Nutrition tips for children with constipation: A guide for parents

Author: Jacqui Palmer APD, PhD, Paediatric Dietitian

Constipation is a common concern for children. It can impact appetite, nutrient intake, and cause pain and irritability! If you’ve ever been constipated, you’ll know how uncomfortable it can be, but kids aren’t always great at letting us know this.

Constipation is usually defined by infrequent bowel movements (<3 per week) and /or passing hard, dry stools. Signs of constipation include:

• passing very large stools that block the toilet
• soiling and accidents – where liquid passes around the hard “stuck’ stool
• abdominal pain and straining to pass a stool
• pebble like stools

This video provides a great explanation of Bing Videos of what happens to food in our gut.

For younger children, going to the toilet can be a stressful experience. Helping your child understand how their body works can help to reduce some of the stress around toileting.

One of the most important things to remember is that diet (food and water) and routine (regular time to go to the toilet + physical activity) play a huge role in your child’s gut health. Let’s dive into how you can support your child…

What causes constipation in children?

Firstly

• not drinking enough water (6-8 full cups per day) – one of the main reasons!
• not eating enough fruit, vegetables and wholegrains (2 fruit + at least 1.5 cups veggies)
• sitting around too much – not getting enough physical activity (too much screen time)
• holding on because distracted by play or avoiding public toilets
• lack of routine (not making a regular time to sit on the toilet)

Then

• retaining because of fear of pain due to past experiences of constipation
• being pressured to toilet train before they are developmentally ready Potty training and constipation: Tips and more
• lack of awareness of body signals (low interoception)
• non IgE allergy e.g cow’s milk or soy protein usually in younger children
• other medical reasons including anatomical and physiological reasons

How you can help your child overcome constipation

Remind them to drink water every 30 minutes (just a few sips regularly will help them reach their target for water each day). Use a reward chart, use a drink bottle that helps understand how much water they need.

Include fruit and veggies in their lunchbox each day: fresh fruit, veggie sticks, fruit or veggies in baked goods like muffins and protein balls. Aim for 1/3 of the dinner plate full of veggies.

Swap to wholemeal bread and wraps and choose cereals with wholegrains such as Weet Bix™, Special K™, Sultana Bran™ or Milo™ cereal. These are packed full of wholegrains, iron and B vitamins.

Keep your child active – movement helps the bowels work. Games like soccer, basketball, netball or just running, active play and jumping on the trampoline help to keep “the wheels in motion”.

Establish a routine – consistency is the key. Choose a time when you child is not rushed (for example, after meals when digestion is most active / after school) and encourage them to sit on the toilet for a few minutes, even if they don’t need to go. Read a book, read a comic, sing, chat, breathe in slowly and breathe out slowly – help them relax. Do this at around the same time each day to teach their body a rhythm.

Talk about the importance of listening to their body – this video might help (https://youtu.be/_5ZHvQLv2dM)

Some help from medications

When constipation is more chronic (ongoing), your child might need more than water, physical activity and extra fibre. Stool softeners like Movicol, Osmolax and Coloxyl can be helpful to make the stool softer and easier to pass. These do not make the bowel “lazy” – they simply act to draw water back into the stool to soften it and make it easier to pass. In more extreme cases (where there is a build-up of stool in the rectum), your GP may suggest a washout (a higher dose of these stool softeners to clear the bowel) followed by a lower dose to maintain regular soft stools while your child gets into a good routine with diet, fluid, and activity. Watch this video for information on how stool softeners work (https://youtu.be/gHQEpu-hZ6k). Sometimes, a laxative (a medication that increases contractions of the bowel) will be required but it’s important to speak to your GP about this.

Prebiotics and a healthy gut

Prebiotics are natural, non-digestible fibres found in many plant-based foods like fruits, vegetables, and whole grains. Prebiotics feed our “good gut bacteria” and play an important role in promoting healthy digestion by helping the stool become softer and easier to pass.

How do prebiotics help with constipation?

1. Drawing in water: Foods like fruits, vegetables, and whole grains contain soluble fiber, which draws water into the stool. This process helps to keep the stool hydrated, preventing it from becoming too hard and difficult to pass.
2. Bulk up the stool: Insoluble fibre, found in foods like whole grains and leafy vegetables, adds bulk to the stool. When the stool becomes larger, the body recognizes that it needs to expel it. This bulk signals to the intestines that it’s time for a bowel movement, helping to regulate the process naturally.
3. Increase gut acidity: The fibre in these foods also helps increase the acidity of the gut environment. A slightly more acidic gut stimulates the natural contractions of the bowel muscles, which can act like a natural laxative. These contractions, known as peristalsis, help move stool through the intestines and out of the body.

So, what are some of the best foods you can include in your child’s diet to help soften their stool and improve digestion?

Top fibre-rich to help manage constipation

• Fruits: Apples, pears, berries, kiwi and bananas are all excellent sources of fibre and water. Pears in particular, contain sorbitol, a natural laxative.
• Vegetables: Leafy greens like spinach, kale, and broccoli are packed with fibre. You can also try sweet potatoes, carrots, and peas.
• Whole grains: Brown rice, oats, whole wheat bread, and whole-grain pasta are rich in fibre that helps bulk up the stool.
• Legumes: Beans, lentils, and chickpeas are fantastic sources of fibre that can keep things moving in the digestive tract.
• Nuts and seeds: Chia seeds, flaxseeds, and almonds are also good sources of fibre.

Wrapping up

Constipation can be uncomfortable, but with the right nutrition and a healthy routine, it’s manageable. By encouraging plenty of water and foods with a high water content (e.g., watermelon and cucumber), providing a diet rich in fibre from fruits, vegetables, and whole grains, establishing a consistent bathroom routine, and encouraging plenty of active play or sports, you can help your child overcome constipation.

If your child’s constipation persists, it’s always a good idea to consult with your doctor to rule out any underlying issues. With patience and the right support, your child’s gut health can improve and regular stools will become… regular!

Image from: https://patient.gastro.org/constipation/

Fruits are a great source of fibre. They help to soften stools but also to make them bulky so that the bowels recognise there is something to pass. Vegetables and wholegrains are also great for this.

The Bristol Stool Chart for kids: Aim for type 3 or 4 stools at least 3 times a week

The Bristol stool chart is often used to determine what gut transit is like. It can be a good way for you kids to let you know how their toileting is going.  

About the author

Jacqui Palmer is a South East Queensland based paediatric dietitian who specialises in gut health, feeding difficulties and neurodiversity. Jacqui is a member of Dietitian’s Australia and The Nutrition Society of Australia. She has worked in a variety of settings Australia and the UK of which the past 12 years in paediatric nutrition. Jacqui completed a PhD which examined the links between gut health and behaviour, and is passionate about the importance of nutrition to children’s development.