Monday, January 2, 2012

Kids and constipation

I thought I'd write a brief article on children and constipation as it's such a common complaint. I remember when Jamie Oliver did his school dinners programs, he was astounded to find out that a particular hospital in the north had a special clinic for children with constipation. What he didn't mention was that many hospitals in the UK have a special clinic for children with constipation. It is one of the leading complains that children present to paediatricians with.

Typically a child with constipation will have hard, dry stool (poos) and not go to the toilet very often. (It can be difficult to say what is normal in terms of how frequently a child goes to the toilet but I would consider normal to be once or twice a day and constipation to be less than 3 times a week.) When constipation gets bad, there is a back-log (excuse the pun) of hard poo. Behind the hard poo is soft watery poo which can leak down the sides. So strangely, a child with constipation may actually appear to have diarrhoea.

Constipation can also be very painful, so children can present with tummy aches.

There are many factors that contribute to having constipation: not drinking enough water, not doing enough exercise. Sometimes children get a small cut in their anus (where the poo comes out) which makes it painful to poo, or sometimes they have a bad experience which leads them to 'hang onto their poos' which can lead to constipation. There are also diseases that cause constipation.

However, the most common cause by far is not eating enough fibre (i.e. vegetables). Fibre is the bit of food that our bodies cannot digest. It sits in the bowel, bulking out the poo and making it easier for the poo to pass through the body. When I'm explaining constipation to children, I use an analogy of a tube of toothpaste. When a tube of toothpaste is full, you press it a little and toothpaste comes out easily (a bowel full of fibre). When the tube is empty, you have to squeeze really hard to get just a little bit out. That is a bowel without any fibre.

What can I do to help my child?
The first thing to think about is vegetables. Many people think that their children eat enough vegetables. But chances are, if they are a little over weight or have constipation, that they don't. I ask children what their favourite vegetable is and if they answer 'chips' (which they frequently do) I begin to suspect that they don't enough of the green ones! (That is generally where the fibre is). 

Some vegetables, such as potatoes and cucumber don't have heaps of fibre (it's all in the skin, so if you peel that away, there isn't that much left.) Vegetables that are a bit more woody have more fibre (wood is also fibre but I wouldn't recommend eating it.) Broccoli, sweetcorn, cabbage, beans are all good fibre boosters. 

So how do I get my child to eat more vegetables?? Well, that can be a difficult one. Ideally you start right at the beginning, when you wean them. If they are used to eating vegetables from a young age, they will carry on (ok, they'll probably eat sweets and chocolate too, but at least some of what they eat is the good stuff.)

Leading by example is also a really good way of getting your children to eat vegetables. Young children are desperate to be grown up and considered 'a big boy or girl'. My 3 year old didn't used to eat greens like cabbage or lettuce. I wasn't that worried as he was good with other things like peas and carrots. Then, a few months ago, he started asking for bits of cabbage when I was serving it to the adults. Now he always has a piece of cabbage or beans (still not keen on lettuce).

I also used to grow peas in the garden when he was little (we only had a tiny garden, I didn't manage to grow much else.) I didn't even manage to grow enough to eat them. My little then 1 year old would always be helping himself. But what better introduction to green vegetables that peas picked out of the pod?

If your child is older, how about getting them involved in the cooking. (I know, I know, it's FAR FAR easier just to do it yourself, but it should get them interested in what they're eating and they'll learn how much effort goes into each meal.) Anyhow, make sure you cook something with lots of veggies in…

Other than vegetables, you can encourage your child to go to the toilet. If you put them on the toilet after dinner the chance of them doing a poo is increased (due to a particular reflex that we have.) It's important to sit in the 'poo position' which is back straight (rather than leaning forwards which can make it difficult to poo). If you child is young, they may need a step to rest their feet on. Drinking lots of water and exercise can also help people with constipation.

Mostly constipation is an avoidable or at least curable illness. It can be very unpleasant and lead to further problems (such as wee infections.) So if you're child has constipation or you think they may have constipation:
Make sure they are active, drinking enough and EATING LOTS OF VEGETABLES.

For more information on what is a portion size for each fruit or vegetable check out this leaflet on the NHS website. Remember the portions published are for adults, they say a child's portion should be roughly what they can hold in their palm.


  1. My 2 and a half year old isn't constipated but I worry about him eating enough veg. I can't get him to eat the leafy green stuff! He'll eat carrots, sweetcorn, parsnips, peas (sometimes), tomato and sweet potato but it all has to be cooked - he won't touch raw veg. I love salad and still offer it to him, but he won't eat it. He eats tons of fresh fruit though - I don't think there's a single fruit he doesn't like. I know the '5 a day' guideline is fairly arbitrary, but is it OK if it's mostly made up of fruit?!

  2. Yes, 5 portions of fruit is fine. It sounds like you're doing all the right things. For a 2 1/2 year old he sounds like he eats a really good variety of fruit and vegetables. And don't worry if it's all cooked veg, that's fine too.

    Just keep presenting it to him (the new stuff). If he doesn't eat it, don't make a fuss, just keep giving him the opportunity.

  3. Another thought, have you tried something like hummus? My son loves having carrot and cucumber sticks to dunk into things.

    Also, if you want your son to eat raw vegetables, I'd start with softer things like cucumber. Kids are quite sensitive to texture as well (which is why it takes time for them to get used to leafy greens like cabbage and lettuce.)

  4. Hey Lena...Great blog and fab article on such a common problem. I wanted to clarify though- doesn't potato skin have quite a lot of fibre in it?? And how about dhaals/ lentils? They're pretty high in fibre and protein- they could also be a good thing to try perhaps??

  5. Hey Ash, Interestingly potatoes don't count towards your 5 a day. But yes, as you say, they do have fibre in the skins. I guess if you just ate skins it would contribute towards 'bulking' but most of potato is starch.

    And beans and lentils only count as one portion, no matter how many you eat. (I think that might not include green beans though.) But definitely good things to give your children.

    The NHS website is quite interesting, they have a section on what constitutes a portion. I've added it as a link in the main article. Actually you only need 2 inches of a cucumber to be considered a portion.