Constipation in children

Constipation is a disorder in which a child 

  • a.) has infrequent stools (2 or fewer a week)
  • b.) has painful bowel movements, or 
  • c.) passes large stools that often require a lot of straining  

There are some common developmental stages when constipation occurs:

  • When introducing solid foods or transitioning to cow’s milk
  • Potty training
  • Beginning school

If we can plan for the possibility of constipation at these stages, it can often be prevented, or if not prevented, quickly treated with some easy interventions. Two of the best things you can do to prevent/treat constipation is to increase fiber and fluid intake.

For children 2 years and younger, the goal for fiber intake should be about 5 grams per day. An easy way to do this is with several servings of pureed fruits and vegetables, and cereals that contain fiber. Most fruits and vegetables contain about 1 gram of fiber per serving, but prunes and peas can have up to 2 grams per serving. Rice cereal has almost no fiber, but whole grain cereals like barley and wheat supply 1-2 grams per serving. Fluid intake does not need to go beyond usual maintenance amounts, however, if constipation has been associated with the transition to cow’s milk, it may be wise to limit intake to 24 fluid ounces per day.

When potty training, some of the best things parents/caregivers can do to prevent constipation is to take a relaxed approach, give adequate foot support for kids while sitting on the potty (for comfort and to relax the pelvic floor), make sure there is enough fiber in the diet, and limit excessive cow’s milk. A good rule of thumb for fiber at this stage is the child’s age + 5-10 grams per day (which ends up being between 7-15 grams/day for kids aged 2-5 years). Drinking more than 32 ounces of whole milk per day can slow the intestines down and can also make kids feel full. This will then limit their desire to eat and drink the things that will prevent constipation (fruits, vegetables, and water). 24 ounces of cow’s milk per day is enough to meet the daily calcium requirements for kids aged 1 to 5 years old.

When kids transition into attending school, constipation can become a problem because they may not want to use the toilet at school (causing stool withholding), or because the new schedule can interfere with their routine. Parents/caregivers should routinely ask about their child’s bowel movements. Check in to see if they feel embarrassed about using the bathroom at school, or if they are holding their stool. Give kids a designated, routine, unhurried time to sit on the toilet at home after meals. The fiber goal for a 6-year-old is between 11-16 grams/day (based on age + 5-10 grams/day).

These are just some simple ways in which constipation can be anticipated, prevented, or quickly treated with simple interventions. As always, please call our office for any questions or concerns or to make an appointment with one of our providers.

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References
Sood, M.R. (2021). Recent-onset constipation in infants and children. In A. Hoppin (Ed.), UpToDate. Retrieved January 4, 2022 from https://www.uptodate.com/contents/recent-onset-constipation-in-infants-and-children?search=constipation%20in%20children&source=search_result&selectedTitle=1~150&usage_type=default&display_rank=1