As a pediatric nurse practitioner, I frequently get questions from parents/caregivers about constipation. How do I help my child poop without pain? Should my child be pushing hard to poop? Does this look normal (as I’m handed a smart phone with a picture of recent poop!)?
Constipation is a common struggle for kids of all ages. Although common, it’s important that kids do not remain constipated. It’s a problem that will only build up! So, what constitutes healthy pooping? And how do we provide natural constipation support for kids, without jumping straight to medication?
Poop should be soft and squishy: think about the consistency of peanut butter. Hard, dry pellets or balls of poop are a tell-tale sign of constipation. Moreover, kids should not have to strain to get the poop out. Some kids will poop more frequently than others and what is normal certainly varies from child to child. A kid should poop at least once every few days. This is not the case for breastfed infants, however, who can go up to two weeks without pooping! You can read more about infant poop here. Pooping should not be painful. When it hurts, kids often become afraid to poop. Cincinnati Children’s Hospital cites pain associated with pooping as a frequent cause of withholding poop. The result is a vicious cycle of increased constipation, pain, and a stretched-out lower colon. Once that happens, the muscles and nerves used for pooping can actually stop functioning correctly. This breakdown leads to further withholding and constipation.
While medication is sometimes a necessary intervention, it’s best to begin with lifestyle changes. These natural ways to prevent and remedy constipation are the keys to success for healthy pooping in kids.
Water is essential for soft, regular poops. If a child is not consuming enough water, their intestines are unable to infuse the poop with water, leaving it hard and dry. The American Academy of Pediatrics (AAP) recommends the following daily fluid intake for kids to maintain adequate hydration:
- 1 – 3 years: 4 cups
- 4 – 8 years: 5 cups
- 9+ years: 7 – 8 cups
The AAP notes that other factors like activity level and humidity can affect these numbers. If drinking water is a struggle for your child, try purchasing a fun water bottle or adding a special straw to their cup. You can also create a game or challenge for everyone in the family to participate! Adding a few raspberries or other fruit to water infuses it with flavor and can make it more palatable to some kids.
You might not think exercise has much to do with pooping, but a little movement can go a long way. According to Harvard Health Publishing, those who exercise routinely are less likely to experience constipation. These findings are consistent with respect to children as well. A 2018 study in Iceland found that children who engaged in regular physical activity did not develop constipation as often as their more sedentary peers.
The World Health Organization advises at least 60 minutes per day of rigorous activity for children ages 5 – 17. While children are historically very active, there’s been an unfortunate recent decline in outdoor and physical activity. A study on activity during the COVID-19 pandemic found that children and young adults across the world became increasingly inactive. Lockdowns and changes to daily routines are challenging. Any increase in physical activity is beneficial (for you, too!). A simple 10-minute walk around the block or quick trip to the playground provides important stimulation for the colon. Don’t forget that several small activities will add up.
Have A Routine
Pooping at the same time every day can help train a child’s body and prevent holding poop inside. For instance, after brushing teeth, spend some time letting your kid sit comfortably on the toilet even if they’re not sure they need to poop. After a few days, a routine will emerge. If your child already poops around the same time each day, plan to be home at that time. Many kids prefer to poop in their own bathroom instead of at school or elsewhere in public. Proper positioning is another essential tool for effective pooping. Functional pushing requires feet flat on the ground, knees slightly higher than hips, and cushioning underneath the buttocks. For a smaller child, you can use a foot stool to prevent feet hanging in the air. Additionally, a seat insert on top of the toilet provides support if the opening is too large.
Limit The Constipation Culprits
Did you know bananas can be “binding”? They contain certain plant lectins that bind to carbohydrates. A review from the journal Molecules of banana lectins describes their use in treating diarrhea (if something is treating diarrhea, it’s sure to worsen constipation!). Furthermore, according to a study in Pediatric Gastroenterology, Hepatology & Nutrition, bananas that have not fully ripened have higher starch content that can cause or exacerbate constipation. Bananas are tricky because they are a good source of fiber when ripe. Nevertheless, over-consumption often leads to constipation, perhaps due to their binding nature. They’re also notorious for causing constipation in infants and toddlers. If your child is struggling with constipation and bananas are a consistent part of their diet, consider removing them for a few weeks to see if there’s any improvement.
Any food high in starch can worsen constipation. A major culprit for kids, however, tends to be dairy. In a study published in Nutrients, researchers found that 68% of children with chronic functional constipation who were given soy milk instead of cow’s milk had a resolution of symptoms. The children who continued to drink cow’s milk, however, remained constipated. Try swapping out cow’s milk for a non-dairy alternative. When in doubt, offer water.
Increase High Fiber Foods
Years ago in the grocery checkout lane, my then 2-year-old was holding a container of prunes. A man in front of us winked and said with a laugh, “someday you’ll know what those are for.” Without hesitation, my daughter smartly replied: “I know. They’re for my poops!” Prunes are a superfood when it comes to healthy pooping, but they aren’t the only ones. Fiber is found in a wide variety of foods, including fruits, vegetables, grains, legumes, and seeds. The Cleveland Clinic explains fiber is indigestible and holds onto water, thereby helping to keep poop moving and soft.
As part of natural constipation support, it’s essential for kids to regularly consume enough fiber. According to the American Academy of Pediatrics, a helpful way to remember a child’s suggested daily fiber intake is to add 5 to their age. For example, a 3-year-old should eat about 8 grams of fiber per day. An easy way to boost fiber intake for your kids (and yourself!) is adding chia seeds and ground flaxseed to a smoothie. The Mayo Clinic has a robust list of high fiber foods. Check out the infographic below with my favorites and brainstorm some fiber food ideas for this week!
If your child is following these natural methods to promote healthy pooping but is still constipated, be sure to talk with your medical provider about next steps. Happy pooping to one and all!