Constipation in children is quite common and often times simply adding in more fiber-rich foods or fluids can be an easy fix. However, a number of children struggle with constipation for months or years even after trying a variety of treatments. In these cases, I have to “think outside the box” when it comes to determining the underlying cause of the constipation.
What are the signs of constipation?
Your child is constipated when they aren’t having daily bowel movements or their bowel movements are painful and hard. Some children have very large stools every 2-3 days, which is also a sign that your child is constipated. Some children can have associated stomachaches or leakage of stool.
What causes constipation?
Lack of fiber or fluids in the diet can cause constipation. Processed foods and dairy products tend to make children more prone to constipation. Minimal exercise is also associated with constipation. Constipation can also be due to underlying illnesses like celiac or thyroid disease.
How is constipation treated?
Sometimes simply increasing fiber-rich fruits and vegetables, like berries, broccoli, green beans, peaches, pears, can help with constipation. For more moderate to sever constipation osmotic laxatives like miralax or milk of magnesia are used. A stimulant laxative is usually used along with these laxatives when doing a bowel clean-out.
What is the naturopathic approach to treating constipation?
I am often seeing children for the treatment of constipation after they have been dealing with it for years and they have already seen a number of gastrointestinal specialists, but they are still struggling. This is where I will utilize other natural therapies and do further testing and evaluation to see if we can improve the situation.
Food sensitivities:
Food sensitivities are different from food allergies where they are not an immediate reaction, but a delayed reaction, so something that your child ate a few days ago could give them problems today. I will simply start in this category by trialing a 100% elimination of cow dairy for at least 4 weeks to see if that helps. If no change, then we consider testing for food sensitivities. Testing for food sensitivities is tricky because there is no great way to test and their can be false negatives and false positives, but it will often give us enough information to get started. I have found this testing to be the missing link in many chronic constipation cases.
Lab and stool testing:
If lab work has not been done I will typically screen for celiac disease (true gluten allergy), thyroid disorders, and since I am doing a lab draw on a child I will often screen for low iron at the same time.
Stool testing helps me to assess the good vs. bad bacteria in the digestive tract. It also gives me an idea of normal digestive enzyme production. I have found that treating an imbalance of this digestive bacteria to help with tricky constipation cases when nothing else has worked.
Supplemental support:
Sometimes children don’t respond well to typical laxatives, so we will trial natural laxatives. My favorite natural laxatives to use are magnesium citrate and Vitamin C. The dose of either of these is very child dependent, so sometimes it takes a little trial and error to find the right combination that achieves mashed potato consistency stool. Sometimes I will use these in combination with an over-the-counter laxative.
There is a lot of research on probiotics for the use of functional constipation (constipation without any true cause) and no one really knows if there is a certain strain that works better than another. Stool testing will sometimes help me choose a certain probiotic strain, but often I am just recommending a good quality probiotic as well as having children get probiotics from there diet in the form of yogurt (if they can tolerate dairy), sauerkraut (tasty in smoothies!), and kombucha.
Bowel retraining:
This step is super important when treating constipation. Children often will become afraid of having a bowel movement when they are constipated because it can be painful, so they tend to hold their stools which makes the constipation worse. It is important to break this cycle. Encourage your child to sit on the toilet for at least 10-15 minutes twice per day. Right when they wake up or immediately after breakfast is a good time to start because it mimics the natural timing of our intestines. Bowel retraining is especially important for school-aged children who avoid public bathrooms during the day.
Use a reward system, like a sticker chart or penny jar, to encourage your child to sit on the toilet. This is where it is ok to allow them some extra screen time! Praise your child for trying, even if they do not have a bowel movement. Bowel retraining isn’t necessarily about having a bowel movement every time, but about sitting on the toilet at regular intervals to get their body back into that habit.
Dietary factors:
A big part of preventing and treating constipation in children is to avoid constipating foods. Foods in this category include all dairy products, rice, starchy veggies like potatoes, sweet potatoes, squash, fried foods, and most processed foods like crackers, cookies pretzels. All of these foods listed are low in fiber, unless otherwise labeled. In order to prevent constipation foods with higher fiber content need to be included, this would be all veggies besides the ones listed prior, whole fruits (not fruit juice), beans, nuts, seeds, whole grains (brown rice, quinoa, amaranth, etc…).
It can be difficult to adjust the diet of a child, especially a toddler who might be going through a picky phase. It is best to make small adjustments and to start developing other healthy habits around food, like cooking together in the kitchen or growing their own veggies in a little garden.
There are number of ways to treat constipation in children and it is important to treat the whole child and think outside the box when it is a complicated or prolonged case.
References
Akman S, et al. Is celiac disease misdiagnosed in children with functional constipation? 2018 Turk J Gastroenterol Mar;29(2):210-214.
Huang R, et al. Positive effect of probiotics on constipation in children: a systematic review and meta-analysis of six randomized controlled trials. 2017 Front Cell Infect Microbiol Apr 28;7:153.
Kubota M, et al. Lactobacillus reuteri DSM 17938 and magnesium oxide in children with functional chronic constipation: A double-blind and randomized clinical trial. 2020 Nutrients Jan 15;12(1).
