Constipation is a common problem in children. It is defined as infrequent bowel movements or poo that is hard to pass. Constipation can cause irritability, bloating, stomach cramps and withholding behaviours. Treatment usually involves improving the diet, encouraging healthy bowel habits and adding gentle supplements into the mix if necessary.
What is normal?
Bowel movement frequency in a child can vary significantly. In a newborn bowel frequency can range from after every feed to once every few days. In an older child frequency can vary from a few times a day to a few times a week.
You only need to worry about the firmness or frequency of your child’s poos if it seems to be causing a problem.
What to look out for
Common signs and symptoms of constipation include:
- Large, hard stools or small dry pellet-like stools
- Infrequent bowel motions
- Stomach cramps
- Loss of appetite
- Irritable behaviour
- Saying that it hurts when they do a poo
- Refusing to go to the bathroom to avoid pain of passing a stool
- Straining—indicated by reddening of the face and whole-body tensing
- Anal fissures (small splits in the skin around the rectum) or haemorrhoids which can bleed and cause pain
Long-term constipation
Your child's rectum (bottom) may be full of poo for a long time and this makes it become stretched. Your child may not get the urge to go to the toilet because of this. The poo can then pass into the child's pants, without them feeling it. Soiling is medically called encopresis or faecal incontinence.
Constipation causes
Natural tendency—some children naturally have a slower transit time through the gut and a lazier bowel. In most cases of constipation in children no serious cause is identified
Poor bowel habits—some children ignore the urge to have a bowel motion for various reasons. Sometimes they are too busy and put off going to the toilet—causing the poo to get larger and harder. During toilet training it is common for a child to hold on and at school they may avoid bathrooms due to lack of privacy. If a child has had pain in passing a poo they may display holding on behaviour to avoid the same experience.
Diet—a child with constipation may have an inadequate diet. It could be low in dietary fibre which is found in wholegrains, fruit, vegetables, nuts and beans. There may also be inadequate fluid intake or excessive cow’s milk consumption.
Disease—in a small number of children there may be an underlying reason for constipation.
Organic causes of constipation may include anorectal malformation, underactive thyroid, spina bifida and other metabolic disorders.
Natural treatment options
Establish a regular toilet routine
It is important for constipated children to develop the habit of sitting on the toilet regularly—especially if they have the urge to go and even if they don’t. This can be for 5 minutes after a meal including breakfast, lunch and dinner. Provide encouragement and reinforce good behaviours with age-appropriate stickers and reward charts. Discuss the school toilets with the teachers if this is a problem.
Nutritious diet
Usually a change in diet is sufficient to correct constipation in most children. Avoiding processed foods is vital as usually these foods are low in fibre. When buying pre-packaged foods make sure the ingredients are wholegrain and there is more than 7g of fibre per 100g. Increase serves of fresh fruit and vegetables and make sure your child is drinking plenty of water. Natural yoghurt may help to provide a source of healthy bacteria.
Herbal medicine
Herbs that help to improve digestion can result in softer stools and less bloating. Suitable herbs in children include dandelion root, liquorice, peppermint, chamomile, fennel and lemon balm. Many of these herbs are pleasant-tasting and be made from an infused tea leaf or purchased as drops and added to drinks such as a bottle or food.
Fibre supplements
Sometimes fibre supplements are necessary to add into the diet to establish regular bowel motions. They are a better choice than laxatives, especially for safe, long-term use. Slippery elm powder is an excellent choice (especially in infants) because it has a mild taste and can help soften a stool aiding in improved bowel motions. Inulin is a tasteless powder that even the fussiest of children will approve of. Other examples of fibres include ground up linseeds, oat bran and psyllium husks.
Exercise
Encourage your child to exercise more. Studies show that sedentary and overweight children are more likely to experience constipation.
Adequate exercise/activity is important to prevent constipation and helps to maintain a healthy weight range.
Think about activities that get your child moving and which includes bike riding, team sports, swimming or playing games at the park.
Probiotics
Constipation may occur due to low levels of beneficial bacteria. Supplementing with probiotics is safe for any age group and is easy to administer. For infants they can be added to a bottle after heating, applied to the teat or nipple or administered straight into the mouth. In older children they can be sprinkled onto cereal, mixed in yoghurt or taken straight off the spoon. Examples of probiotic strains that have been shown to have a beneficial effect on constipation in children include Bifidobacterium longum, Bifidobacterium lactis, Bifidobacterium animalis, Lactobacillus rhamnosus and Lactobacillus acidophilus.
Final notes
- Try to solve the problem quickly – the longer your child remains constipated, the worse it may become and the longer it may take to treat
- Limit the use of laxatives. They should not be used more than once or twice. They don’t solve the underlying problem and may change the way your child’s bowels work
- See a doctor if constipation is a long-term problem and occurs in infants
References
- Hechtman L (2014). Clinical Naturopathic Medicine. Churchill Livingstone, Australia
- https://www.betterhealth.vic.gov.au/health/conditionsandtreatments/constipation-and-children
- https://www.rch.org.au/kidsinfo/fact_sheets/Constipation/
- https://www.webmd.com/children/guide/constipation-treatment#1
- Guerra PV, et al. Paediatric functional constipation treatment with Bifidobacterium-containing yogurt: a crossover, double-blind, controlled trial. World J Gastroenterol. 2011 Sep 14;17(34):3916-21https://www.ncbi.nlm.nih.gov/pubmed/22025880
- Magro DO, et al. Effect of yogurt containing polydextrose, Lactobacillus acidophilus NCFM and Bifidobacterium lactis HN019: a randomized, double-blind, controlled study in chronic constipation. Nutr J. 2014 Jul 24;13:75 https://www.ncbi.nlm.nih.gov/pubmed/25056655
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