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How to treat constipation in babies & children

 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 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 more severe symptoms of constipation like 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) High Fibre Foods:

Insoluble fibres like bran bulk up stool. The old dietary 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 extra 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 this level of fibre intake is too lofty a goal for young children. Besides, their tummies are small and 19g of fibre wouldn’t leave them very hungry for more calorie-dense foods. But offer one fibre-rich foods at each meal, and your child should get adequate fibre.

    • Fruits and vegetables (with the skins on),

    • Whole grains instead of refined,

    • Beans and legumes (these are the best source of fibre!)

    • Ground Flax: add 1-2 tsp per day to a smoothie, oatmeal, yogurt or applesauce.

Note: If you’re increasing fibre, make sure FLUID is increased along with fibre to push things along!

2) Water: 

Water is the only thing that helps my babies get over their constipation. Not fibre, juice, prunes or Restoralax – just simple water. My youngest boy had troubles drinking from an open cup when he was young, 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:

Apple, pear or prune juices 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. And we all know that plain old prunes are a great natural laxative! Here’s a Prune Energy Ball recipe your little ones might like, and I’ve also included a Fruit Lax recipe below.

4) Probiotics:

While expensive, there is no physical harm to adding probiotics temporarily, and work towards creating a healthy gut.  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/

5) Dairy Intolerance:

If your child is unresponsive 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 work as stool softeners 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

  1. Soak raisins, prunes and dates overnight in just enough water to cover it.
  2. Pour into a food processor. Add the prune juice and bran and blend well.
  3. If it’s too thick, add orange juice until a paste consistency is reached.
  4. Store in an airtight container in the fridge for up to 2 months, or freeze.
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