Those tell-tale signs; your toddler pauses in the corner of the room, looking like she’s concentrating really hard, her face goes red, and the whiff in the air tells you it’s time to change a nappy.
But what if it’s never that easy?
Does your baby, toddler or child seem in physical pain when she passes a stool?
Is she miserable and off her food?
Does she keep you awake at night, thrashing around and drawing up her legs in agony, only to produce a hard pellet?
If your child is ‘going’ less than once a day she may be suffering from constipation.
A good transit time is 12 hours, but up to once a day is acceptable.
Over 30% of children become constipated at some stage or another
Whilst a short bout (a couple of days) is fine, statistics show that in the UK 1 in 3 children who become constipated will go on to suffer long-term.
This sadly interferes with their daily life and can become a problem at school.
Because of this, it’s essential you get to the bottom (sorry for the pun) of this as soon as you can.
……..as it’s called, is constipation where the is no easily identifiable cause.
It’s my belief that there is always a cause, but it may be difficult to identify simply because there can often be more that one contributing factor (see my checklist at the end of the post).
That’s why it needs a synergistic approach.
Let’s look at this in more detail….
I saw a baby who was exclusively breastfed but hadn’t ‘been’ for over a week!
The mum was downing orange juice to try and get things moving so to speak, and eventually it worked in a big way, but this wasn’t a solution.
After analysing her food diary, we identified cow’s milk as the offending item, and on elimination the baby’s bowels returned to normal.
Whilst breast-fed babies seldom get constipated (more common in formula fed and weaned infants), this tiny baby’s immature digestion had reacted to cow’s milk protein through mum’s breast milk.
In weaned babies’, toddlers and children, gluten, the protein found in wheat and other grains, is also often implicated in constipation.
My daughter and I are not good with gluten, suffering from bloating and that bunged up feeling when we eat it. Because of this we largely avoid it and everything works just fine.
In fact, giving up helped me lose two stone (but that’s another story).
Could gluten be the problem for your child?
Gluten in some people can cause coeliac disease, which is the most dramatic response.
However, from many years of clinical practices, I have observed that there also seems to be a spectrum of gluten intolerance where some people feel mild discomfort.
Whilst this does not usually show up on a coeliac test at your GP’s, a study in the journal BMC Medicine shows how gluten can set off a distinct reaction in the intestines and the immune system, even in people who don’t have coeliac disease.
The word gluten comes from its glue-like properties
Gluten mixed with water forms a sticky cross-linked network of proteins which give dough it’s elastic stretchability. Imagine a pizza chef pulling his dough.
However, in the digestive tract it sticks to the gut wall like chewing gum.
Combined with mucus and other gut debris, it forms a barrier on the intestinal wall which blocks secretions, slowing down digestion and inhibiting lubrication in the colon.
Not only that, but because it tends to be cheap, accessible and utterly delicious, it’s very easy to eat too much…
Think….Wheatabix, Cheerios or toast for breakfast, pizza, pitta or sandwich for lunch, crackers, biscuits, cakes for after school snack, and pasta, breaded fish or cous cous for dinner.
If this is your child’s diet, then it would be wise to take an objective look at the foods you’re feeding them.
Because the result could be….a slower transit time and that bloated bunged up feeling.
What about cow’s milk?
Cow’s milk can also be a problem for digestion, and various studies have proved this.
One study demonstrated that 80% of constipated patients had a cow’s milk intolerance, with only 1 patient showing this on a positive skin prick test for CMPA (Cow’s milk protein allergy).
Besides intolerance, pasteurised milk also neutralizes stomach acid making it more difficult to break down proteins in food such as the gluten in wheat.
So, you should never give your child milk with a meal.
Dairy milk also encourages excessive mucus production in the gut and promotes unhealthy alkaline-producing bacteria; natural probiotic yoghurt being the exception.
Other symptoms that my alert you to a Cow’s Milk Protein Allergy (CMPA) include colic, eczema, asthma, glue ear, hay fever and poor sleep.
What about Calcium?
If you’re worried about your child’s calcium intake, then goat and sheep yoghurt are more easily digested and usually better tolerated.
There are also many dairy free milks fortified with calcium.
Not to mention plenty of naturally calcium rich foods – including green leafy vegetables, nuts, hummus, sardines, salmon, apricots, and figs.
Check out this calcium rich recipe – Kale Pesto Pasta
What about Soya?
Switching to soya milk does seem to have benefits.
However, I would not recommend any more than the very occasional use of soya milk as it is one of the top allergens, contains natural plant toxins and is largely indigestible; causing bloating and wind.
Soya should only really be eaten in the traditionally fermented form, for example tempeh, natto, miso and soy sauce.
I know myself that twenty years ago before I trained as a Nutritional Therapist, when I consumed soya milk daily, my menstrual cycles lengthened and I suffered from exaggerated PMS from the plant oestrogen content.
Whist this might be of benefit when I’m going through the menopause, I would not want to subject these side effects to a child.
You can read more about the dangers of soya here.
Fibre, or the lack of it, can be an obvious contributing factor in constipation.
But eating the wrong kind of fibre can make things worse.
In decades past, doctors recommended bran to people with irritable bowels, thinking that it could improve bowel regularity.
However, a landmark study published in 1994 was the first to suggest that the fibre in bran tended to make symptoms worse rather than better.
In 2014, a review by the American College of Gastroenterology concluded that insoluble fibre sources – like wheat bran – were not to be recommended, due to the risk of increased gas and bloating (read that study here).
SOAK YOUR OATS!!!
Oats however, which contain soluble fibre, can be beneficial.
Oats do not naturally contain the gliadin portion of gluten which causes the intolerance, however if manufactured in a factory with wheat, oats may be contaminated.
Gluten-free oats are available in supermarkets and health food stores.
When eating oats, make sure they are soaked in water, milk or yoghurt before consuming which makes them easier to digest, that’s why porridge is ideal (see our overnight oats recipe here).
Fruit and vegetables
Fruit and vegetables are also an excellent source of fibre.
If you visit your GP looking for a solution to your child’s constipation, after ruling out anything serious, the first suggestion would usually be to try an osmotic laxative.
What’s an osmotic laxative??
An osmotic laxative is a bulking agent that helps draw water into the bowel to largen and soften poos so that’s they’re more easily and less painfully passed.
Typical brand names you’ll find include Movicol, Lactulose and Cosmocol.
We can replicate the actions of an osmotic laxative with certain healthy foods.
For example – prunes, figs, ground flaxseeds, pears and probiotic foods.
For a Gentle but effective Home Remedy for Constipation – click here
This leads to the topic of probiotics.
Live yoghurt is beneficial despite being dairy, because fermentation has altered the character of the milk solids.
Good bacteria in live sugar-free goat, sheep or coconut yoghurt improves constipation by helping to form soft, bulky stools which pass easily through the colon, and may be regularly included in your child’s diet.
A study which involved giving probiotics to 70 people with chronic constipation found an improvement in 89% of subjects.
If your child has had a course of antibiotic at any time his life, his gut will be wiped clean of these beneficial bacteria and so a probiotic supplement may be necessary.
I’ll be reviewing my favourite kid friendly probiotics supplements on the blog soon.
Please also read my post on how to improve your child’s bowel flora naturally – through their diet.
Medications… a last resort?
Many parents I talk to want to keep medications such as laxatives as a last resort.
I think this is sensible.
If you’re not addressing the root cause of the problem, you may be setting your child up for a lifetime on medication.
Plus it can never hurt to increase the variety of foods in a child’s diet.
However, if you’ve tried all the natural suggestions, and things haven’t improved, it’s important to get checked out by your GP.
1) Fluids – is your little one drinking enough? – water is needed to soften stools, and dehydration can lead to constipation. Chamomile tea is a gentle constipation remedy – see more info here.
2) Fibre – is your child getting enough of right kind of fibre? Gluten free soaked/ cooked oats, wholegrain rice, beans and other pulses, plus a wide variety of fresh fruit and vegetables.
3) Food intolerances? They main culprits I see are gluten and dairy largely because the western diet tends to focus on them too much.
4) Emotional issues – some children learn to ‘hold it in’ for various reasons which may need addressing.
5) Movement – is your child moving enough? Exercise helps move undigested food through the intestines. How about a little massage for your baby – (more here).
6) Breastfeeding : if you are exclusively breastfeeding and your child suffers with constipation look at your own diet – again gluten, dairy and soy can pose problems for some.
7) Antibiotics – has your child had antibiotics, recently or at birth? Antibiotics wipe out the good flora. This altered gut bacteria leads to an altered bowel habit. Consider a probiotic supplement.
8) Holistic therapies. See the appropriate health professional. Need help with improving your general diet – call a Nutritional Therapist. Want to use herbs to get things moving – try a Herbalist. Did your child have an assisted birth or was in breech position throughout the pregnancy – you may need some structural help – reach out to a Craniosacral Therapist.
If you have any questions about this article, any experience or insight you can offer sufferers, or if you simply found it interesting, I’d love to hear from you.
Please leave any comments below, or contact me directly.