Childhood Constipation – Causes & Treatment

Childhood constipation, it’s no fun for parents and certainly no fun for your little one. As a Nutritionist and mum, talking about poo really does take up a lot of my day. Right from the day my little boy was born we tracked his poo: what it looked like, what it smelt like and when it happened, and these are the same questions I ask all of my clients during our nutrition consultations, because our poo tells us so much about what’s going on inside our bodies and how well they’re functioning. So when the poo stops, there’s a problem.

Imagine your body as a sink that fills up with the good (food and nutrients), the “bad” (infectious illnesses) and the ugly (toxins and allergens from food and the environment). A healthy body accepts and benefits from the nourishing input, and flushes poisons and waste: from every cell, through our bodies detoxification systems: lymphatic, to liver, spleen, kidneys and gut, and eventually through urination and defecation (poo), sweat, coughing and sneezing, tears and even vomiting if necessary. But sometimes our sink doesn’t drain well or as quickly as it should. When the sink fills up it overflows with toxins and interferes with normal bodily function, and this when we start to see symptoms. These symptoms can look different in different children, depending on their genetic vulnerabilities, i.e.: skin (eczema), brain (ADHD, migraines, seizures), respiratory (asthma). One of the early signs of “sink overflow” affecting the gut can be constipation (along with Irritable Bowel Disease and reflux), and if ignored can amplifying into something more serious.

Constipation is defined as hard stools (poo), passed infrequently, but the problem is often more complex than that and what is “normal” varies greatly for each child. So what is a normal poo you ask? Below is the Bristol Stool Chart:

Types 3, 4 and 5 are considered a normal, healthy poo. They should be medium-brown in colour, smooth and soft and easy to pass like toothpaste and sink in the toilet bowl.

Childhood constipation is one of the most common health complaints, and although we all know that the simple answer may be to just “eat more fibre and drink more water”, that’s seldom the case when it comes to kids. The good news is there are several things you can try to help resolve the symptoms and the issues causing it, using natural remedies. First, let’s have a look at some signs your child might be constipated and what might be causing it.

SIGNS & SYMPTOMS OF CHILDHOOD CONSTIPATION

Childhood constipation can cause:

• Stomach cramps, with the pain tending to come and go
• Reduced hunger – if your child is backed up inside, there’s not going to be a lot of room to accommodate additional food and they may even refuse it. It’s important to acknowledge this and not force a child who may be constipated to eat
• Irritable behaviour
• Anal fissures (small splits of skin around the anus) that can cause pain and bleeding when they do a poo – these can be caused by straining to do a large, hard poo
• Holding-on behaviour, such as: cramping, crossing legs or refusing to sit on the toilet

If your child is constipated, their stomach may look more bloated than normal and you may even be able to feel hard lumps of poo if you press gently on their stomach.

Long-term constipation may cause your child to do a poo in their pants. This happens if your child’s bottom is full of poo for a long time and can become stretched. Your child may not get the urge to go because their bottom always feels stretched and the poo can then pass in to your child’s pants, without them feeling it.

WHAT CAUSES CHILDHOOD CONSTIPATION?

DAIRY INTOLERANCE

Intolerance to cows dairy is the number one food culprit when it comes to childhood constipation, with approximately 65% of people having a reduced ability to digest lactose after infancy. When the lining of our gut is compromised we can develop sensitivities or intolerances to foods we consume often – this is a condition known as intestinal permeability or “leaky gut”. Food intolerance is not the same as a food allergy. An allergy causes an immune response and in some cases can be life threatening (anaphylaxis), where as intolerance is usually much less serious and limited to symptoms associated with problems digesting certain foods.

Eliminating all dairy (this includes: milk, cream, cheese, yoghurt, butter and ghee) from your child’s diet completely for a period of 3-4 weeks – with a view to then slowly reintroduce to test tolerance – usually helps. You may get a withdrawal effect in the first week or so (with a temporary flare-up of symptoms for a few days) so don’t give up too soon – keep a diet and symptom diary to monitor any changes.

There are plenty of dairy alternatives available, with nut and coconut products being the best options – remember to choose ones with no added sugars or thickeners (especially carrageenan) – I like this, this and this. If your preference is soy, choose only an organic fermented soy milk, like this. I would avoid rice milk as rice is high in arsenic – although the levels not high enough to bring about immediate or short-term health effects, if a child were consuming a lot of it every day, I would err on the side of caution.

When eliminating dairy from your child’s diet, make sure they are consuming those valuable fats, protein and calcium elsewhere in their diet, especially calcium that is crucial for growing bodies. Foods high in calcium include: sesame seeds, chickpeas, sardines, wild caught salmon, almonds and leafy green vegetables. I add a tablespoon of sesame seeds when making homemade nut milk to boost the calcium. Check out Healthy Bones Australia for a full list of calcium containing foods.

DEHYDRATION

Not drinking enough water is going to leave poo hard and dry, difficult to move through the bowel and uncomfortable to pass. Kids can easily mistake feeling hungry for being thirsty and can often need reminding (especially in the cooler months) to drink water.

HOLDING ON

Some kids will “hold on” to their poo because it causes them discomfort on the way out and they’re scared to go after a previously painful bowel movement, such as doing a hard poo when they have anal fissures. This can quickly snowball the problem as the more they hold on, the harder their poo becomes and the more painful the next bowel movement will be.

POOR CHEWING

If your child is swallowing large pieces of food because they’re eating too quickly or not chewing their food properly, their little tummies will struggle to break it down to further digest it causing it to build up in their intestines. Make sure your children aren’t distracted with TVs of iPads or toys while they’re eating, so they can focus on the meal in front of them – this will encourage mindful eating and stimulate saliva and gastric acid production, which helps to breakdown food.

POOR DIET

A diet high in processed or packaged foods, sugar and refined carbohydrates and low in fresh vegetables and fruit can lead to constipation.

LOW MUSCLE TONE

Different to muscle strength, tone is the quality of the muscles in the body. Everyone has different muscle tone be it high or low and it is possible to have strong muscle strength and low muscle tone. Children that have low muscle tone often have delays in gross motor skills like crawling or sitting because their muscles fatigue more easily. Other signs that your child may have low muscle tone are: sitting with their legs splayed in a W position, frequent slouching, or being unstable during gross motor play that requires core strength. If your child has low muscle tone, even slightly, it may be difficult to physically push their poo out.

NATURAL RELIEF FROM CHILDHOOD CONSTIPATION

TIMING

Missing your cue to “go” can have a huge impact on how constipated your child gets. A lot of children will hold on to their poo if they get the urge to go and they’re somewhere they don’t want to go (like a shopping centre or at school), or they’re too busy playing outside and don’t want to stop the game for a toilet break. Toilet time should be set aside 3 times a day (the best times are after breakfast, lunch and dinner), every day, to allow for regular, undisturbed visits to the toilet. To avoid turning this time in to a stressful situation for you or a negative situation for your child, give them plenty of warning that’s its coming up, like “when you’ve finished eating, get your book and we’ll go and sit out the toilet”. Let them sit for 3 – 5 minutes, even if they’ve done a poo before then. Using a kitchen timer can prevent arguments about how long they have been sitting.

POSITIVE REINFORCEMENT

Sitting on and pooing in the toilet should be rewarded with encouragement and age-appropriate reward charts or stickers etc. Praise your child for sitting on the toilet, even if they don’t do a poo too and encourage your child to respond to their urge to do poo.

VITAMIN C

If you take more vitamin C than your body needs or your body can absorb, the extra vitamin c stays in the gut. This has a softening effect on poo, making it easier to pass.

MAGNESIUM

Occasional childhood constipation can be treated with magnesium, in particular, magnesium citrate. As an osmotic laxative, magnesium draws water in to the large intestine. The water helps soften and bulk up the poo, which makes it easier to pass. Magnesium also relaxes the muscles, including the intestines – and improves the peristaltic contractions (wave-like movements) in the gut, which moves the poo slowly but surely to it’s final destination. Magnesium citrate is relatively gentle and shouldn’t cause any emergency bathroom trips, unless you take too much of it.

CHILDHOOD CONSTIPATION TUMMY MASSAGE

No matter the cause of the constipation, a gentle tummy massage a couple of times per week can greatly improve bowel motility and relieve constipation. Try doing the below “I Love You” technique massage three times a day.

• Apply one tablespoon of preferred massage oil (olive oil, coconut oil or castor oil – castor oil can help breakup compacted poo through the skin and gut wall) on to the tummy
• Working on the small intestine first, use the flat part of two of your two index fingers (the tips may apply too much pressure for a baby) to massage the small intestines in small circular clockwise motions around the navel. Repeat a rotation of these circles 3 – 5 times
• For the large intestine, use the ‘I love you’ technique to help push poo along the colon to break up the compaction or blockage. Start with medium clockwise circles from the right hipbone using the flat ends of your fingers. Gently circle and gradually move upwards towards the first rib. This pattern travels along the ascending colon (as shown in diagram A coloured purple) and resembles the ‘I’ (as shown in diagram B). Repeat 3 – 5 times
• Then continue to the next step which includes circle for both the I and the L together so this starts from the right side hip along the ascending colon and travels to the left side along the transverse colon (as shown in diagram A coloured blue) and resembles the ‘I and L’ (as shown in diagram B). Repeat 3 – 5 times.
• Finally, complete the cycle with continuing the process by combining “I L U’ motions together as we aim to move matter towards the rectum for release. Once again start from the right hip bone up the ascending colon, across the transverse colon and then move down the descending colon (as shown in diagram A, coloured yellow) completing the full ‘U’ cycle (as shown in diagram B). Repeat 3 – 5 times or more

The above massage technique is encouraged two to three times daily.

WATER

Adequate hydration is important to keep poo soft and easy to pass. Have a cup of water ready to go as soon as they start the day and offer water with every meal. Younger children will need reminding to drink water, so always have their bottle near by. For children that are older, it might help to have a transparent water bottle so they can see how much they need to drink before the end of the day. If your child doesn’t like drinking water, trying added a few slices of fresh fruit to it to flavour it slightly.

ESSENTIAL OILS

My Tumnmy Tamer essential oil roller for kids is a digestive blend designed to ease upset tummies; bloating, gas, constipation, diarrhoea, nausea, travel sickness and reflux. Made from 100% pure therapeutic grade essential oils and diluted with fractionated coconut oil, it contains: ginger, fennel, and coriander to help ease occasional stomach discomfort, including motion sickness and indigestion, as well as peppermint, tarragon, anise, and caraway to aid with digestion and help maintain a healthy gastrointestinal tract. You can apply this blend of to your child’s tummy and massage in a clockwise motion, or use in conjunction with the tummy massage as a safe and effective way to help relieve childhood constipation.

PROBIOTICS

Our gut flora has a big influence on how quickly we pass a bowel movement and there is some preliminary evidence to suggest that probiotics may assist in relieving childhood constipation. Bacteria constitute about 30% or more of the weight of poo, so it makes sense that supplementing with beneficial bacteria can support overall digestive health. Rather than using a single strain of probiotic bacteria, it’s best to use a multi-strain formula composed of highly viable and compatible strains such as Bifidobacterium bifidum, Bifidobacterium breve, Bifidobacterium infantis, Lactobacillus acidophilus, Lactobacillus lactis, Lactobacillus fermentum or Lactobacillus rhamnosus. Try fermented foods like coconut water kefir, or buy probiotic powders or capsules and give for 1-2 weeks (up to 1-2 months) to see if your child feels better on them.

NUTRITION

Eating the right foods is and important part of managing childhood constipation. This includes increasing their fibre intake. To add more fibre to your child’s diet try –

• Eat two servings of fruit each day – fruits with the peel left on, such as plums, prunes, raisins, apricots and peaches, have a lot of fibre
• Eat least three servings of vegetables each day
• Choose wholegrain breakfast cereals like: quinoa, amaranth, millet, buckwheat or rolled oats, and avoid refined breakfast cereals
• Choose wholegrain sourdough bread instead of white bread
• Add fibre-filled beans, lentil and legumes to meals and snacks – try making homemade baked beans, hummus or lentil bolognese

If your child is a particularly picky eater, don’t force these foods on them, just start slowly and check out my fussy eating article for some more ideas.

It’s also important to avoid foods that can contribute to childhood constipation, such as: dairy; red meat (if too much of it is taking the place of fibre rich foods – just make sure you serve meat with plenty of vegetables or some beans/legumes); high fat/fried foods (which can cause delayed digestion); cakes/biscuits/pastries (low in fibre and high in fat and sugar); bananas (can either be a cause of constipation or source of constipation relief depending on their ripeness – unripe green bananas are constipating but ripe banana are high in soluble fibre which may help to relief constipation). For a child with low tone, increasing their fibre content may actually worsen their constipation.

For babies on solids, increased fruit and vegetables in their diet might help. You can give your baby up to three tablespoons of strained, stewed prunes or apricots, three times a week, or give them prune juice diluted with water. For breastfed babies, the mother must remove all dairy from her diet. Babies with constipation who drink formula might need their formula changed to a diary-free one – this is best done under the supervision of a paediatrician.

NATURAL LAXATIVES TO RELIEVE CHILDHOOD CONSTIPATION

• Chia seeds – chia seeds are particularly high in soluble fibre. Soluble fibre absorbs water to form a gel, which can help to soften poo. Add some chia seeds to porridge or a smoothie, sprinkle over yoghurt or make some chia puddings
• Flaxseeds – flaxseeds contain a good mix of both soluble and insoluble fibre, which helps reduce intestinal transit time and add bulk to stool. Add to smoothies, muesli or sprinkle over yoghurt. Grind flaxseeds to up make them more digestible for little tummies. If buying ground flaxseeds, choose a brand like Stone Creek that’s packaged in a tin as once flaxseeds have been ground, they oxidize when exposed to light (this includes all those clear plastic bags full at the supermarket)
• Prunes – prunes are probably one of the most well known natural laxatives out there. They also contain a type of sugar alcohol known as sorbitol, which acts as an osmotic agent, bringing water into the gut, which helps induce bowel movements. Look for preservative-free prunes or add some unsweetened prune juice to water
• Apples – apples are high in fibre and full of pectin, a type of soluble fibre that can act as a laxative and prebiotic (food for our gut bacteria), speeding up transit time and increasing the amount of beneficial bacteria in the gut. Stew some apples with a little water and cinnamon, then eat them as is or blend them with a little cultured butter to make an apple mouse.
• Rhubarb – rhubarb contains a good amount of fibre and a compound known as sennoside A, which is a potent laxative
• Slippery Elm – slippery elm contains mucilage, a sticky substance that can’t be digested that may increase bowel movements. Add to smoothies, or mix with yoghurt
• Psyllium Husk – psyllium husk swells when it comes into contact with water, which helps to keep poo soft as it passes through the gut. You need to remember to increase the amount of water you’re drinking if taking psyllium husk, because without adequate lubrication, psyllium husk could absorb too much water and make matters worse.

WHEN TO SEE A DOCTOR

If your baby is under 12-months old and you think they are constipated, you should consult your doctor or paediatricain. For older children, if simple diet changes aren’t helping, your child is in significant pain or if they are bleeding from their bottom, you should consult with your doctor or paediatrician.

DISCLAIMER

Always consult with a health care professional before taking any supplements – dosage guidelines must be tailored to your baby or child’s weight and age.