Wednesday, April 9, 2014

What Helps Constipation in Kids?

Constipation has been an issue in my house for last 3.5 years.  It is a huge thorn in my side and frustrates me often.  As an OT that specializes in feeding, I knew well about constipation and the affects it can have on a child's eating habits.  I know more than the basics to help with constipation, which I will share here, but in my case it wasn't enough. I had to dig deeper.  I am not a nutritionist and don't specialize in this per say, but wanted to share what I have learned so that it might help you.







To make a long story short, Sam, who is 4.5, began to have difficulty going regularly after transitioning to cow's milk from breast milk.  At its worst, he had sharp referral pain in his back, which was frightening.  At that time, we put him on Polyethylene Glycol (PEG for short, or Miralax as you likely know it) an over-the-counter stool softener.  He was on it daily until about 6 months ago when I started to realize he wasn't growing out of this.  I wasn't sure I wanted to keep him on it indefinitely and couldn't believe that much time had passed with daily use. Although the doctors assured me that it was totally safe, after more than 2 years I decided to do some of my own research - not sure why it took me that long. I was shocked to learn that although no major incidents or side effects have been reported, it has never been approved by the FDA for use in kids or for use on a long-term basis.  Miralax and I assume other stool softners are not absorbed into the body, but keep water with the bowel as it is being digested, thus freeing a child of constipation.

Please know that my intent here is not to attack Miralax, for some kids it is necessary and at times it has been a miracle for us. BUT - I couldn't help wondering, aren't there other solutions, especially when this is a long term problem?  So let's get to it...  


Why Your Kid May Be Constipated

Genetics - Unfortunately for some kids, it is in the genes, but that doesn't mean that their isn't potential for them to grow out of it.

Diet - Processed foods, low fiber foods, mostly white bread products, and frequent consumption of the foods on the list to avoid below.

Intolerance to dairy or wheat or both - An intolerance is different that an allergy and some kids may have difficulty digesting wheat or dairy, which slows down their elimination. Dairy is more likely and often moderating it and eliminating cow's milk is a winning combination.

Holding it in - Some kids actually hold it in because they don't like how the poop feels coming out or they had a previously painful movement.  This can snowball quickly and the longer the they hold it the worse it becomes.  I'll talk about this more in the next section.

Poor Chewing/Picky Eating - If you child doesn't chew their food well or has difficulty chewing and swallows large pieces of food it could contribute to constipation. Of course, picky eating with a diet limited in fruits and veggies can also lead to constipation. Keep in mind that if constipation is the underlying problem it can cause picky eating.  If a child is backed up then there isn't a lot of room to get more food in and they will often refuse to eat, which needs to be respected because eating could cause them more discomfort.

Poor Water Intake - I think this often goes unnoticed and is often a piece of the puzzle with my son.  He drinks water well, but in the winter months when he isn't as thirsty I need to make sure I give him reminders.  A low amount of water makes it difficult to move the poop through the intestines.

What Helps?

Timing - Sooooo many kids hold it when they have to go because they are somewhere they would rather not "go" or they don't want to run in from outside or stop in the middle of playing.  Missing those cues can have a huge impact on how constipated your kid gets. If you happen to be staring at your kid at that moment you might catch the signal and can rush them off anyways, but sometimes they hide it well and often we miss that quick moment.

The solution is to have them sit on the toilet at the same time everyday or every other day. The best time is usually right after they eat.  I try very hard not to turn toilet time into something negative or worse, a power struggle.  I need to give Sam lots of warnings throughout the meal ("As soon as your done, go and pick out your book for the potty.") and mornings usually work really well.  When we are on top of this it is very helpful. 

Eating the "right" foods - This should be a huge part of your plan if your kid is constipated. I know some of these foods may be difficult to get into your child if they are a picky eater. If that is a case, don't try to lay down the law, slowly start to introduce these foods in fun and playful ways to get your kids interested.  See the large volume of picky eater articles I have in the article index for more ideas!


Some of our favorites from left to right: Trader Joe's Fiber Bread (5g per slice), Whole Wheat Noodles (5g per serving), Kashi Go Lean (10g per serving), Freeze Dried Peas (4g per serving)
  • Pears
  • Avocados
  • Prune/Pear/White grape/Apple Juice
  • Most veggies especially peas and broccoli
  • Lentils
  • Beans, especially black beans! (Think about adding these or lentils into burgers, rice, and soups)
  • Oatmeal
  • Whole Wheat Pasta
  • Barley
  • Whole Grain Cereals (We will eat these dry as a snack, too)
  • High Fiber Bread (We like the kind at Trader Joe's)
  • Flax Seed Meal (I add some into yogurt, which we only have once a week, and oatmeal)
Check out this high fiber article from Greatist for even more ideas!


Read the Label - All of the foods above are high in fiber, which helps relieve constipation. However, you can't always assume that because something is whole grain, whole wheat, or brown rice that there is fiber.  Also, there are a lot of high fiber products that don't necessarily fit into those categories either, so it is really important to read the label.  I would recommend trying to avoid buying foods that have anything less than 2 grams of fiber.  That may sound overwhelming, but there are so many options now when it comes to breads, pretzels, crackers, etc.  You will also want to try and maximize the fiber, don't just stop at 2 grams.  Keep flipping over boxes and bags until you find the highest number. Of course, the natural sources of fiber are superior because many of the high fiber products add processed fiber.

Natural Supplements - When we started to back off of Miralax I was happy to have found Fiber Advance Gummies For Kids an all natural fiber gummy that I give to the kids. There are very few ingredients and no sugar.  My kids love them.  



I want to try this product, Heather's Tummy Fiber POUCH a Facebook fan recommended it, but haven't had the chance yet.  It looks pretty awesome. Needless to say I wanted to share it here.






*UPDATE* Several readers have shared other products that have been helpful. Again, I am not endorsing these products, but passing on information. Discuss any medications with your doctor.

Fletcher's Gentle Laxative Kids

Aloe Vera Juice

                                                      

Prebiotics


Water - As I mentioned above, get the water in!   Have a cup ready to go at the start of your day and readily available all day long.  Give gentle reminders as needed. Also, take water with you everywhere so they can drink in the car or running errands.



Foods to Avoid

As a feeding therapist, I hate to tell kids there are foods they can't or shouldn't eat.  At four years old, I did begin to explain to my son that these were foods we could only eat sometimes because they made it much harder for him to poop - can't say I liked doing that, but he gets it.  None of these things are totally off limits, but I do limit them as much as possible.


  • bananas
  • marshmallows
  • ice cream
  • cheese
  • rice krispy treats
  • rice cakes (unless they are brown rice and have a few grams of fiber)
  • applesauce 
  • white rice
  • white bread products/crackers/pretzels
                          .................................................................................


We are still working at this ourselves and haven't found a complete solution.  We switched to almond milk for several months and still allowed some dairy, with a lot of moderation. The switch off of cow's milk didn't seem to make much of a difference so we have recently gone back to it.  It is something I am constantly managing and monitoring.  At this point we are still using Miralax on an as needed basis, which can be anywhere from 2-6 times per month.  For us, that is a lot of progress from daily use.  Ultimately my goal is to rarely need it. 

As I mentioned, this post isn't exhaustive but mostly my personal and professional experience.  If something is working in your house that I didn't list here, PLEASE share so that it can help others, myself included!

Also, sign up for an email subscription in the right side bar so that you can catch new articles as they're posted. I write a lot about kids eating, developmental feeding milestones, and sensory play!







16 comments:

  1. Alisha, I really appreciate this post! My son is also 4.5 and he has been dealing with constipation issues since he was about 10 months old. Though we try to maintain a diet mostly of whole grains, fruits, and veggies, we often fall short and are inconsistent. He is completely dependent on Miralax once, sometimes more a day. We've had him tested for food sensitivities, celiac disease, Hirschprungs disease and more, of which he has none. When he turned four it finally dawned on me that he could be withholding much more that we have been aware of. We are still working with him to sit on the toilet. He gets backed up and its as if he simply can't hold it in any longer and then it comes out, often without his control, so it seems. He has a lot of accidents and I think he gets frustrated. Sometimes he insists on wearing a diaper still. He is suppose to start Kindergarten in the fall, but I get really discouraged that he may not be able to participate for 3.5 hours a day, 5 days a week. Anyway, thanks for your post! I'm definitely going to try having him go after breakfast every morning. Thanks for the fiber supplement recommendations too. I look forward to hearing more about your journey.

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    1. Hi Brittany, thank you so much for that comment, I really appreciate it. Our stories are so similar, I just added a few more products that were recommended by other readers, you will see the bold UPDATE above, if you are interested. Sitting him on the toilet regularly was a huge success for us, although we admittedly don't always follow through. I have ordered the tummy fiber and am really hoping for success with that- I will update that too! The accidents have been an issue here to and I think that is where the miralax doesn't allow them to hold it anymore. Best of luck to you to, I hope some of these strategies are helpful!

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  2. My daughter (now nearly 4) started having issues with constipation when I began introducing solids. It didn't matter what she ate, she was constantly constipated. I don't know if she was holding it in (at ~1 year old?) or what, but I tried everything. Asked my doctor for help, and he told us to use PEG. It just gave her a massive diaper rash and diarrhea. Finally I brought her to my chiropractor, and he found that her spine was out of alignment down where it is connected to nerves in the intestines. He also suggested aloe vera juice. There was not an immediate change, but after several visits she was pooping regularly and not long after we ditched the aloe entirely. She still goes regularly for wellness visits, but hasn't had problems since. She can eat tons of cheese and bread and is still fine. I literally credit my chiropractor with saving her life, because otherwise I have no idea how she would have been able to eat properly.

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    1. Thanks Anje! That is a really helpful idea, that I'm going to have to consider!

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  3. I have a daughter and she has had the abdominal pain off and on for about a year now. We've been in and out of her doctor's clinic. The doctor ordered for an x-ray then said it's just poop while I know for a fact that my daughter is not constipated because she regularly moves her bowel. We've also done ultrasound, stool test, etc. All tests came clean. But she is still in pain.

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    1. I'm sorry Brandy, that is so frustrating. Sometimes you have to keep going to different docs until someone finds a solution. It might be helpful to try a natropathic dr- they look at problems through a different lens. Good Luck!

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    2. If a child is pooping that doesn't mean they are not constipated or blocked further up. My daughter was pooping every day, but it's the type of poop that makes the difference (ie hard pebbles, softer stools). Also they can be impacted further up but some can get through to give a regular poop. If the dr saw poop in the xray then it is most likely there. They also should have followed it up, because impaction is very painful for kids and can cause problems. I know as my 2 have had them. My youngest has been on a stool softener for 12 months. When constipated the bowel stretches. Once going regularly, with the correct poop consistency they need to stay on the stool softener for twice the length of time they were constipated; as it takes the bowels this long to go back into shape. I know this as my childrens bowel issues are hereditary and have been extensively researched by paediatricians, gastroenterologists and other specialists. Impaction can also mimic signs of recurrent UTI's as the bowel compresses the bladder; causing frequent urination, pain when weeing etc. I would go to another gp, get an xray and if there is still too much build up then ask them to follow it up ASAP. Good Luck.

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  4. Great post, i have a two kids which of one get often constipation problems. Thanks for sharing this informative post i would be following this tips.

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  5. I'm a PNP and I second absolutely everything you said in this post!! My recommendation usually is for a big initial clean out with miralax, then starting to do the dietary stuff along with fiber and probiotic supplements (I like florajen and culturelle) but like you said one of the most important things is to have a scheduled bathroom time. I like your idea of reading books but one thing I have found very helpful is blowing balloons!!!! Sounds crazy. But of course it forces them to valsalva without even knowing they're doing it. Works like a charm and makes bathroom time fun. Give it a try sometime!! Thanks for sharing your tips. I often send my mommy friends to your blog. You're one of the few mommy blogs I feel like I can trust to give evidence-based advice!

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    1. Thank you so much for the helpful comment. I will be trying the balloon!

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  6. My 6 year old has chronic constipation (since at least age 2). She struggled with daytime wetting (and had daily BMs - but her insides were full of stool pushing on her bladder). I wanted to add that too much fiber can also be constipating when not balanced with liquid.
    Daily fiber should be the child's age + 5g with minimum fluid being total fiber x 3oz. (For example my 6 year old needs 11g of fiber at at least 33oz fluid daily.) If she eats more fiber than that she needs to drink more water, etc. this info is from our GI clinic. All the best you all the moms & kiddos dealing with this!

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    1. Thank you so much for that very helpful comment Cathryn. I haven't heard that before but it makes a lot of sense and I will be figuring out the calculation for my kids!

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  7. My third child is a holder and it upsets the entire family because she night wakes in pain :( She is almost 2 and is still nursing. If we give her a "pooper" (enema) she can hold it still until the next day. Sometimes she even vomits when she tries to poop. It's really awful. She doesn't get much dairy except yobaby (with probotics). I would really like to be done nursing so I plan to switch to the Silk until we get this figured out. She doesn't seem to be allergic to anything and she's overall pretty happy. I just think she hates to poop. We tried miralax and she started throwing up.
    Things we have done that DO help:
    She does great with adding mineral oil to her yogurt.. She also seems better with some fiber bars and lots of water. I saw a stool suggested on Amazon...
    http://www.amazon.com/Squatty-Potty-Toilet-Stool-Elimination-Aid/dp/B008G9B11E/ref=sr_1_1?ie=UTF8&qid=1410217667&sr=8-1&keywords=constipation+stool

    and Magnesium lotion:
    http://www.amazon.com/Ancient-Minerals-Magnesium-Lotion-Bottle/dp/B0079QHN0S/ref=sr_1_1?s=hpc&ie=UTF8&qid=1410217756&sr=1-1&keywords=magnesium+lotion

    I hope this helps!! Poor Babies!!

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  8. My daughter has struggled with this since she was just over a year old. she would have tears everyone she had a bowel movement from the pain. she still eats dairy products, but I switched her to almond milk. There is also a great juice called "plum smart"that works wonders! It is good tasting prune juice that she willing asks for. Might be something others want to look into as well!

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  9. We have had the same issue from 6 months and after being told by a pediatrician to use actalax/lactolose whih is also not intended for long term use-our chiropractor recommended Metagenics fibroplex for kids. We are in Australia not sure about worldwide but it is a magnesium powder for kids. I'm my gosh worked from day one-AMAZING. Our boy at 1 1/2 has gone from pooing every 4-7 days to every day if not every 2 days. Magnesium is apparently to drug that doctors will not prescribe as it does every thing from lowering blood pressure to depression to helping autistic kids and constipation as it relaxes the muscles. Please try it it is natural and we are in the process of increasing our sons intake of magnesium rich foods. We are so thankful to our chiropractor as our son would still be being dosed up with artificial stuff to make him poo wen he went to school

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  10. Thanks so much everyone for all the amazing tips and advice you are sharing. That is exactly what I was hoping for! I can tell you that the more my kids drink a lot of water the better off they are!

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