As both a mother and dietitian, I deal with constipated babies and kids a lot. Two out of three of my own babies suffered for months after starting solids. It’s difficult to watch your little one in pain while trying to pass stool, or because they are so backed up!
The first thing to assess if you think your young child is constipated is the definition of constipation. The Canadian Pediatric Association defines constipation as “ bowel movements that occur less often than usual, that are hard and dry, and/or painful or difficult to pass.” So it’s not the frequency of stools as much of the consistency that is important. Your exclusively breastfed infant isn’t constipated when they don’t poo for 2 weeks, as long as their poo is regular breastfed-baby-poo consistency!
Causes of constipation can include toilet training, starting daycare or starting solids. It seems a tough transition for most babies to go from breastmilk to starting solids. If constipation is a constant problem, take your baby to the doctor to make sure there are no underlying causes. Especially if your babe also has fever, abdominal distention, has stopped eating, has blood mixed with stool, slow weight gain or weight loss.
As for diet, here are some foods and supplements that can help prevent constipation:
1) Fibre. Insoluble fibres like bran bulk up stool. The old fibre recommendation that I often still use is your child’s age +5g per day. The newer Dietary Reference Intakes include all fibre in the child’s diet (including functional fibres added to many foods now, like inulin). These recommended intakes are 19g of fibre per day for a 1-3 year old and 25g per day for a 4-8 year old. As many adults struggle to get this amount, I feel it’s too lofty a goal for young children. Besides, their tummies are small and 25 g of fibre wouldn’t leave them very hungry for more calorie dense foods. But offer one fibre-rich foods at each meal, and your baby/child should get adequate fibre.
Note: If you’re increasing fibre, make sure FLUID is increased along with fibre to push things along!
You can also add wheat bran as a fibre supplement, but in small amounts. While it has been shown to be the most beneficial food fibre for helping with constipation, it can also lead to mineral imbalances, so check with me regarding dosage.
2) Water. Water is the only thing that helps my babies get over their constipation. Not fibre, juice, prunes or Restoralax – just simple water. And my youngest buy has troubles drinking from an open cup, but I found he will take water from a dropper just fine. If your baby or child doesn’t drink much (or any water) give it a try to increase even by an ounce for young ones.
3) Natural laxatives. We all know that prunes are a great natural laxative! I’ve also included a Fruit Lax recipe below. Apple, pear or prune juice can also help draw water into the bowels to make stool easier to pass, as they contain sorbitol. Offer ¼-1/2 cup per day for little ones with a meal.
4) Probiotics. A study using lactobacillus casei in kids under 10 found improvement in stool frequency. Culturelle contains this probiotic and has a powder and chews for kids: http://www.culturelle.com/
Ecologic Relief probiotic results in increased stool frequency, improved consistency and decreased abdominal pain. This is a blend of 6 different probiotic strains, but I can’t seem to source it in Canada yet. I’ve sent the company and email and will update you when I find out!
5) Dairy Intolerance If your child is non responsive to laxatives, it is possible that their constipation is the result of a dairy intolerance. When my 4 month old was exclusively breastfed and still constipated, I took dairy out of my diet for a month (and I can tell you – there’s no substitute for cheese!). It made no difference, which is what most will find. But it’s worth a try, if you can provide the nutrients in dairy from other food sources in your diet.
6) Laxatives. Including barley malt extract, lactulose, corn syrup or sorbitol can soften stools in infants. Polyethylene glycol (PEG) is a popular powder laxative that is safe for treating constipation in infants and toddlers. Talk to your doctor of pharmacist before using any of these methods, as doses are weight-dependent. Suppositories are also an option, but talk to your doctor first.
Fruit Lax Recipe
Makes 1 cup, or 16 servings (1 Tbsp each)
½ cup raisins
¼ cup pitted prunes
¼ cup pitted dates
6 Tbsp prune juice
¼ cup wheat bran
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