Constipation in babies and toddlers

Diet

1. Increase fibre intake

Fibre is essential for healthy bowel movements. In the gastrointestinal tract, fibre attracts water, creating soft, bulky stools that stimulate bowel contractions to push the contents along.  

The DRI (Dietary Reference Intake) for the fibre intake of a 1- to 3-year-old child is 19g per day. Read the nutritional tables on food labels to identify high-fibre foods. A product is seen as a good source of fibre if it contains 3g or more per serving.  

Choose foods made with wholegrains such as wholegrain bread, and high-fibre breakfast cereal such as bran flakes, muesli, wholewheat ProNutro and other multigrain cereals (use cold milk, not hot). 

Try to include a variety of vegetables and fruits into your child’s diet. “Mealies, either on the cob or frozen kernels, work well as they help to sweep the colon clean,” says Dianne Ivison, registered dietitian in Cape Town. Stewed prunes are a natural laxative. Make your own or find them in the baby food section of supermarkets. 

Choose snacks that are rich in fibre, such as wholegrain crackers, digestive biscuits, fresh and dried fruits (apricots, peaches, pears, raisins, figs, prunes and dates), raw vegetables and fruit bars. 

Try to get your child to eat peas, beans and lentils; these are some of the richest sources of fibre. When you start adding fibre to the diet, start slowly and gradually increase the amount so your baby’s body can get used to it.  

2. Give enough fluids

When you increase fibre intake, you must also always increase fluid intake – they work together. Children should drink at least one litre of fluids every day. Water is obviously best, but diluted fruit juice and rooibos tea are also good options. A small glass of apple juice a day can help to keep constipation at bay.  

“Having a cup of warm liquid in the morning, with or after breakfast, can help with constipation,” says Dianne. “If a child is prone to constipation, avoid follow-on formulas for children over 1 year of age. Rather allow moderate amounts of full-cream cow’s milk.”  

3. More dietary tips

Dianne recommends that children who are prone to constipation should avoid refined starches and fast foods as these are difficult to digest. Red meat, especially biltong and “droë wors”, can worsen constipation. 

There are many home remedies that may be passed on to you, like adding brown sugar or oil to bottles or cereal. Although they will not be harmful, it’s better in the long term to adopt healthy habits that promote healthy bowel function. 

Physical activity

Encourage your child to be active. Regular exercise helps to stimulate normal bowel function and does wonders for constipation. 

1. Explain how exercise works

If a child knows what causes constipation, he may feel more open to dietary changes. Draw a picture: toddlers can be shown what their intestines look like and how stool needs to move along like cars or a train. Illustrate how water helps to soften the stool, and how holding it in can cause it to become hard and painful to pass.  

2. Create a toilet routine

Set aside relaxed times for a bathroom visit. Due to the effect of the gastrocolic reflex (the peristalsis that the colon undergoes after a meal in its attempt to clear the bowels), the highest probability of a successful bowel movement is right after a meal and, for most children, right after breakfast. So it may help to make a bathroom visit part of the daily routine, at a set time after a meal. 

Have your child sit on the toilet for at least 10 minutes. It is often easier if his feet are on the floor or on a footstool.  

Don’t make a big fuss but try to make it fun and relaxing. Keep some toys and books nearby so your child has something to do while he sits on the potty. Give praise and a reward for a bowel movement.  

Teach your child to go immediately when nature calls. If ignored (as can easily happen when children are busy with exciting activities), the urge will pass and the stools will become dry and difficult to pass. 

In rare cases where a child has psychological issues around going to the toilet, a visit to a child psychologist may be worth it. Before they have dealt with their issues, they won’t be able to overcome the constipation.

FAQ:

How is constipation treated medically?

The treatment depends on the child’s age and the severity of the problem. Medications that may be prescribed are a stool softener, a mild laxative, or a suppository. Never use constipation medications without discussing it with your doctor first. Improper use can be harmful to children! 

Avoid all preparations containing castor oil and cascara. Mineral oil, stimulant laxatives and enemas should also not be used. 

It is important to take prescription medications correctly. Follow the doctor’s instructions accurately. One of the biggest mistakes parents make in treating their child’s constipation is stopping the medication once the child begins having soft stools. If stopped too early, your child is likely to relapse and become constipated again. 

Although it’s not seen as a medical treatment, massaging the abdomen can help to ease some discomfort in children with constipation. But make sure you know how before you try it.