In Focus: Constipation

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A question I get asked a lot by parents is about foods to help with constipation. Constipation can be a weekly battle for some families with little ones and it is an important topic, as the symptoms can cause discomfort and distress. This blog post is written in conjunction with our partner paediatric dietician Bianca Parau. As a starting point Bianca and I discussed how every child is different and “normal” can vary; bowel habits are also dependent on a child’s age and what they eat.  Bianca defines general constipation as having 3 or less bowel movements per week and/ or having stools that are hard or difficult to pass. Constipation is mostly caused due to a combination of factors, which she will explain. There is also a list of preventative steps you can take, to act as a practical framework and some ideas for treating any symptoms you might spot. 

Factors
  • An infection or illness can all cause dry, hardened stools (due to factors like fever, dehydration and immobility)
  • Dehydration, due to low fluid intakes will contribute to constipation developing
  • Inactivity – a sedentary lifestyle will cause constipation
  • Formula milk is often more difficult to digest, this can lead to fewer bowel movements that can be thicker in consistency and often have a greenish colour.  Another reason is that formula fed babies are not able to drink more than the amount offered to them, which can lead to slight dehydration
  • Weaning difficulties are one of the most common causes of constipation.  Inadequate dietary fibre, increased milk intake, low fluid intake, over feeding and fussy eating can all trigger constipation
  • Delayed or inappropriate toilet training, bad positioning whilst on the toilet and changes in daily routines will also contribute to constipation. Some children avoid passing stools (withholding) in an attempt to control their environment, this leads to harder stools that hurt when passed.   Stressors are usually; a new sibling or school, moving house, unfamiliar bathrooms
  • Emotional upsets and anxiety can all affect the digestive system
  • Pain – when pain is experienced with passing large or hard stools, this can lead to a pattern of withholding.  Passing large or hard stools can also cause a painful anal fissure (a small tear in the lining of the anal canal); this is very common in infants and toddlers, especially between 6 – 24 months and in turn can lead to a negative cycle of withholding stools to avoid further pain
  • Food allergies or intolerances can also cause constipation.
  • Family history of bowel related problems, where parents of siblings are constipated can increase the likelihood of constipation
How to prevent and / or treat constipation

If constipation is recognised early, simple interventions i.e. dietary changes may be adequate and effective.  But in some cases a combination of nutritional, medical and behavioural interventions will be required. It is vital that a well-balanced varied diet will be implemented and encouraged from the weaning age, this will ensure optimal bowel functioning and the formation of good habits.

Foods

Fibre promotes the growth of healthy bacteria in the colon, which in turn can assist in preventing constipation. Ensure that sufficient amounts of fibre are consumed (see ideas below)

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  • Varied fruits and vegetables; pureed or chopped depending on your child’s age and ability to chew
  • Best fruits for preventing and treating constipation in babies are; P-letter fruits ~ pears, prunes, plums and peaches.  Apples, apricots, raspberries, strawberries and grapes are great too.  Prune or pear juices are also great for dealing with constipation.
  • Beans, pulses and lentils are also very good sources of fibre. But, keep in mind that whole grains, lentils, beans and pulses may fill your child up before they have eaten enough other foods, thus take care to not serve too large portions. 
  • Cereals and grains (white and wholegrain varieties, as appropriate for age and weaning stage)

N.B. a sudden increase in fibre intake can cause abdominal discomfort, bloating and wind, so rather aim to gradually increase the fibre content of your child’s diet

Supplements
  • Probiotic supplements can be used for both infants and toddlers to improve the friendly bacteria in the colon.  Speak to your dietitian, or a health care professional about suitable products.
Fluids
  • Hydration is another key point for preventing and treating constipation, as water makes up a large part of stools.  A lack of fluid in the diet will cause hard stools. All fluids, water, diluted juice or age appropriate milk will count towards their daily intake, but water remains the best option. 
Staying Active 
  • Encourage physical activity in toddlers and allow infants to have some “tummy time” on a play mat, to encourage movement.
Potty training

Potty training is an important milestone in a child’s development.  Ensuring the right environment, providing motivation and encouragement as well as teaching the correct position for passing a stool are all helpful to establish a positive toilet routine. It is also worth trying to monitor key times of the day when your child might pass a stool help, as routine can be effective also, for some children.

 

 

 
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This blog post was written in conjunction with paediatric dietitian Bianca Parau. Bianca offers expert advice and nutritional guidance to children and their families. Her NHS clinical role at Chelsea & Westminster Hospital includes a specialist multidisciplinary feeding clinic, for children with eating problems, often resulting from a history of gastrointestinal problems and food allergy

visit https://www.lavie-nutrition.com for more information

Miriam Cooper