Constipation is fairly common in children. From challenges of potty training and insufficient fiber in diet to side effects of certain medications, there is a variety a reasons why pooping becomes an issue.

 How do you know if your child is constipated? Passing hard stools or having a bowel movement less frequently than twice a week for a couple of weeks can signal a problem. Besides, if passing stools becomes painful, children tend to withhold it making things only worse.

My story

Before I became a dietitian, I had no idea that drinking too much cows milk or sensitivity to cow’s milk protein can also cause constipation in some children. I still clearly remember the painful 2-month period my younger daughter struggled through when she was around one year of age. There were no changes to her diet except for introduction of cow’s milk. She was already eating lots of fiber rich foods like fruits, vegetables and whole grains. She was also drinking what seemed like enough water. Kids tend to become less interested in food when they are constipated and her appetite also went down. We added prunes and berries to her diet, gave her laxative on our doctor’s advice, but the problem did not go away. But when she stayed away from cow’s milk for a couple of days, things started moving forward (or should I say “down”)! Since then, her pooping has become a reliable indicator of how much dairy she ate on any given day. A cheese stick here and there seems to be harmless, but a slice of pizza, yogurt and a piece of ice cream cake at a birthday party predictably makes her constipated.

So what can you do if your little one dreads visits to the bathroom:

– First of all, talk to your doctor about testing to make sure constipation is not a sign of a bigger underlying issue like hypothyroidism or celiac disease. Ask your doctor to rule out dairy sensitivity or allergy by following a dairy-free diet for a few days if dietary changes and laxatives do not seem to cut it.

– Your doctor may recommend gentle laxatives if the problems persisted for a very long time. Doctors use the term “disimpaction” to describe the first step in treating chronic constipation. When using laxatives, It is very important to follow the treatment through, including the maintenance stage.

Behavioral and nutritional approaches to treating constipation:

Back off with toilet training. If this is what is causing constipation, give your child time to regroup and try again a couple of months later.

Work on the routine. Allow at least 30 minutes between breakfast and getting out of the door to give nature some time to do its work. Most kids prefer pooping at home versus at a less private school bathroom and may hold in order to avoid the embarrassment of doing it there.

Watch the dairy. Make sure your child is not consuming too much dairy. Check these guidelines for age-specific recommendations. Children between 1 and 2 years of age need 3 servings of dairy, older children between 2 and 8 years of age need slightly less – 2 servings and from 8 years of age the requirement increases to 3 servings again.

– Include fruits WITH skin. Pears, plums, peaches, apples and apricots have particularly high fiber content. One small pear has 4.4 g of fiber. Dried versions of plums, grapes and apricots can also be a good source of fiber. Berries are full of fiber. One cup of raspberries has around 8 grams!

– Boost fiber rich veggies. Certain veggies like broccoli, asparagus, green peas, corn and squash are higher in fiber than others. One cup of fiber rich veggies will provide 4-9 grams of fiber.

– Add legumes: chickpeas, kidney beans, navy beans, black beans and lentils (6-10 grams of fiber in ½ cup) and switch to whole grain bread and pasta (1/2 cup of whole wheat spaghetti has 6 grams of fiber).

– Add bran cereal or ground flax seeds. Sprinkle them over a yogurt or cereal. Or mix them into your muffin or pancake batter.

– Boost fluids, especially water.

– Increase physical activity. Exercise has been known to help relieve constipation as well. So get your child up and about several times a week.

How much fiber your child needs:

Children 1 – 3 yrs   19 g (max)

4 – 8 yrs    25 g (max)

9 – 13 yrs  31 g (max)

 Tell me your stories about your kids’ poop!

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Evaluation and treatment of constipation in infants and children: recommendations of the North American Society for Pediatric Gastroenterology, Hepatology and Nutrition. Constipation Guideline Committee of the North American Society for Pediatric Gastroenterology, Hepatology and Nutrition. J Pediatr Gastroenterol Nutr. 2006 Sep;43(3):e1-13.

Afzal N., Tighe M., Thomson M. Constipation in children. Ital J Pediatr. 2011; 37: 28.

National Nutrient database for Standard reference

Dietary Reference Intakes