Constipation Management with Food

How does food help us treat chronic constipation, and other GI conditions, in children? Kelli Borgman, RD, for the Vermont Continence Project gives recommendations on a diet that supports healthy elimination.

A full transcript of the video appears below.

Hello, I’m Kelli Borgman, a dietician consultant with the Vermont Continence Project. The topic of this video is constipation management through food.

Once you’re nearing the end or past the initial clean out cycle with your child and have a stable medication maintenance plan, it might be time to start thinking about, or taking action to support them in changing the balance of foods in their diet to include more unprocessed or less processed foods. There are also some simple cost-effective nutrition and lifestyle changes I discussed back in week three, “Nutrition in the Beginning Stages of Constipation Treatment.” Those are all still good things to consider if you feel like they’re applicable to your child. You can watch it if you want more detail, but as a reminder, the suggestions were to swap out grains and swap in fruit, to swap foods that may be constipating, such as dairy products, less ripe green bananas, excessive amounts of applesauce and sub in foods that don’t typically constipate. To try a smoothie or a small glass of 100% fruit juice, keep in mind the flavors and temperature your child enjoys and to have a fluid plan when your child is sick.

In order to prevent constipation, we want to increase your child’s intake of unprocessed or less processed plant foods. These foods are the ones that have meaningful amounts of fiber. When you’re introducing a new balance, you never need to force, bribe or sneak foods. Feel free to start at whatever place you and your child need to. Smaller sustainable changes are usually best, because you and your child both feel more confident and capable that way. You can also monitor your child’s response through communication with you as well as with their toileting patterns.

The more variety the better when it comes to fiber, please watch the fiber video for more information on this topic. A wider variety of fiber containing foods will contain a broader base of nutrients, important for GI health, as well as provide a happy home for a wider variety of beneficial bacteria. From a practical perspective, having some flexible options day-to-day will help your child match a fiber food to their current food mood, as well as whatever’s on the menu that day. Small amounts throughout the day add up, so even if the fiber food isn’t central to the plate, they may get closer to their daily goal, which is great.

For example, there’s many whole grain flours and flours made from nuts, beans, and seeds. These are high in fiber and many families can find options their kids like in this category. I also encourage you to think about ways to fit in fruit into their choices and into your shopping cart. There are multiple constipation preventing aspects to fruit, the fiber, the fruit sugars called fructose, vitamin C, natural disease fighting and immune boosting compounds called antioxidants and phytonutrients, as well as enzymes naturally contained in raw fruits that help digest the fruit, but also the other foods eaten with the fruit. Fruit is indeed awesome.

From my perspective, working with families, fruit can be the hardest foods to keep in the house and offer consistently, especially with price and seasonal variety challenges at play and if your child has a hard time with variety, please tune into our picky eating videos this week. When families are working to incorporate new foods or more volume of unprocessed or less processed foods, I really like to focus on texture. Texture is a huge aspect of food, from how it looks to how it feels on our spoons and forks, in our hands or in our mouth. A lot of the kids I work with have differences in their sensory systems or oral motor abilities and they’re still progressing at their own pace with learning to eat and for all of us, adults included, but especially younger kids, there’s a sensory aspect related to texture and we all have our preferences. It’s what makes food pleasurable and motivating to eat, besides the flavor, of course.

In the next few slides, I’m going to give you some examples of unprocessed or less processed foods in each major texture category. I hope you can see all the color and the variety within these choices and get you brainstorming about foods your family already has easy access to. Think about your child’s preferences in general and even at different times of the day. Also, think about how you might mix and match the choices. They may literally be mixed together, layered, or offered separately at the same meal or snack or spread throughout the day. Think about what your child can easily eat in different environments, school, the car between activities and home, for example. Also think about using family recipes or cultural foods that you make more often. Traditional dishes often already have or can be adapted to include less processed versions of ingredients. To be clear, there are some brand names or food examples that I’m not specifically endorsing here, but since most families buy and prepare packaged or convenient foods, I don’t necessarily avoid showing and mentioning them. Just know there’s many brands and products that are acceptable, available locally and hopefully within target for your budget.

Here’s a sampling of some less processed purees. Bean dips like hummus or re-fried beans, guacamole or avocado puree, nut or seed butters, pizza or marinara sauce, apple sauce and fruit or veggie or whole grain pouches. There are wide variety of purees in the infant food aisle, but also every aisle of the grocery store.

Here’s a few examples of easier to eat foods, like puffs that are crunchy and melt-ey snacks that are higher in fiber. I see a lot of beans, lentils and nuts near the top of the ingredients list when I look at these labels. I’ve already talked enough about fruit, but did you know that chocolate can be high in fiber? The darker the chocolate, the more fiber it has.

If your child is still learning to chew more complex foods or has a preference to quickly eat and swallow foods without chewing much, the soft cubes texture category may be worth checking out. Often these are a good fit for kids who want to feed themselves, but haven’t quite mastered or don’t prefer using utensils. They can be easily chopped into smaller uniform pieces or pulled from other family mixed dishes that have good flavor, such as tofu or mixed veggies from a stew, soup or casserole type dish. Examples here include tofu, which is pressed bean curd, soft muffins or quick breads, peeled and cooked potatoes, soup, stew or casserole vegetables, wild cooked or steamed veggies, avocado cubes, infant finger foods, specifically tested to have just the right texture, banana and fruit cups.

These are some examples of less processed or unprocessed chewier foods that have a bit more texture than the soft cubes category. Bite to bite they are more uniform in texture, though not exactly uniform. We’re getting into some pretty unprocessed options here, like the beans, ripe mango and homemade versions of cooked fruit, as well as the steamed or boiled veggies. There are a lot of great options these days for less processed convenience food items, like the sweet potato puffs or the veggie fries.

Here are some examples of mixed texture foods with lots of different flavor and texture profiles. In general, mixed dishes and sandwiches or wraps can incorporate whole grains, beans, lentils, and spreads and finely chopped or pureed veggies. A veggie burger is often a mixture of several different grains, beans and veggies, softer granola bars or other soft bars like these fig bars, especially if they’re made with whole grains, nuts and dried fruits as the primary ingredients.

I put the fresh fruits and veggies in this category for a couple reasons. Some fruits like grapes, blueberries and peas have a skin texture to chew through and then become softer, sweeter in the inner flesh. That’s two texture categories and a mixed sensory experience. Fresh produce can also be really variable with different bites, some are more firm and some are more squishy and soft. If your child prefers harder chewier textures and has good oral motor skills, then these might be some good options to try. Because of the choking hazard, it’s generally recommended to avoid whole nuts until at least age four. Many raw veggies and fruits are in this category, even though fruits are softer and sweeter, because of seeds and skins, they can be tougher to chew and generally navigate for those kids still developing their oral motor skills or those with texture aversion. Dried fruits are obviously pretty chewy and the fiber is concentrated, so while it can be a great food for constipation, they’re more dense and take longer to chew and soften. There are a lot of enjoyable, crunchy, hard and chewier foods in the whole grain category as well.

You don’t have to take a probiotic supplement to enjoy the benefits of probiotics. Layering both fiber intake, as well as live active cultures from fermented foods is a great idea for a long-term sustainable strategy. Probiotic foods tend to taste sour, which is a preferred flavor for some kids, while other kids like the sweet and sour taste. When looking for live cultures in fermented foods in the grocery store, they’ll typically be in the refrigerated section. The exception to this general rule is the raw apple cider vinegar, a shelf stable related to the acidity. The example shown here from left to right, top to bottom are Kefir yogurt, pickled vegetables or their juice like dill pickles, sauerkraut or kimchi, raw cheese, miso and apple cider vinegar. Also, it’s good to read labels, because there’s some yogurts that don’t contain live cultures. If your child likes yogurt, try Kefir, it has five times more probiotics per serving compared to yogurt and has a smoothie-like drinkable texture that can be sweetened to your child’s liking. Cheeses contain certain probiotics if they’re aged, but the bacteria die off if the cheese is heat treated, which is most commercial cheeses.

When you’re introducing your child to these foods, there can be a side effect of an initial but temporary increase in gas and bloating while their GI tract is introduced to the new bacteria and will quickly rebalance and adjust if the food continues to be eaten. You may want to start with small servings to monitor or prevent GI distress.

If your goal is to introduce unprocessed and less processed foods into your meals and snacks, you may think of, and want to try ways of adding them to dishes or changing recipes to incorporate more plant foods. This can be a great way to increase fiber without making big changes. However, if the change is too drastic regarding texture or taste, or too many changes are made too quickly, or your child happens to have a sensory sensitivity, then it’s best to proceed with caution when trying to sneak these foods in. You don’t want your good intentions to backfire and undermine trust. These are a few tips I have learned. If you use puree or blended plant foods, such as tomato sauce or bean purees, texture aversions can decrease or not be an issue, but this can also change the density, the heaviness, the stickiness, in the overall texture of the dish, too much if overused or changed quickly.

You can replace a quarter to a half of the flour in homemade baked goods to whole grain and lentil flours, like cookies, pancakes, and breads and often this change can be a minor texture change. However, you may need to add binders like arrowroot flour, for example, to avoid crumbly texture, since many high fiber choices lack gluten, which helps create the springy texture in baked goods. Food waste can be an issue due to the trial and error process to get the texture right. If this is a concern for you, think carefully about your child’s food texture preferences. Use your kitchen tools to try to match the foods you’re preparing to those preferences. A sharp knife, blenders or food processors and other kitchen tools can help to increase consistent texture and flavor, batch to batch.

Lastly, being transparent about what’s in their food is smart. Involving kids in the cooking process is a great way for the long-term learning experience to develop and gentle exposure to new additions can give them confidence at the table with that particular dish. Just remember to give them the right size bite task to accomplish or bring them in at a step where they might have the most fun.

Thank you for taking the time to watch this. The information contained in this video is for informational purposes only. It is not a substitute for professional health or medical advice, diagnosis or treatment. Always seek the advice of your physician or other qualified healthcare provider.