Constipation In Children - What You Need To Know
Constipation in infants and children is common. It can cause abdominal discomfort, pain when passing a poo
(stool), and an unhappy unsettled child.
Constipation can be short lived and be resolved with a few changes to diet and lifestyle, but if your child has ongoing issues it is important to see their GP to investigate if there might be any underlying reasons for constipation.
Some signs of constipation in children over 1 year (and formula-fed babies) are:
· not having a poo within 3 days
· when the poo is very hard or pebble-like
· very large motions
· pain when passing a poo
· regular soiled underpants
· fresh blood relating to a tear
Exclusively breastfed babies usually open bowels daily, but can go up to 7-10 days without a poo due to the breastmilk being easily digested. If your baby is settled and exclusively breastfed then there is usually no need to worry if they do not have daily motions. From the age of 1 year onwards a poo should be around type 3-4 on the Bristol stool chart (see below) and bowels open every 1-2 days without discomfort or straining. On the bristol stool chart type 1 and 2 indicate constipation and type 5-7 indicate diarrhoea.
Laxatives are usually the first treatment for ongoing constipation and are needed when diet and lifestyle changes do not work. Laxative use should be discussed with your GP and it is important that once starting on laxatives that they are taken consistently and slowly decreased rather than abruptly stopped.
A common reason for constipation in children is related to fluid intake. Lower fluid intakes means the poo cannot easily move through the intestinal tract causing the stool to become hard and difficult to pass. Children can often be poor drinkers and need regular reminding to drink over the day. Children should drink water and milk as their predominant drinks. Diluted juice such as prune, apple and pear juice can help for a child over 1 year of age to move their bowels. Other ways to increase fluid intake is with foods containing high fluid content, such as yoghurt, fruit and vegetables (e.g. cucumber). For more information on improving fluid intakes, head to: https://jumpstartnutrition.co.nz/2017/02/16/tips-to-get-more-fluid-into-your-child/.
Fibre is essential for the formation of stools and to aid the movement of the stool down the intestinal tract. Fibre comes from fruit, vegetables and wholegrain breads and cereals. If your child does not have a high fibre diet, then introduce fibre slowly into their diet. This is where a consult with a Dietitian can give you further advice around introducing more fibre into your child’s diet.
Fruit is a natural source of soluble fibre and fluid and is an important part of a child’s diet. Ideally a child should have at least two servings of fruit per day. A serving would be the size of the child’s fist. Encourage fruit intake as snacks, pureed fruit added to yoghurt or cereal, fruit in smoothies and added into cooking or baking. Natural laxatives such as prunes and kiwifruit can be added to cereal, smoothies, yoghurt and baking.
Vegetables are an important fibre source, but it is one food group that children may prefer to exclude. Ideally your child should have at least three serves of vegetables and similar to fruit, a serve is the size of the child’s fist. To ensure vegetables are part of the diet it is important to introduce vegetables in earlier infancy to get the child used to the different flavours. Vegetables are fantastic first weaning foods as they can be pureed to a smooth texture, but can also be steamed and given as finger foods. Hidden vegetables in the form of grated carrot, courgette, broccoli etc can be added to sauce dishes such as pasta sauce and used in baked foods such as savoury muffins to help increase intakes. Using puree vegetables is a great way to bulk up meat dishes such as mince and casserole. Offering vegetables sticks with a hummus or other dip can make eating vegetables fun and enjoyable for kids.
Wholegrain breads and cereals are an important fibre source for children and should slowly be introduced in to the diet over their childhood. Children are more likely to eat wholegrain breads if their parents also eat wholegrain breads, so it should be a change for the whole family. Wholegrain cereals can be introduced from an early age in the form of oat porridge and wheat biscuits. Good additions to foods to increase the fibre content are ground linseed and psyllium husk, which can be added to cereal and smoothies, or used when baking muffins. Bran can be used in the older child, but should be introduced slowly to avoid bloating.
Regular toileting after each meal and snack can encourage the natural movement of the bowel and help prevent constipation. Modern toilets are not well designed to support natural movement of poo, and raising your child’s knees higher with a foot stool, or encouraging a squat position with a potty may help. Warm baths, gentle massage and cycling of the legs while lying down can help infants and younger children.
In summary, when your child is constipated, think:
If these ideas do not help your child, then contact your GP and/or a Dietitian for further advice.
For more information on constipation, head to: https://www.kidshealth.org.nz/...
For more information on continence, head to: https://www.continence.org.nz/...
Original article on www.jumpstartnutrition.co. nz