How to help your child with constipation
It’s tough as a parent to see your child uncomfortable with constipation. Let’s start with taking away the embarrassment of talking poo. I spend my days talking bowel movements and use many different words. For consistency in this blog, I am going to refer to them as BMs (bowel movements) and stool.
The NHS guidelines for constipation in children are below (for accuracy I am using their exact wording).
Children are classed as constipated when:
- they have not done a poo at least 3 times in the last week
- their poo is large and hard or resembles rabbit droppings
- they are straining or in pain when they poo
- they have some bleeding due to a large hard poo
- they have a poor appetite or tummy pain that improves after a poo
In addition, they can also experience bloating, nausea, irritability and fidgeting.
Organic vs functional constipation
Research suggests that 95% of the time, constipation doesn’t have a medical reason due to an anatomical or physiological abnormality, known as organic constipation. This can include food allergy, hypothyroidism, coeliac disease, Hirschsprung’s disease, and connective tissue disorder (Ehlers-Danlos Syndrome).
It is often due to poor diet, poor bowel habits, emotional factors or after they have had a gastrointestinal infection. All these are termed functional constipation. An underlying cause is found in less than 5% of functionally constipated children.
According to a 2022 study, functional constipation occurs in 29.6% of children worldwide. That’s a lot of children.
Let’s look at ways we can help to improve constipation in children.
How can we improve constipation in children?
Just as we have mindful eating, I encourage mindful toileting too.
Let’s start with the ‘call to stool’. A moment when the stool pressure in the rectum gives your child a warning that a stool is on its way. It is common for children to get so absorbed in what they are doing that they ignore the ‘call to stool’ and a BM is delayed, making constipation more likely. The rectum gets used to being stretched, while stool becomes dehydrated and backs up in the large intestine causing discomfort.
Teach your child to listen to their body and recognise the signs a BM is imminent. When the call arrives, encourage sitting on the toilet in as relaxed a manner as possible. Keep books available in the toilet so that a relaxed posture means relaxed bowel muscles.
Withholding behaviours include tensing up, crossing the legs or tightening up buttock muscles when the urge to have a BM is felt. Stool withholding may be an intentional behaviour to avoid unpleasant sensations and associations with BMs. It’s vital therefore that the household makes toileting an acceptable, normal bodily function. Avoid commenting on smell or getting frustrated with soiled clothes or accidents. If embarrassment is taken out of the equation, your child is more likely to be happy having a BM anywhere. If they are unhappy to have a BM at school, at a friend’s or a public toilet, then teach them that everyone is doing it and it’s perfectly OK.
It’s common for children to slump over at the waist making it harder for stool to be released. Enter the 'Squatty Potty' - a stool that raises your knees above your hips to put you into a squat-like position, just like our ancestors did. This promotes the relaxation of the puborectalis muscle and straightening of the anorectal angle to make passing stool easier. You can use the same step you use for your child to reach the basin or even just a box.
If your child learns to act on the ‘call to stool’ regularly, a BM should be a comfortable experience.
Watch out for red flags
There are some red flags you need to watch out for. If your child experiences any of these below, please contact your GP:
- A BM that is painful (they should never cause pain).
- ‘Overflow’ diarrhoea that works its way out around the impacted stool. You may think your child has diarrhoea when they have constipation. This is called encopresis, soiling or faecal incontinence.
- Faecal streaking which is a precursor to encopresis where passing gas leads to streaks of stool. Finding skid marks on underwear is a typical sign.
- Anal fissures, tears to the skin of the anus.
Encourage your child to ‘eat the rainbow’ and tick off different colours they have eaten throughout the day.
The three essentials for constipation – fibre, hydration and movement
These are your starting point and, in addition to mindful toileting, should be thoroughly covered before you start looking elsewhere. Most constipation cases can be sorted with these simple changes.
For most children, focusing on fluids and high fibre is a good start:
Aim for five servings of veg and fruit per day. Switch white grains such as rice, pasta, bread to wholegrain versions as much as possible. Include legumes in your child’s diet such as beans, lentils & chickpeas. I find humous and baked beans (although not necessarily together!) go down well.
Portion size for a small child can be a couple of small carrots or half a cup for a larger child.
Kiwi fruit is a good fibre and a fun fruit to scoop out with a spoon.
Some of the highest-fibre foods I find popular with my child clients are: raspberries, pear, broccoli & carrots. Kidney beans top all these per gram of fibre so if you can make a bolognese, adding whole or chopped/pureed kidney beans is a great way of sneaking them in.
Porridge oats with milled flaxseed and berries is a great fibre-rich breakfast for any age child. Flaxseed has a favourable nutrient profile of essential fat (which can lubricate the path for stool) and fibre, both of which help keep bowels moving.
Go slow with increasing fibre though – the gut needs time to adjust. Plus it is important to increase fluid intake when increasing fibre to avoid constipation – offer your child fluids regularly throughout the day.
Fluid is essential to move the fibre through and soften the stool. Avoid soft carbonated drinks and offer water or diluted fruit juices. Even better if your child will try warm or room temperature herbal teas that also have beneficial digestive effects such as fennel or mint.
Prune juice can help relax the bowel (it acts like a natural laxative) and children often like its sweetness. Try 1/3 cup prune juice with 2/3 cup water before bed to benefit from the laxative effect in the morning.
Movement massages the intestines. Children play inside much more than they used to, so encourage your child to get outside and run around at home and at school playtimes. Having a regular movement class they enjoy is helpful too such as martial arts, swimming, dance or team ball games. It doesn’t matter what the class is, as long as they enjoy it and move!
Specific foods that deserve a mention
Magnesium containing foods
Magnesium is required to stimulate peristalsis. Peristalsis is the muscular movement of stool through the large intestine and rectum. Magnesium works by relaxing muscles and as a stool softener to help smooth the passage of stool making it easier to pass.
Incorporate magnesium-rich foods into your child’s diet such as:
- Nuts and seeds - as butters, ground, chopped or whole.
- Dark green leafy veg – baby spinach is easy to add to many dishes, broccoli is often a winner or make kale crisps.
- Wholegrains – brown rice and whole grain bread.
As long as your child does not have a dairy allergy or lactose intolerance, incorporating cultured dairy can be useful. Plain yoghurt or kefir is best for this, you can add flavour by adding fresh fruit (which also adds vitamins, minerals and fibre).
However, cow’s milk products are also a common allergy-induced cause of constipation, so if you try cultured dairy and find things don’t improve or get worse, please speak to a registered nutritional therapist about doing a dairy elimination under supervision.
A diet packed with fresh food as nature intended is key for supporting gut health. By definition, this means avoiding processed foods as much as possible. Encourage your child to ‘eat the rainbow’ and tick off different colours they have eaten throughout the day.
In most cases, these suggestions should enable a positive effect. If not, then other things to consider are: food sensitivity or allergy, dysbiosis (imbalance of gut bacteria) and/or parasitic infection or an underactive thyroid. These are best pursued with a registered nutritional therapist.