Original publication 2016 | Updated November, 2019
If your child is constipated, you know how distracting that can be during the day. My guess is you want to provide relief… fast.
You may want to know how to treat constipation naturally, so that you and your child can move those difficult to pass stools, and get back to normal bowel movements (literally, and figuratively).
In this article, we’ll talk about constipation, normal bowel movements, why kids get constipated and natural constipation relief techniques such as natural laxatives, stool softener foods, and other home remedies.
Identifying Constipation Symptoms
Kate’s son used to “get sick” right after eating breakfast and just before he boarded the bus for school. Nary a morning passed that he didn’t complain of a tummy ache.
Kate thought he was lactose intolerant since his tummy aches seemed to happen after he ate cereal with milk. Eventually, she took him to the doctor and an ultrasound was done.
He had chronic constipation.
It turns out her son was trying NOT to go during the day at school. And, he wasn’t taking the time in the morning to go to the bathroom.
When she came to me, Kate was clear she didn’t wanted to relieve her son’s constipation. She wanted to know whether she could use natural laxatives for her child, and the most effective ways to quickly relieve his constipation.
Specifically, she wanted to know which foods could help his constipation. Simply put: she was interested in natural stool softeners for kids.
So, we got to work.
We targeted quick relief strategies, including a change in her son’s diet to bring in more food-oriented natural laxatives.
With some additional bowel training, Kate’s son was able to get back on course.
Prevalence of Constipation in Kids
Did you know about 3 to 5% of general pediatric office visits are due to constipation complaints? Thirty percent of all referrals to pediatric gastroenterologists are for constipation, according to UptoDate.
Constipation is common in kids, and I am seeing it more and more in my practice. Constipation happens when a child (or adult) is unable to, or has difficulty passing stool.
Typically, this is due to hardened stool, which can occur for several reasons, including poor diet, dehydration, medications, or a medical problem.
I will be focusing on a more natural, food-based approach (rather than the medical model of constipation management including stool softeners), using foods that are natural laxatives.
[If your child has a more serious issue with chronic constipation, you may need a combination of medication like stimulant laxatives and lifestyle approaches, which should be discussed and guided by your doctor.]
First, a little background information.
What are normal bowel movements?
If your child passes a bowel movement once or twice per day, or even up to once every 2-3 days, without discomfort or pain, he or she is considered to have normal bowel movements.
Typical Constipation Symptoms in Kids
People with constipation have several symptoms. The following ones should alert you to constipation, but they aren’t always terribly obvious:
Stools which are hard and/or dry and/or difficult or painful to pass
Many days without a bowel movement
Soiling (apparent diarrhea or stool in the underwear, also called encopresis)
Poor appetite and eating
Notable efforts to make a bowel movement; your child may actually be trying to hold it in
Rome IV Diagnostic Criteria for Chronic Constipation
To objectively identify chronic constipation, healthcare professionals look at the Rome IV diagnostic criteria, which were established by expert consensus:
Your child has suffered for at least 3 months (and the symptoms started at least 6 months ago) with at least two of the following symptoms:
- lumpy or hard stools in more than one out of four bowel movements
- straining during these movements
- a feeling that there is more stool to pass but he is unable to pass it
- a sense of blockage preventing the passage of stool
- needing help to remove stool (manual extraction or stimulation)
- less than 3 spontaneous bowel movements per week
- rare instances of loose stools (even with use of laxatives)
Is it Diarrhea or Encopresis?
Sometimes constipated kids have diarrhea, which can be very confusing for parents. Often this is what is called encopresis.
Encopresis happens when stool is withheld in the intestinal tract and grows very large, stretching the rectum.
Over time, the feeling of having to go may become dulled and your child may not realize he needs to pass a bowel movement.
Sometimes, liquid stool makes its way around the large, hard stool in the rectum and leaks out into the underwear. It often looks like diarrhea, but is really a side effect of significant chronic constipation.
4 Reasons for Constipation in Kids
There are four main reasons your child might be prone to constipation. They include diet, illness, withholding, and lifestyle changes. Let’s take a look at each one.
1. Eating Foods that Cause Constipation
In infants, constipation is rarely a problem, but it can crop up when you start giving your baby solid food.
Baby constipation is merely due to the intestinal tract adapting to the digestion and processing of a more complex food-based diet.
Adding a bit of juice or more water to the diet can help make this transition easier, soften the stools and make them easier to pass. I had to do this with one of my kiddos when we transitioned off breastmilk and on to a full food diet.
In older kids, diet is often the culprit of constipation. A lack of fiber and fluids in the diet are two of the most common diet mistakes leading to constipation.
Toddler constipation can occur when kids are picky and have a limited diet. Often, toddlers stop eating vegetables. These contain quite a bit of fiber and eliminating them from the diet can lead to constipation. Also, if you haven’t introduced whole grains yet, your toddler’s diet may be low in fiber.
Foods that cause constipation such as those with little fiber including dairy products, or too many processed foods, may not support normal bowel movements.
Additionally, when kids don’t drink enough water in the diet (from liquids and/or fruit and veggies), this can lead to a back up.
2. Illness Can Interrupt Bowel Movements:
Low food and fluid intake due to an illness can throw regular bowel movements off track. Thankfully, this is most likely temporary.
Medications may also cause constipation. Certain medical conditions, such as thyroid problems, may make children more likely to be constipated.
3. Withholding Stool (Trying Not to Go #2):
There are many reasons children may withhold their stools.
Fear of pain associated with passing a bowel movement, a desire to be independent or have control over visits to the potty (common during the toddler years), distractions, too busy playing, or being afraid to go to the bathroom outside of the home (at school, friend’s house, camp, etc) are all reasons.
Withholding can lead to constipation and may even contribute to encopresis.
4. Changes in Routine, Environment, or Added Stress
Moving, starting a new school, re-starting school, travel, or difficult relationships are just some of the everyday life occurrences that may throw some children off of their normal stooling pattern.
If constipation is untreated, it may get worse, leading to a need for regular medications or an enema to eliminate stool and relieve constipation.
Natural Remedies for Constipation in Kids
The goal of constipation treatment is to relieve it and re-establish normal stooling patterns. There are several ways to treat constipation naturally. The method used will depend on your child’s age and how serious the problem is.
First and foremost, I suggest you try using natural laxatives coming from food. Establishing a healthy diet and lifestyle will support your child’s regularity. In fact, this will help every child with constipation.
In severe cases of chronic constipation, medications may be prescribed to “clean out” your child’s intestinal tract.
Some medications soften the stool. These are known as stool softeners (such as Miralax, a stimulant laxative). Other medications help clear out the stool (an enema).
You should always consult with your pediatrician before giving over-the-counter stool softeners or enemas to your child.
Understanding Fiber and Constipation
You probably already know a high fiber diet, which includes both insoluble fibers and soluble fibers, is key to keeping the digestive system working normally.
Fiber is key to constipation prevention.
It makes your child’s stool easier to pass.
What is insoluble fiber?
Insoluble fibers are fiber sources that are not dissolvable in water. They add bulk to your child’s stool, such as wheat bran and vegetables.
What is soluble fiber?
Soluble fibers dissolve in water. They help lower cholesterol and keep blood sugar levels normal. Foods such as oats, barley and fruit are sources of soluble fiber.
Fiber adds bulk and draws water into the stool, making it softer and helping it move through the intestine.
However, bulking your child’s diet up with fiber may not always work initially.
In fact, a high fiber diet may make constipation worse in some children.
Added fiber may add too much bulk to the stool, stretching the rectum and colon and interfering with the sense of needing to go, especially in children who tend to withhold their stool.
Your child should drink enough water, especially when adding more fiber to his diet. Exercise is also beneficial to the child who struggles with constipation.
Warning: If your child is “clogged up,” extra fiber combined with poor water and fluid intake can lead to an impaction. This worsens constipation and blocks the intestinal tract. An enema may be needed in this situation, so consult with your pediatrician.
How Much Fiber Do Kids Need?
The American Academy of Pediatrics (AAP) recommends that children get enough fiber in their diet.
Here’s a quick and dirty calculation to determine how much fiber your child should get—as a minimum—each day:
Age + 5 grams of fiber = total daily fiber
So, a 2 year old would need 7 grams of fiber per day; an 8 year old would need 13 grams of fiber per day.
Other guidelines are as follows:
14 grams of fiber per 1,000 calories
And still other guidelines:
- 1 to 3 year-olds should get about 19 g of fiber each day
- 4 to 8 year-olds should get about 25 g of fiber each day
- 9 to 13 year-old girls should get about 26 g of fiber each day
- 9 to 13 year-old boys should get about 31 g of fiber each day
- 14 to 18 year-old girls should get about 26 g of fiber each day
- 14 to 18 year-old boys should get about 38 g of fiber each day
Tips for a Constipation Diet Plan
- Target five age-appropriate servings of fruits and veggies each day –this will give fiber and water together.
- Frequently serve high fiber fruits and veggies, leaving the skin on (prunes, plums, berries, beans, cruciferous veggies like broccoli, cauliflower).
- Swap refined grains like white bread and white pasta to whole grain versions such as whole wheat bread, brown rice, whole wheat pasta, and fiber-rich cereals.
- Add beans to your meals such as kidney, black or pinto beans.
- Make sure your child is drinking enough water every day, and an extra cup or two won’t hurt.
Home Remedies for Constipated Kids
Several foods act as natural laxatives for kids. Simply adding some of these foods to your child’s diet can help relieve constipation. Many of these foods are easy to find in the grocery store.
Fruit nectars are different from fruit juices. Juices that are labeled 100% fruit juice are just that—100% juice.
Nectars, on the other hand, may contain added sugar or the addition of other juices.
Because of this, nectars a higher osmotic load, increasing the amount of water into the intestine and helping to stimulate a bowel movement.
I suggest this as a quick home remedy for all my families who deal with chronic constipation. I’ve seen it work in children who are non-mobile due to a medical condition such as cerebral palsy or developmental delay, or other mobility constraint.
Tip: Warm up the nectar for additional movement potential.
The seeds on berries like strawberries add roughage and bulk to stools.
Cherries or Apricots
These fruits are high in fiber. Apricots also contain sorbitol, which may have a natural laxative effect.
Sesame, poppy, flax and chia are some examples of seeds. They add a punch of fiber to food.
Add them to cereal, or grind in a coffee bean grinder and mix into hot cereal such as oatmeal. Layer atop cold high fiber cereal or yogurt.
I used this with my first child! I added an ounce of prune juice to her formula every day as we were transitioning to solid food, just to keep things moving along.
Use prune puree or prune juice—they are both high in fiber.
Did you know that 1 cup of prune juice contains about 3 grams of fiber?
Molasses syrup is a good source of magnesium, which can act as a bowel stimulant. Mix some molasses into smoothies and hot cereal.
Beans and Lentils
You know these are high in fiber, now you just need to figure out how to work them in your child’s diet!
Try including beans and lentils in salads, soups, quesadillas, and bean dip.
You can find whole grains in plenty of foods: oatmeal, barley, quinoa, cold cereal, breads, crackers and more. Start shifting your refined grains over to whole grain foods for extra fiber.
Breads and Cereals
Not sure which cereals to buy? I’ve got an article on what I consider the 17 best cereals for kids — they are high fiber, low sugar cereals.
Don’t forget to look at the serving size! Target at least 2 grams of fiber per serving.
Raisins are a standout, as they have tartaric acid.
Researchers have found that one small box of raisins per day helped to increase transit time in the gut (translated: bowel contents traveled faster through the intestine).
Fibrous and fabulous. If your child isn’t allergic, dig in!
BeneFiber and Metamucil are examples of fiber supplements. Any fiber supplement can make constipation worse, as they may be dehydrating, potentially encouraging constipation.
Check with your doctor before using them.
More Constipation Relief Tips
In addition to food sources that act as natural laxatives for constipation, there are other lifestyle and food considerations for helping your child relieve constipation.
Children should drink enough water and consume plenty of other sources of fluid, such as juicy fruit and soups. Watch out for the sugar content of beverages though!
If your child is willing to drink hot tea, perhaps a mint tea would help. Menthol is known to relax muscles. The entire gastrointestinal tract is one long muscle!
Herbal preparations of senna such as senna tea are not regulated by the FDA or proven safe for children. They could be contaminated and harmful for your child.
Senna is found in tablets or syrup form, such as Ex-Lax or Senekot, and may be used with children who have encopresis.
ONLY use this under the guidance of your doctor.
Are Probiotics Good for Constipated Kids?
There is little evidence in favor of probiotics as a cure for constipation, however, anecdotally, I have heard from patients that it can help soften and regulate bowel movements.
We need more research in this area.
Consider using these 6 kid-friendly fermented foods you can find in the fridge, as they contain probiotics.
Do Dairy Products Cause Constipation?
Removal of dairy may help relieve a child’s constipation.
I suggest trying this for two weeks, and if you see improvement, continue a dairy-free diet.
You will need to substitute a fortified, non-dairy substitute, such as soy milk, so that your child gets a good source of calcium and vitamin D.
Be sure to cut back on milk if your child is a big drinker.
Two to three cups of dairy per day is enough (that’s 16 – 24 ounces per day), and more than that could be contributing to constipation.
Does your child struggle with constipation?
Need More Help for Constipation?
Preventing constipation is the key to avoiding this issue and that begins with a healthy diet. My program, The Nourished Child Project, helps you set up a food system that is healthy and full of fiber.
I’ve discussed constipation on my podcast, as well.
Lastly, don’t forget to keep your eye on the end goal: Raising a healthy eater. Here’s what you need to know if you really want to raise a healthy eater.
Written by: Jill Castle, MS, RDN
Published on: October 27, 2019
Updated on: November 6, 2019