Preventing and managing childhood constipation

Constipation is very common in Australian children, with approximately one in three Aussie kids struggling with this issue. Generally constipation is defined as an ongoing difficulty passing bowel movements that lasts longer than two weeks. It is frequently characterised by infrequent stools, very firm or dry stools and pain upon passing them, which can be very distressing for children of all ages.

How do I know if my child’s stools are abnormal?

There is a huge variety of ‘normal’ when it comes to healthy poos, but in general a healthy child over the age of two will pass one to two formed (but not solid) stools each day. A normal poo for an infant will depend on whether they are breastfed or formula fed. A breastfed infant may pass three or more soft poos daily, or as they get older, may only pass one or two movements per week. A formula fed baby will generally pass two to three poos daily. It is perfectly normal for a baby to look a little ‘strained’ or red in the face when preparing to poo!

Some red flags that your child may be constipated include:

• • An infant with hard or pellet like poos
• • A reduction in stool frequency
• • Passing hard, dry stools
• • Complaints of tummy pain
• • Signs of withholding, such as tightening the buttocks, rocking back and forth or hiding
• • Small amounts of liquid faeces on child’s underwear
• • Poor appetite

What causes constipation?

Most children do not have an underlying medical problem causing constipation – in fact, only 5-10% of cases are attributable to a medical cause. Most commonly, constipation is triggered by a change in behaviour or routine.

One common cause of constipation is withholding, where the child ignores (or fights against!) the natural urge to poop. This is commonly triggered by a child passing a large or hard stool and experiencing pain in the past, causing them to withhold stools in the future to prevent experiencing further pain. Other children are uncomfortable passing a stool in an unfamiliar environment, such as when they start school. It is also known that stressful life events can trigger constipation in children.

How can I prevent constipation?

1. Take a look at their diet: Recent research suggests that children who consume a more Mediterranean style diet have a lower risk of developing constipation. This type of diet is characterised by a regular intake of fruit, vegetables and wholegrains, a moderate intake of fish and dairy and limited intake of red meats, processed foods and soft drinks. While this might sound a far cry from your child’s regular intake, an all or nothing approach is not required to start them in the right direction. Start by making some small and simple changes such as:

• Swap red meat for fish based meals once or twice weekly

• Swap processed fruit snacks for fresh fruit (with the skin on where possible!)

• For older children, offer nuts, fava beans or roasted chickpeas as a snack

• Swap soft drinks for water

• Cook family meals with Extra Virgin Olive Oil

• Swap high sugar breakfast cereals for whole grain options (or start with half of each mixed together!)

• Expose them to a broad range of colourful fruits and veggies

There is no need for children who are prone to constipation to consume excessive amounts of high fibre foods – simply aim to meet the recommended guidelines.

2. Keep them physically active: The gut needs regular physical activity to keep it moving! Encourage your child to be active and develop limits on screen time from an early age. The Australian physical activity recommendations for children over five years indicates that children should accumulate at least 60 minutes of moderate to vigorous exercise each day. This can include a range of activities such as active play, organised sport or walking/riding a bike for transport. It is also recommended that screen based activities (outside of school work or homework) are limited to two hours per day. Another great way to encourage kids to increase their activity levels is to increase activity as a family. Schedule in activities that your family enjoy doing together, such as bushwalks, riding bikes or backyard games. Take time to pass on any special sports skills you might have (even if those skills are a bit rusty!), like bowling a cricket ball or shooting a netball.

3. Keep them hydrated: Fluids and fibre work in tandem to produce a formed, soft stool in the colon that is easy to pass. Without fluids, a higher fibre diet may actually contribute to the problem, rather than prevent it! Studies show that only 20% of Australian children and adolescents are meeting the recommended intake guides, leaving many Aussie kids at risk of dehydration.

 If your child is struggling with constipation and would benefit from the input of a specialised dietitian book in with one of our dietitians at Eatsense today.