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Constipation has been an issue in my house for the last 3.5 years. It is a huge thorn in my side and frustrates me often. As an OT that specializes in feeding, I knew well about constipation and the effects it can have on a child’s eating habits. I know more than the basics to help with constipation, which I will share here, but in my case it wasn’t enough. I had to dig deeper. I am not a nutritionist and don’t specialize in this per say, but wanted to share what I have learned so that it might help you.
To make a long story short, Sam, who is 4.5, began to have difficulty going regularly after transitioning to cow’s milk from breast milk. At its worst, he had sharp referral pain in his back, which was frightening. At that time, we put him on Polyethylene Glycol (PEG for short, or Miralax as you likely know it) an over-the-counter stool softener. He was on it daily until about 6 months ago when I started to realize he wasn’t growing out of this. I wasn’t sure I wanted to keep him on it indefinitely and couldn’t believe that much time had passed with daily use. Although the doctors assured me that it was totally safe, after more than 2 years I decided to do some of my own research – not sure why it took me that long. I was shocked to learn that although no major incidents or side effects have been reported, it has never been approved by the FDA for use in kids or for use on a long-term basis. Miralax and I assume other stool softners are not absorbed into the body, but keep water with the bowel as it is being digested, thus freeing a child of constipation.
Please know that my intent here is not to attack Miralax, for some kids it is necessary and at times it has been a miracle for us. BUT – I couldn’t help wondering, aren’t there other solutions, especially when this is a long term problem? So let’s get to it…
Why Your Kid May Be Constipated
Genetics - Unfortunately for some kids, it is in the genes, but that doesn’t mean that their isn’t potential for them to grow out of it.
Diet - Processed foods, low fiber foods, mostly white bread products, and frequent consumption of the foods on the list to avoid below.
Intolerance to dairy or wheat or both - An intolerance is different that an allergy and some kids may have difficulty digesting wheat or dairy, which slows down their elimination. Dairy is more likely and often moderating it and eliminating cow’s milk is a winning combination.
Holding it in - Some kids actually hold it in because they don’t like how the poop feels coming out or they had a previously painful movement. This can snowball quickly and the longer the they hold it the worse it becomes. I’ll talk about this more in the next section.
Poor Chewing/Picky Eating - If you child doesn’t chew their food well or has difficulty chewing and swallows large pieces of food it could contribute to constipation. Of course, picky eating with a diet limited in fruits and veggies can also lead to constipation. Keep in mind that if constipation is the underlying problem it can cause picky eating. If a child is backed up then there isn’t a lot of room to get more food in and they will often refuse to eat, which needs to be respected because eating could cause them more discomfort.
Poor Water Intake - I think this often goes unnoticed and is often a piece of the puzzle with my son. He drinks water well, but in the winter months when he isn’t as thirsty I need to make sure I give him reminders. A low amount of water makes it difficult to move the poop through the intestines.
Timing - Sooooo many kids hold it when they have to go because they are somewhere they would rather not “go” or they don’t want to run in from outside or stop in the middle of playing. Missing those cues can have a huge impact on how constipated your kid gets. If you happen to be staring at your kid at that moment you might catch the signal and can rush them off anyways, but sometimes they hide it well and often we miss that quick moment.
The solution is to have them sit on the toilet at the same time everyday or every other day. The best time is usually right after they eat. I try very hard not to turn toilet time into something negative or worse, a power struggle. I need to give Sam lots of warnings throughout the meal (“As soon as your done, go and pick out your book for the potty.”) and mornings usually work really well. When we are on top of this it is very helpful.
Eating the “right” foods – This should be a huge part of your plan if your kid is constipated. I know some of these foods may be difficult to get into your child if they are a picky eater. If that is a case, don’t try to lay down the law, slowly start to introduce these foods in fun and playful ways to get your kids interested. See the large volume of picky eater articles I have in the article index for more ideas!
|Some of our favorites from left to right: Trader Joe’s Fiber Bread (5g per slice), Whole Wheat Noodles (5g per serving), Kashi Go Lean (10g per serving), Freeze Dried Peas (4g per serving)|
- Prune/Pear/White grape/Apple Juice
- Most veggies especially peas and broccoli
- Beans, especially black beans! (Think about adding these or lentils into burgers, rice, and soups)
- Whole Wheat Pasta
- Whole Grain Cereals (We will eat these dry as a snack, too)
- High Fiber Bread (We like the kind at Trader Joe’s)
- Flax Seed Meal (I add some into yogurt, which we only have once a week, and oatmeal)
Read the Label - All of the foods above are high in fiber, which helps relieve constipation. However, you can’t always assume that because something is whole grain, whole wheat, or brown rice that there is fiber. Also, there are a lot of high fiber products that don’t necessarily fit into those categories either, so it is really important to read the label. I would recommend trying to avoid buying foods that have anything less than 2 grams of fiber. That may sound overwhelming, but there are so many options now when it comes to breads, pretzels, crackers, etc. You will also want to try and maximize the fiber, don’t just stop at 2 grams. Keep flipping over boxes and bags until you find the highest number. Of course, the natural sources of fiber are superior because many of the high fiber products add processed fiber.
Natural Supplements - When we started to back off of Miralax I was happy to have found Fiber Advance Gummies For Kids , an all natural fiber gummy that I give to the kids. There are very few ingredients and no sugar. My kids love them.
*UPDATE* Several readers have shared other products that have been helpful. Again, I am not endorsing these products, but passing on information. Discuss any medications with your doctor.
Fletcher’s Gentle Laxative Kids
Water – As I mentioned above, get the water in! Have a cup ready to go at the start of your day and readily available all day long. Give gentle reminders as needed. Also, take water with you everywhere so they can drink in the car or running errands.
Foods to Avoid
As a feeding therapist, I hate to tell kids there are foods they can’t or shouldn’t eat. At four years old, I did begin to explain to my son that these were foods we could only eat sometimes because they made it much harder for him to poop – can’t say I liked doing that, but he gets it. None of these things are totally off limits, but I do limit them as much as possible.
- ice cream
- rice krispy treats
- rice cakes (unless they are brown rice and have a few grams of fiber)
- white rice
- white bread products/crackers/pretzels
We are still working at this ourselves and haven’t found a complete solution. We switched to almond milk for several months and still allowed some dairy, with a lot of moderation. The switch off of cow’s milk didn’t seem to make much of a difference so we have recently gone back to it. It is something I am constantly managing and monitoring. At this point we are still using Miralax on an as needed basis, which can be anywhere from 2-6 times per month. For us, that is a lot of progress from daily use. Ultimately my goal is to rarely need it.
As I mentioned, this post isn’t exhaustive but mostly my personal and professional experience. If something is working in your house that I didn’t list here, PLEASE share so that it can help others, myself included!
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