Around 30% of children suffer from episodes of constipation, mainly associated to the suppression of the bowel impulse because of fear of pain. When children have a bad experience in bowel movement (pain) they go into a vicious circle where they suppress the impulse to avoid pain. When that happens, the fecal content accumulates and hardens, provoking even more pain.
There are 3 periods where your child has more probability of having constipation, mostly associated to tough changes in habits or diets: weaning (babies), stop wearing diapers (toddlers) and when they start going to school.
I had a chance to interview Nutritionist and Registered Dietitian, Raquel Papu, about when it’s a good time to try a children friendly laxatives, how to choose the right one and the correct dosage to take. Ms. Papu always recommends ‘food first’ to solve constipation, but often recommends laxatives if the situation is right.
What are some factors that can lead to constipation in children?
One of the major factors that can lead to constipation in children is dehydration or lack of proper fluid intake. Children ages 4 through 8 need about 5 cups of fluid a day and those needs increase with age. Children ages 9 through 13 need about 7-8 cups a day and those who are 14 through 18 years old need about 8- 11 cups a day. Fluid requirements also increase with increased activity levels, as well as in warm weather climates. Because water is needed to stimulate bowel movements and soften stool, it’s important that children consume enough water and fluids throughout the day to prevent constipation.
Another factor that can lead to constipation is a diet low in fiber. Both soluble and insoluble fibers are crucial for the formation of stool and the stimulation of a bowel movement. Soluble fiber is found in plant foods such as apples, oats and bananas and is responsible for giving stool bulk. Insoluble fiber is found in tough outer surfaces of plant foods such as the skins of most fruits, wheat bran and whole grains and it helps speed up the transit time of food in the digestive tract, thus preventing constipation. Younger children ages 5 through 10 should aim for a total of 10-20 grams of fiber per day and older kids ages 15 through 25 should aim for a minimum of 15-25 grams of fiber per day.
These fibers also act as prebiotics, which are food for the trillions of little bugs in our gut known as probiotics. These good strains of probiotics have been found to benefit digestive health, prevent constipation, and promote regular bowel movements.
Another cause of constipation in children may be a lack of exercise. Younger kids usually can’t sit still, but as they get older they become increasingly more sedentary. It’s important to highlight the importance of staying active for general health and for preventing constipation.
Other factors that may contribute to constipation in children are feeling shy about using public bathrooms, fear of painful bowel movements or even stress regarding potty training if it’s something new for them. Certain medical condition may also cause constipation such as celiac disease, hypothyroidism, and diabetes, so it’s always best to reach out to a doctor if the issue is ongoing.
What are some signs that parents and caregivers should be on the lookout for?
Signs of constipation in children are usually easy to spot, but there are some that are less obvious so it’s important to stay on the lookout for any of the following symptoms. The first sign of constipation is having less than two bowel movements per week. Another sign of constipation is having stools that are hard, dry, or lumpy or having them complain of stools that are hard to pass. This is usually accompanied by discomfort and, in some cases, pain, so kids will usually complain when they’re feeling this. Take your child to the doctor if constipation is accompanied by rectal bleeding, blood in stool, vomiting, weight loss or extreme abdominal pain.
How can parents support healthy, regular bowel movements?
The main ways that parents can support healthy, regular bowel movements are through food and lifestyle interventions first. Make sure they’re drinking enough water/ fluids, consuming enough fiber (both soluble and insoluble) and staying physically active. Once all of these are consistently being done and there are still no consistent bowel movements, a natural laxative or stool softener may be recommended but only if advised by a doctor.
When is it necessary to use a laxative and how can families find the right one?
When dietary and lifestyle modifications have been made without any success, laxatives and/ or stool softeners may be indicated. Chemical laxatives are usually too harsh for children and I tend to recommend natural laxatives once the child’s doctor has authorized the introduction of one. PEG 3350 is usually found in many chemical laxatives and while it’s considered safe at low levels in older children, young children should stay away from this compound.
For younger children under 4 years old, I usually recommend going for natural foods instead of supplements and these include prunes, prune juice, pears, pear juice, papaya, kiwi and chia seeds. For kids 4 years old and up, once they’ve tried everything else and are still constipated, I recommend reaching for natural laxatives and stool softeners such as fiber supplements and laxatives that use foods and herbs. One brand I love is Prunelax. Their liquid is a great option for kids because it’s made from a combination of prune juice and senna leaf, is usually highly effective and doesn’t contain any harsh chemicals.
Laxatives should be used only to treat constipation and should never be used for more than the indicated time (usually 3-7 days max). As always, consult with your child’s doctor in order to find the supplement that’s best for them.
Raquel Papu, MS, RD, LDN
Registered Dietitian
Master’s in Functional Medicine
Social Media: @rawkalebyraquel
Learn even more in this recent radio show discussing gut health: LINK
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