Kids and Constipation: Is Quick Relief Possible?

Did you know that about 5% of visits to the pediatrician & about 25% of referrals to a pediatric gastroenterologist are for constipation?

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What even is constipation?

According to the Rome IV criteria, constipation for toddlers (> 4 years old) can be diagnosed when at least two of the following occur for one month:

• Two or fewer defecations (poops) per week
• History of excessive stool retention (holding it in)
• History of painful or hard bowel movements
• History of large diameter stools
• Presence of a large fecal mass in the rectum
• At least one episode/week of incontinence after the acquisition of toileting skills (child already toilet-trained and still pooping in his/her pants)
• History of large diameter stools which may obstruct the toilet (poop getting stuck in the toilet)
  

If your child has belly pain and constipation and that pain is not alleviated when the constipation is resolved, they could have Irritable Bowel Syndrome. Make sure to check in with a pediatric gastroenterologist if this is the case!

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Did you ever wonder why your child is suffering from constipation?

Here are 4 main reasons why your child may be backed up:

1. Diet: if your child's diet consists of too many processed foods, that is likely taking the place of fiber-rich, water-containing foods like fruits & vegetables 
2. Illness: if your child is sick, it's likely that their food intake, in general, is lower than usual. 
3. Medical conditions: some medications or medical conditions like IBS-C, an anal fissure, or a thyroid condition can cause constipation.
4. Withholding Stool: when a child has the opportunity to have some element of control, they sometimes take advantage. We've all been there- like when a child refuses to eat, for example. They also have control of their bowel movements. Some children hold in their poop for this reason! But if they have a gastrointestinal issue, like IBS-C  or an anal fissure- they could be afraid of the pain passing stool may cause-something important to be mindful of! 
5. Change in Routine: maybe your child has traveled ✈ recently, or moved, started a new school or they are experiencing a difficult relationship. Stress in your child's life could also be to blame.

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So how can you help them become super poopers? Is there a quick relief for kids with constipation?

The goal is to relieve & re-establish normal stool patterns and the method depends on many factors including:

• Child's age
• Reason behind their constipation
• Severity of stool burden

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Some actions you can take regardless of the reason your child is constipated:

1. Establish a healthy diet and lifestyle: include fruits and vegetables on a daily basis, about 5 servings, as well as whole grains--->Fiber is their friend and helps move stool out the back door!
2. Make sure your child has some physical activity in their life: remember your intestines are a muscle that contracts and relaxes---> it needs exercise! The American Academy of Pediatrics recommendations state that children ages 3 to 5 years should have at least 180 minutes per day of physical activity while kids ages 6 to 17 years should have 60 minutes
3. Check-in and see how much fluids your child is getting each day: in addition to water, fluids come from fruits, vegetables, soups, smoothies, ice pops, etc. Find out your child’s estimated daily fluid needs from the Institute of Medicine.
4. Probiotics---> stay tuned, we need more research!
5. Seek help from a registered dietitian or pediatric gastroenterologist (especially in severe cases)

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Which foods offer natural, quick relief for constipated kids? 

Foods that are rich in fiber may help move things along in your child’s gastrointestinal tract. If your child’s current eating pattern is low in fiber, make sure to gradually increase fiber to allow time for your child’s body to adapt. There are two types of fiber and both can be helpful in relieving constipation, but which one you choose may depend on the reason behind the constipation. 

Soluble dissolves in water and creates a gooey, spongy mass and slows down the GI tract which can promote soft, well-formed and easy to pass stool formation. It can be found in oatmeal, apples, sweet potatoes, bananas, squash, avocados, carrots and beets. 

Foods rich in insoluble fiber include leafy greens, nuts, seeds, popcorn, 100% whole-wheat bread and fruit skins. This type of fiber doesn’t absorb water and, thus, maintains most of its physical properties (hence the nickname “roughage”). It adds bulk to your stool and puts pressure on the colon which helps stimulate a bowel movement. 

Foods that are rich in fiber may help move things along in your child’s gastrointestinal tract.

Here is a list of our go-to, fiber-rich favorites for kids:

• Kiwis
• Berries
• Cherries
• Apricots
• Prunes
• Seeds & Nuts
• Molasses
• Beans & Lentils
• Whole Grains
• High-Fiber Cereals
• Dried Fruit
• Pear Nectar
• Whole Wheat Breads

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How do I know if my child needs a laxative or fiber supplement?

If simply offering your child one of these foods isn’t doing the trick, a combination of a bowel regimen and diet may be warranted.  This can include a specific type of laxative as well as the specific timing of when you take the laxative. Be sure to check with your pediatrician to understand which may work best for your child.

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Do I need your help with my kid’s constipation?

When it comes to relieving constipation with food meal timing, the amount of water and fiber as well as when you eat foods can be key in conquering constipation. As registered dietitians, we have the knowledge to help guide you. We know the different types of fiber: their properties, when to use them, as well as the effect they have on the gastrointestinal tract.