Childhood constipation is extremely common and depending on criteria used it is believed to affect between 5-30% of the child population. Symptom based criteria includes reduction of bowel movements, faecal incontinence and a change of stool consistency. Individuals can have very different bowel times but optimal transit is between 12-24 hours. As constipation slows transit time this can cause problems as putrefied material stays in the colon longer, which can increase toxins along the intestinal wall. This increase in toxins can also affect absorption of nutrients and can deprive the body of its requirements for energy and vitality. Malabsorption also increases the risk of toxins being reabsorbed into the body rather than eliminated which can be linked to other symptoms such as fatigue, aching joints, low immunity, mental sluggishness, irritability and headaches.
As a parent it’s important to address the underlying causes of constipation and break what can become a vicious cycle for some children due to pain when passing stools and then reluctance to go to the toilet. Ensuring your child is well hydrated and their diet contains adequate fibre and helpful nutrients such as vitamin C, magnesium and probiotics is a great starting point. Use some of my top tips below to get things moving!
Sweetcorn test: A simple test for assessing transit time is giving your child a good portion of sweetcorn and observing when it’s eliminated. Ideally it will be 12-24 hours. If it takes longer it’s worth trying out some of the tips below.
Soluble fibre: Increase whole grains in the diet and reduce processed grains (white bread, pasta, cereals), which can slow the passage of food through the digestive system. Wholegrains will increase a feeling of fullness and help to control blood sugar levels. Remember to increase fibre rich foods slowly in the diet and read more about fibre here.
Include:
- Oats – porridge, home-made sweet/savoury flapjacks, smoothies
- Brown rice – risotto, kedgeree, egg fired
- Beans and chickpeas – hummus, mashed beans (alternative to potato)
- Vegetables – steamed, apple and parsnip mash, stir fried
- Fruit – apples
Insoluble fibre: This includes cellulose and lignins found in nuts, flax, rye, seeds and some vegetables and these add volume to stools by holding water and improving transit time. Linseeds are a fantastic sources as they are high in fibre and can help to regulate stools. They feed the beneficial gut bacteria, which also supports the immune system.
Include by:
- Stirring into porridge
- Adding to yoghurts
- Including in flapjack recipes
- Adding to smoothies
- For younger children (6 months to 2 years) you can use flaxseed oil as above.
Vitamin C: Increasing vitamin C rich foods can help to soften stools and reduce transit time.
Include: Foods such as peppers, dark green leafy vegetables, kiwi, broccoli and berries.
Magnesium: This is required for peristalsis, the rhythmic relaxation and contraction of muscles and research suggests that over 50% of the general population do not consume adequate levels. Read more about the importance of magnesium here.
Include: Leafy vegetables, whole grains, nuts, seafood, sea vegetables, legumes. Add Epsom salts to your child’s bathwater and before bed rub magnesium oil on their abdomen.
Pro and prebiotics: Probiotics are the bacteria that help support the natural balance of organisms most notably in the intestines, whilst prebiotics help to nourish and stimulate the growth of these bacteria. Read more about them here.
Include: Probiotic rich foods such as cottage cheese, kefir, olives, yoghurt. Prebiotic foods such as asparagus, bananas, garlic, honey, leeks, legumes, onions, peas and yoghurt.
Hydrate: Consuming plenty of water daily supports the absorption of nutrients, flushes waste and toxins from the body and can helps to prevent constipation. Read more about the signs of dehydration and how to encourage good habits here.
Listen to your body: Encourage your child to recognise the signs that they need to go to the toilet. By following their bodies signals they will help things to work normally. If we choose to hold on the rectum can get stretched and then our usual signals can become supressed. Encouraging children to sit on a potty or toilet in the morning can be worthwhile and help them to read the signs that they need to go.
Active: Keeping active is important for getting the digestive system moving.
Be Aware: Look out for possible irritants and look to reduce or avoid any triggers. These may include:
- Wheat products
- Milk or other dairy products
If you feel you need personalised support and advice please make an appointment at the Food Teacher Clinic for a consultation or consider a Personalised Food and Lifestyle Review, which could provide some useful feedback for your child.
References:
- Gordon, Morris, et al. “Cochrane Review: Osmotic and stimulant laxatives for the management of childhood constipation (Review).” Evidence‐Based Child Health: A Cochrane Review Journal 8.1 (2013): 57-109.
- Bardisa-Ezcurra, Lauren, Roz Ullman, and Jenny Gordon. “Diagnosis and management of idiopathic childhood constipation: summary of NICE guidance.” BMJ 340 (2010): c2585.
- Paul, Siba Prosad, Samuel Robin Broad, and Christine Spray. “Idiopathic constipation in children clinical practice guidelines.” Archives of disease in childhood-Education & practice edition (2015): edpract-2014.
- Digestive Wellness, 4th edn., Lipski
