For bowel-basics and how to tell if constipation is chronic, check out part 1 of this series. We caught up with leading digestive disorder dietitian Tamara D. Freuman, MS, RD, CDN, who specializes in all things GI, including Celiac Disease and food intolerances. Whether your child is in the early stages of potty training or having the problem of going poop, Tamara has the full scoop on how to prevent and treat constipation.
In young children, particularly those who are potty training, holding in bowel movements can lead to chronic constipation issues if it develops into a pattern called “functional retaining.” Functional retention refers to when people voluntarily hold in their stools when they have to go, and it’s surprisingly common in children. It’s also pretty common in schoolteachers, who are not able to use the bathroom at will in the morning when bowel motility is at its most active. In kids, functional retention often occurs as the result of an emotionally upsetting or physically painful bathroom experience—whether it be a pain on defecation from hard stools, being shamed as the result of an accident or feeling too pressured to be potty trained. Regularly being asked to hold in stool during errands may also contribute to a functional retention habit, because kids get the message that they can’t use the bathroom unless they’re home.
When children hold in their stools rather than passing them, the stools can become large, bulky and dried out—making them hard and painful to pass. The pain associated with passing these stools can then fuel a vicious cycle of more retention, as children fear the pain associated with pooping. In chronic cases of functional retention, children may experience fecal soiling when they pass gas, as liquid stool squeezes past the harder, constipated stools along with the gas. Children who develop a functional retaining habit often grow into adults who are functional retainers, feeling unable to move their bowels anywhere but home. Needless to say, this causes significant difficulty at work and when traveling.
Bottom line: if your kid has to poop, try to find a bathroom for him or her as expeditiously as possible, even if it’s inconvenient. (I kept a potty in my minivan until my kids were about 4, and they’ve probably pooped in every supermarket, restaurant, and Starbucks in a 50-mile radius of my house.)
The main issue for most kids who experience constipation is a lack of dietary fiber. (The role of water and hydration is way oversold regarding its effect on bowel regularity.) American kids are typically weaned to a very low fiber diet of french fries, Goldfish, chicken fingers, pasta and pizza, and the most popular fruits and veggies are lower fiber choices like bananas and potatoes.
For kids, a little bit of fiber goes a long way. Switching cereals from low fiber Rice Krispies, Chex or Corn Flakes to Cheerios or Puffins is a pretty kid-friendly tactic, as is bringing oatmeal into the rotation. If your child likes smoothies, try tossing some ground flaxseeds into the blender and call it confetti; they don’t affect the flavor. If you make pancakes from a mix, add 1/3 cup canned pumpkin puree and some cinnamon to the batter (see this pumpkin pancake recipe), or look for ‘paleo’ style pancake recipes that use almond flour as the base. Any fruit with lots of skins or seeds—like berries and cut grapes—are also helpful. Many children will happily snack on roasted seaweed sheets, dry roasted chickpeas, salted nuts of any kind, roasted ‘pepitas’ (pumpkin seeds), or plain coconut chips, so don’t shy away from introducing some of these higher fiber options into the rotation. Making a trail mix from these crunchy, salty snacks that are adorned with a pinch of chocolate chips may get them interested!
Fruits that are rich in the natural sugar sorbitol can also have a laxative effect; these include apples, pears, cherries, dried apricots or prunes—or prune juice/pear nectar/pear puree for infants who can’t yet handle chewing.
If your child takes a multivitamin with iron, you might consider stopping it or replacing it with an iron-free version. Supplemental iron is constipating.
The goal is to increase dietary fiber toward alleviating constipation, even in children who have a limited repertoire of foods. Children who are difficult to feed will often find fruits more acceptable than vegetables. But if fresh fruit is hard to sell, you can try serving it frozen. My children love eating frozen blueberries, cherries, and mango—all of which have a terrific laxative benefit between their fiber content and the ‘osmotic’ effect of their natural sorbitol and fructose content. (Just be sure to cut cherries to prevent choking risk for little kids.)
A smoothie is another great vehicle for osmotic fruit sugars, and you can toss in a flavorless/textureless fiber supplement like Benefiber as well—it will be undetectable. If your child isn’t averse to the change in texture and appearance, ground flaxseed is an easy add to smoothies as well and has other nutritional benefits to boot.
Kids who don’t easily accept fruits and vegetables may do well with crunchy, salty snacks made from whole grains and beans, like Beanitos tortilla-style chips (5g fiber per serving), Soy Crisps, Dry Roasted Chickpeas or Edamame (soybeans). Freeze-dried veggie snacks like peas and corn may sometimes be better accepted than fresh versions. Snack foods that contain lots of seeds, like Chia bars or refrigerated “Chia Pods”, can be appealing because they’re sweet from fruit or fruit purees; seeded crackers and salty snacks like the pretzels from Mary’s Gone Crackers may find favor with fussy children as well.
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