Childhood Constipation: Management and Strategies

Constipation is a common childhood problem. It happens often at two points early in a child's life. The first time is generally around the time when baby starts eating solid foods and starts to shift from a full fluid diet to having milk/formula and solids. The second time it commonly occurs is around toilet training. Sometimes children don't like the experience of toilet training, start to hold their bowel movements, thereby causing constipation. Beyond these two more common times, constipation unfortunately, can strike at any point.

What does constipation look like?

  • For most children, constipation means passing hard stools, with difficulty or straining.
  • The stool may be very large or smaller, more pebble-like stool.
  • You may also notice your child has hard stools on some days, but almost runny stools on other days. Soiling can also be a sign that your child may have constipation.
  • Your child may experience pain when passing stools and there may be streaks of blood on the toilet paper, caused by tearing of the skin during a bowel movement.
  • Abdominal pain, poor appetite and decreased intake, irritability, restlessness, and even nausea can all be symptoms of constipation.

What causes constipation?

The main problem with constipation in children is the lack of fibre in a child's diet. Many children I see in my practice with constipation are either eating too much non-fibre foods (milk, cheese, yogurt, meat, low fibre grains) and not getting enough fibre-containing foods (fruits, vegetables, whole grains, pulses, nuts, and seeds). This imbalance in the diet is a huge problem when it comes to having a normal stooling pattern. The longer this imbalance goes on, the worse the constipation gets. 

What does a normal Bowel movement pattern look like?

Keep in mind that "normal" for one child may not be normal for another. When talking about regular stooling pattern, the consistency is more important than the frequency.  This means that one child may have a BM twice per day while another child has a BM once every two days. As long as the stool is nice and soft (think of squeezing a tube of toothpaste!), there is no straining or pain associated with it, you child is having a normal stooling pattern. 

How much fibre is recommended?

Age group                               Recommended                                                      amount per day*

Children 1-3 years old             19 grams

Children 4-8 years old            25 grams

Girls 9-13 years old                  26 grams

Boys 9-13 years old                 31 grams

Girls 14-18 years old                 26 grams

Boys 14-18 years old                38 grams

What can I do?

If you are concerned your child may have constipation, there are strategies you can take to help them. However, if the constipation is severe enough, you should first seek medical attention. In more severe cases, children require medications such as laxatives and stool softeners to help their bodies have a bowel movement.  Whether your child is on a medications or not, there are nutritional changes you can make to help overcome the constipation battle.

  • Cut down on dairy products. Offer no more than 500 ml/day of milk.
  • Add more colour to their diets. Aim to add a 1/2 cup of fruits or vegetables at all meals and snacks.
  • Offer them bran. Bran is a natural stool softener and high in fibre.  Try adding bran (bran buds. flakes) into their baked goods, sprinke on cereal or yogurt. 
  • Choose water. Keep water available throughout the day as a first choice when thirst strikes.

For more information and for individual advice please contact Andrea for a consultation.