Is your child straining to pass dry, hard stools? Only having a bowel movement every few days and suffering from tummy aches? Fussing because stool is painful to pass?
Functional constipation may be the diagnosis.
Constipation is a very common childhood complaint. It accounts for many visits to the pediatrician and often referral to GI specialists.
In toddlers, constipation often develops around toilet training. Toddlers withhold stool to avoid going in the potty or are simply too busy with an engaging activity to stop and heed nature’s call.
In school age children, it is common to have constipation develop if the child is not having time for a bowel movement at home on a busy school morning, and then is too embarrassed to use a bathroom outside of the home. These behaviors coupled with low fiber in the standard American diet, and inadequate hydration can contribute the constipation cycle.
Constipation can cause a vicious cycle where if a child has a painful stool, they associate bowel movements with pain. This causes them to withhold their stool to avoid the discomfort.
If stool is withheld, more water is reabsorbed and the stool becomes larger, harder and more painful to pass…thus perpetuating the problem. Hard stools can cause small tears in the rectal wall called fissures which make the stool painful to pass and can present with streaks of blood in the stool.
6 tips to relieve constipation in kids
Most children with constipation are healthy, without any underlying medical condition, and it is appropriate to try some of the natural options below:
1. Sip Some Sorbitol:
Sorbitol is a naturally occurring sugar in certain juices that are not absorbed well in the colon and act as an osmotic laxative.
Water is the recommended beverage of choice for children, but for toddlers and young children, adding a few ounces a day of fruit juice like prune, pear or apple can help increase the water content of stool to allow for easier and more frequent passage.
Fruits, vegetables and whole grains are great sources of fiber to help bulk the stool and relieve constipation, especially if stools are small and hard. Aim for a fruit or a vegetable as part of each meal. Swap white bread and baked goods for whole grain versions.
Try adding 1-2 tsp of flax meal to pancakes, waffles, smoothies or yogurt for a fiber boost. When adding a fiber supplement, like flax meal, be sure to adequately hydrate with 4-6 ounces of water.
3. Magnesium Citrate:
Magnesium is one of my favorite treatments for constipation in children and adults. Magnesium helps to relax the muscles of the colon and pulls water into the intestines to make stool passage easier and more comfortable.
I recommend a powdered form for dosage flexibility. Start with ½ tsp in young children and 1 tsp in school ages children. Increase in ¼ tsp increments. If stools are too loose, cut back by ½ tsp. Dose in the evening for soft, easy to pass bowel movement in the morning.
4. Regular Bathroom Time:
Establish healthy habits by encouraging a regular time to sit on the toilet for 5-10 minutes. Prime times are after breakfast and after dinner. The gastro-colic reflex is the urge to have a bowel movement after a meal. Seize this opportunity!
Ignoring the urge to have a bowel movement can weaken the muscle tone and reduce the sensitivity of the stretch receptors in the rectum. Pay attention to natural rhythms and help your child learn when they have the urge to go. For example, school age children may be uncomfortable using a bathroom outside the home or having to raise their hand in class to use the restroom, so after school may be the best time to try.
With young children, try to make this a relaxing time. Take a few moments to sit and chat, read a story, do whatever it takes to help child relax and pass their bowel movement. To promote the best posture for better elimination, place a bathroom stool in front of the toilet so your child’s feet are on a flat surface for foot support instead of dangling in the air.
Probiotics are beneficial bacteria that help soften stool, make stool easier to pass and relieve gas and bloating. Try a multi-strain formula containing a variety of lactobacillus and bifidobacterium.
This recommendation is especially important for children who have had multiple rounds of antibiotics. Antibiotic kill the harmful bacteria causing illness, such ear infections or sinusitis, but the good bacteria is also compromised. Re-inoculate with a daily probiotic for digestive health.
6. Trial of Dairy Elimination:
Milk protein sensitivity can contribute to constipation in infants and children. Dairy includes foods such as cow’s milk, cheese, yogurt etc. Eggs are in the dairy case, but are not a dairy product and can be kept in the diet.
To see if dairy is a factor, try eliminating dairy in the diet for 2 weeks. If constipation resolves, you can do a challenge by adding in 1 serving of dairy and monitoring if your child’s symptoms return. For many children, minimizing dairy without a full elimination is often sufficient.
I also recommend dairy elimination for atopic children with eczema, recurrent ear infections or asthma. There are many palatable substitutes, like coconut milk, almond milk, soy milk, rice milk or oat milk.
Most importantly, try to reinforce behaviors in a patient, positive way. Praise, sticker charts, or small prizes can be used to encourage young children. Avoid shaming or punishing, for as with any skill, acquiring good bathroom habits is a learning process.
For persistent or severe symptoms, it is prudent to see your doctor to rule out more significant disease.
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Products, information, and services found in on this website, or any subsidiary are intended to be used for education purposes only. These products are not intended to diagnose, treat, or cure any disease, nor are the views expressed by Amanda Levitt, ND intended to be a substitute for conventional medical services. If you or a family member has a medical problem, or if you suspect that you or a family member has a medical problem, promptly contact your health care provider.
Dr. Amanda M. Levitt is a mother of three and a naturopathic physician with a specialty in natural family medicine. She treats her patients with a unique integrative approach, emphasizing education as well as natural therapies including diet, herbal medicine, nutritional supplementation, counseling, stress reduction, and lifestyle modifications.
Dr. Levitt is a Phi Beta Kappa and magna cum laude graduate from the University of Arizona, and earned her doctorate in naturopathic medicine with honors from Bastyr University. She has been practicing as a board certified naturopathic physician for nearly 15 years. Dr. Levitt is an owner and practicing physician at Whole Health in Hamden, CT which has been voted the best natural health facility year after year in the greater New Haven area.
In addition to her thriving private practice, Dr. Levitt consults for Middlesex Hospital’s Integrative Medicine Residency program, helping to train medical doctors in the science and art of natural medicine.
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