep going for, you know, three to six months and then stop. But basically trial, see if it makes a difference, if it seems to benefit, you can continue.
If not, you can stop and save your money, but probiotics may be beneficial, definitely in some situations. So what about food intolerance? Well, look, sometimes there is definitely food intolerances that will cause constipation. If we first talk about dairy, dairy is what I call almost a complete food. It has protein, it has carbohydrate, and it has fat. And
This isn't necessarily a good thing because children can feel very full, very satisfied on dairy, but it doesn't necessarily provide them with everything that they need, such as iron, for example. Now, dairy contains the dairy protein, which has been linked to constipation, and also contains dairy carbohydrate known as lactose. And lactose is now also linked to constipation. We used to think lactose only caused...
loose mucous stools and gas, diarrhoea. But now there's been links and definitely evidence to suggest that lactose can also cause constipation. So removing dairy as a trial for a month is often what I would suggest if everything else we have tried first fails. So I work through my checklist of fibre, fluid, toileting routine, positioning.
All of those things first, I would never overly restrict a child's diet unless we kind of got to the point where it's like, right, now what? And you don't want to just use medication because that's more like a band -aid treatment to cover the constipation, but it's not really getting to the underlying cause. So if you've tried everything else, then I would consider pulling out dairy for a month. And the reason is because there is very good evidence that in a sub group,
Constipation in Children: A Study on Dairy and Wheat (21:05.23)
of children, a population of children, that dairy is constipating. And whether that's the protein or the lactose, basically we're not going to know from that study or from those studies anyway, because what they've done is they've removed dairy completely and the children have gotten significantly better. Their constipation has resolved completely. Then they've re -challenged them with dairy and the constipation has come back. So those children had a dairy induced constipation.
And once dairy was removed again, then they resolved again. So dairy can definitely cause constipation in a group of children. I'm not saying it's everybody, but when we've tried everything else, then I will try a month of dairy free to see if it helps the constipation. And again, making sure that fluid and everything else was appropriate. Aside from dairy, the only other significant food protein that may, or food...
group, I should say, because again, wheat, like dairy, has got the protein, it's got the gluten, and then it's got the carbohydrate, which is a fructan. And look, this is when I would encourage you to have a one -on -one consultation with me because we're getting into some pretty specific scientific stuff here that you really do need professional guidance with. But wheat is the other thing that I will often consider trialling for a month for free, like removing for a month.
going gluten free for a month to see whether it actually improves bowel health. And usually I would also be asking about family history here because whether mum or dad, you know, if they've got food intolerances, that can also influence what I say and the things that we try. So it's really important to look at it from a holistic perspective, including family history. Now, often children that I work with already on what we call stool softeners,
And this is a stool softness such as osmolax, lactulose, homovo -col, milk of magnesia. And these are effective to keep children pooing and to maintain confidence with pooing and keep them clearing out basically. And so I encourage parents if needed to keep the child on these laxatives for as long as needed.
Childhood Constipation Management: A Guide (23:26.51)
until we can get them off. Now, we're not talking about medications that contain like Senna, which is about stimulant, that's different. And that can cause, you know, they're about to be lazy long -term, but the pediatric gastroenterologists that I work with, they don't have a problem with children being on these osmotic laxatives, these stool softeners that basically act just to help move the poo through the...
the bowel and also soften it. So basically encourage water to come into the bowel to soften the poo. They don't have a problem with them being on these longer term because they're not going to induce laziness of the bowel like some of those other stimulant medications. So look at the end of the day, I still say it's great if we can get them off the medication, but on the flip side, if it means that they are going to associate
pain with doing a poo and therefore start holding on, then that's also a very slippery slope. So you've sort of got to work out what's the lesser of two evils. Them being on a bit of bowel medication whilst they're developing, I guess, their own strategies to be able to do a poo on their own. And that could be fluid, fibre, positioning, routine. So, you know, whilst we're working on all of that, it's useful for them to stay on the stool softeners. But...
When we can get them off it and we do get them off it often, then wonderful. Then we get them off, but they do certainly have a place to keep kids clearing out to avoid hospital admissions or suppositories up the bum. They do have a place, absolutely for as long as needed. And then of course, you know, we get them off as soon as possible. But all I'm saying is it's fine for your child to be on a laxative, on a stool softener, osmotic laxative.
for as long as needed until we can wave our magic wand and get them off it. So I hope that's been helpful for you in relation to childhood constipation. I know I focus only on constipation today. I work with children with all types of gut issues and often it's the opposite and they have runny boos and tummy pains or urgently spell actions or lots of wind and...
We have different strategies for that as well. And I will certainly do a podcast on other bowel issues in children another time. But today I wanted to focus on constipation because it is a very common concern. I think it's about at least 30 % of presentations to a pediatric gastroenterologist is for constipation. If your child is constipated, you are certainly not alone. And there is certainly help there.
Please reach out to me, you can catch me in a one -on -one consult if you are wanting really personalised advice for your child or wanting just to pick my brains more. But reach out to me on Instagram as well, link me a message, send me a DM and I would love to hear from you. Also, please leave me a review because I would love to get this podcast out to more and more and more mums. I'm getting some wonderful feedback from mums, which is brilliant, but...
Let's get it out to more mums, so please leave me a review and I'll see you next time. Bye for now.