Nutrition in Acute Phase Constipation Management: Part 1

This video discusses the role of nutrition when you are at the beginning of treating constipation.

Associated Resources:

Table of Children’s Fluid Needs (PDF)

Table of Children’s Fiber Needs (PDF)

A full transcript of the video appears below.

Hello, I’m Kelli Borgman, and I’m a dietitian consultant with the Vermont Continence Project. In this video, we’ll talk about nutrition in the beginning stages of managing your child’s constipation.

I want to begin with the parent child feeding relationship. In the acute phase, this relationship can often feel strained or stressed. In pediatric nutrition, we refer to the Division of Responsibility at Mealtimes to discuss what roles the parent plays in the child’s mealtime to help their needs versus the role the child plays to meet their own needs.

When children are constipated, caregivers often want to help improve their diet by increasing fiber or fluids. Parents often have great ideas about what types of fiber foods to include or which foods might be adding to the issue of constipation. However, most caregivers also know from early experiences on that their child ultimately decides what they’re going to actually put in their mouth and how much.

We often want to control that part even more when we know there’s a medical issue or something. Dietary causing discomfort for most children. Dietary changes take time, forcing, enticing or convincing them to eat doesn’t work in the long term. It often causes refusal of those very foods you want them to eat. Also, your child may not be willing or ready to change much when their belly is feeling full, bloated or uncomfortable.

The clean out and medication management process allows for fast acting relief. It’s the best way to initially promote bowel regularity, slowing toilet training down and reducing stress in the child. And the family also sets up the stage for a more curious, relaxed child at the table or wherever they eat. Our nervous systems need to feel regulated and safe to receive appetite and pleasure signals from our brain and from our gut.

And it’s hard for any of us to change too many things at once. At the initial stages, there are some simple dietary and lifestyle changes to think about, so I’ll go over a few of those now. We’ll dive further into longer term strategies in later weeks. If your child tends to struggle with drinking fluids, remembering to drink, is very active, or eats a lot of drier foods that lack fluids, gentle prompting and a daily rhythm of drinking can help.

Trying a 75% water and 25% juice ratio is a good place to start. The natural fructose sugars, vitamin C and potassium and prune apple, pear juice and coconut water all act as gentle laxatives. But any 100% juice will work. Try for around two cups a day of diluted juice in the acute phase and longer term aim for less than one cup a day, especially for younger kids or those with dental issues.

Smoothies and period fruits are a great fit for some kids and it adds fiber to the fruit toast sugars that act as a gentle laxative. So you get the added benefit from these fluids. In smoothies, you can use fruit juice as a base to increase tolerance If your child like sweeter taste. Using fruit juice as a base also increases effectiveness, especially in smaller kid’s size serving sizes. This can be as simple as adding a ripe banana or preferred frozen fruit fruit to a juice liquid base and blending it together.

Also, when your child gets sick, this can be a point of regression and constipation management because they also may be vomiting, eating or drinking less and they are often not moving around as much for every degree of body temperature beyond 100 degrees and in creases fluid needs by about 10%.

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Anticipating this by having electrolyte drinks or pops at hand and taking small amounts through the day helps reduce the chance that they will develop an issue during illness or once they start feeling better. Having a plan for fluids when they’re sick also helps their appetite return more quickly and helps improve energy levels.

Most kids love and need carbohydrate containing foods. Fruits and grains are both great sources. You can help your child’s stools become softer by rebalancing the types of carbs in their diet. Fructose higher in fruits will aid in softening the stool. Glucose higher in grains does not. If there are already fruits your child enjoys in any form fresh, dried, canned, frozen or pureed offer Those swapping out grains for fruit would be a way to help manage constipation in the initial phases without trying something new.

If your child tends to prefer grains, keeping them out of sight or reducing access can help. Try offering the choice between two different fruits or simply present it as part of the meal or snack. Or try serving fruit with a familiar grain based food.

If your child eats or drinks excessive amounts of milk or cheese, less ripe bananas or applesauce, these may be foods to work on decreasing slowly during this phase. Green bananas and applesauce have increased amounts of fibers called pectin, which tend to slow down movement through the GI tract. There may be other particular foods at play for your child. Keep in mind, most children only need two servings of dairy per day from a nutrient perspective. When you remove foods, offer increased serving sizes or varieties of foods they already like, you can expect them to ask for more of these foods.

If we reduce one of their other preferred foods that might be constipating, the good news is, is that you can reduce these foods without total elimination and often see improvements in bowel movement, frequency and consistency.

Increasing movement in general gently moves and bends the GI tract. This is an image of your digestive organs. Your body, of course, has many other systems. In this picture you can also see your lungs. And right below that, a big muscle called your breathing diaphragm. When the lungs inflate and deflate during more active play, the breathing diaphragm creates pressure changes in the belly. This wakes up digestion and helps move stool along your intestines. Active play also uses and strengthens muscles all around the GI tract.

The last point in this section is basically to do the math. If you don’t already know how much fiber and fluid is recommended for your child, I’ve added two handouts in the resources that have tables of how much fluid and fiber kids need at different ages and sizes.

Your child may have more specific recommendations from their doctor or their dietitian. If you’re considering certain foods or products, you can also use this information to see if, from a fiber perspective, it’s worth considering for your child. Some products are marketed as wholegrain or healthy while still having lower amounts of fiber. There is nothing you need to do with this information just yet.

You can just take this time to observe your child. It can help to track amounts for a few days to get a rough estimate of their intake.

Thank you so much for taking the time to watch this video. 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 health care professional.