Childhood Constipation

Monika Pis, PhD, CPNP

Constipation, defined as hard or infrequent bowel movements (3 or less a week), is a very common phenomenon during childhood. The most likely cause is diet, although some children inherently have a slow peristalsis leading to constipation. There are many medical reasons for constipation, but I will not be addressing those in this article.

As children are transitioned from baby formula to cow’s milk, and from baby to table foods, certain feeding practices contribute to the development of constipation. Many parents think that a child should drink as much milk as formula, when actually, only 16-24 ounces of cow’s milk a day are necessary for healthy growth. While milk contains vitamins A and D, as well as calcium and fatty acids necessary for a healthy development of the brain, milk and its derivatives (cheese, yogurt, ice cream) are constipating in nature. Therefore, most children consuming large quantities of dairy products develop constipation.

Another feeding practice that leads to unhealthy elimination is catering to your child’s dietary whims. If allowed, most children would prefer to eat pizza, macaroni & cheese, noodles, chicken nuggets, and hot dogs instead of fiber-rich foods like fruits, vegetables, and beans. Processed foods high in carbohydrates lack fiber that is necessary for regularity. Therefore, diets high in carbs and low in fiber often result in hard, difficult to pass stools.

Unresolved constipation leads to chronic abdominal pain, feeling bloated, nausea, decreased appetite, heart burn, rectal bleeding from straining, urinary tract infections, vomiting, intestinal obstruction, and even bowel perforation that may result in death.

Toddlers who get constipated may become frightened of heaving another painful bowel movement. They may begin holding the stool in, which in turn causes even more constipation.

Prevent constipation in your child by serving fruits and vegetables with every meal and snack. Offer 16-24 ounces of milk daily, and limit cheese to a couple of slices a day.

The American Heart Association recommends that children older than 2 years should gradually adopt American Heart Association dietary recommendations. That means saturated fat intake should be less than 7 percent of total calories, trans fat intake should be less than 1 percent of total calories, and dietary cholesterol should be limited to no more than 300 mg daily. Children should also get the majority of calories from complex carbohydrates high in fiber.

Both children and adults should consume 14g of fiber per 1,000 calories consumed. Read the nutrition facts panel on food labels to determine how much fiber is in the food you are choosing. According to the Food and Nutrition Board of the National Academy of Sciences Research Council, the dietary fiber intake is summarized below:

Dietary Reference Intakes for Fiber
Age, then grams per day of fiber

Children
1-3 years 19
4-8 years 25

Males
9-13 years 31
14-18 years 38
19-50 years 38
51+ years 30

Females
9-13 years 26
14-18 years 26
19-50 years 25
51+ years 21

Pregnancy
<18 years 28
18+ years 28

Lactation
<18 years 29
18+ years 29

To increase fiber in your diet, follow these tips presented by The Mayo Clinic:

• Start your day with a high-fiber breakfast cereal — 5 or more grams of fiber per serving. Opt for cereals with "bran" or "fiber" in the name. Or add a few tablespoons of unprocessed wheat bran to your favorite cereal.

• Add crushed bran cereal or unprocessed wheat bran to baked products such as meatloaf, breads, muffins, casseroles, cakes and cookies. You can also use bran products as a crunchy topping for casseroles, salads or cooked vegetables.

• Switch to whole-grain breads. These breads list whole wheat, whole-wheat flour or another whole grain as the first ingredient on the label. Look for a brand with at least 2 grams of dietary fiber per serving.

• Substitute whole-grain flour for half or all of the white flour when baking bread. Whole-grain flour is heavier than white flour. In yeast breads, use a bit more yeast or let the dough rise longer. When using baking powder, increase it by 1 teaspoon for every 3 cups of whole-grain flour.

• Eat more whole grains and whole-grain products. Experiment with brown rice, barley, whole-wheat pasta and bulgur.

• Take advantage of ready-to-use vegetables. Mix chopped frozen broccoli into prepared spaghetti sauce. Snack on baby carrots.

• Eat more beans, peas and lentils. Add kidney beans to canned soup or a green salad. Or make nachos with refried black beans, baked tortilla chips and salsa.

• Eat fruit at every meal. Apples, bananas, oranges, pears and berries are good sources of fiber.

• Make snacks count. Fresh and dried fruit, raw vegetables, low-fat popcorn, and whole-grain crackers are all good choices.