As a pediatric feeding specialist, my job includes helping kids become more adventurous eaters by working with registered dietitians, physicians and other team members to ensure a child learns to comfortably try new foods. One frequent issue in kids with feeding challenges is chronic constipation. Why? Because picky or selective eaters often food jag on fiberless “kid food” like chicken nuggets and mac-n-cheese.
Kids—especially picky eaters—need to have regular, almost daily bowel movements in order to feel hungry and increase their desire to try a variety of foods. Steve Hodges, a pediatric urologist at Wake Forest University School of Medicine, says children need daily bowel movements the consistency of “soft-serve ice cream, pudding, hummus” to fully evacuate the colon. When hard lumps of stool remain, those lumps stretch out the smooth muscles of the colon, preventing the muscles from contracting efficiently to fully empty digested material. Plus, the sensory system often won’t detect the urge to evacuate the bowels when muscle tone is compromised. With time, the intestines and rectum can return to normal with consistently soft, easy-to-pass stools.
To accomplish this desired state, parents often tackle the problem with fiber, laxatives and more. But if not administered properly, those strategies can backfire. Here are five common mistakes (and solutions) I encounter when parents attempt to solve chronic constipation:
- Adding more fiber: Increasing fiber immediately and drastically when a child experiences irregular bowel movements causes the system to back up more. The added back-up might then cause gastroesophageal reflux or more discomfort.
The solution: Start with a gentle laxative to help a child achieve regular bowel movements. Ask the parents to consult with their child’s physician to determine the best laxative to get the process started.
- Relying too much on laxatives: Laxatives are designed to empty the bowels, allowing the child to begin more regular and comfortable movements. Relying on increasingly harsher laxatives to keep bowels moving might result in negative consequences for the entire body. Different types of laxatives present various side effects. In addition, concerns about polyethylene glycol 3350—or PEG—in an adult laxative often recommended for children led to many parents searching for alternatives. The child may need a consistent, daily dose of a gentle laxative for a short period of time or a physician may recommend enemas or child-safe suppositories to clean out the intestines.
The solution: Once the child becomes more comfortable and experiences a regular BM pattern, focus on high-fiber foods in feeding treatment. Consider offering these foods whole, blended into purees or baked into preferred items: avocados, coconut flour, figs and peas.
- Expecting kids to pay attention to the urge to go: When a child gets constipated for a period of time, they learn to ignore their body’s signals for emptying bowels. And with school starting, kids get easily distracted, hesitate to use unfamiliar bathrooms or need to adhere to classroom bathroom break rules. All of this contributes to irregular bowel habits.
The solution: External cues help kids tune in to internal cues. Try setting up a watch or phone alarm at the same time every day when they should go sit in the bathroom for a short period of time. Optimal times include after a meal and after exercise. Suggest adding a foot stool to home bathrooms to tilt the pelvis and relax the puborectalis muscle, making elimination easier.
- Pushing fruits and vegetables: For picky eaters, insisting on fruits and vegetables might backfire. Learning to eat a variety of high-fiber foods takes time.
The solution: Soaked or ground chia seeds, whole or ground hemp seeds, ground flax seeds and powdered magnesium provide options to stir into purees, yogurts or smoothies or add to familiar recipes. I consulted with Jill Castle—a registered dietitian/nutritionist and co-author of Fearless Feeding—who suggests starting with a daily serving of one teaspoon of one the seeds noted above. In addition to soaking seeds, you can grind them in a coffee grinder and sprinkle atop oatmeal or cold cereal. Keep working on introducing high-fiber fruits and veggies like plums, berries and beans. Consult with the child’s physician for magnesium supplementation.
- Pushing the fruit juice: Offering a glass of prune juice is a common constipation strategy, but picky eaters often turn their nose up at the smell and taste. Naturally occurring sorbitol in prunes helps draw water into the intestine, not the “juice” itself. As an alternative, parents frequently offer sweeter, more readily available options like apple juice, but the glucose in those gets quickly absorbed into the gut and curbs appetite.
The solution: Parents can mix an ounce or two of prune juice to formula or milk, or add prune puree to muffin mix, pancake batter or smoothies. Try pear nectar as an alternative to prune juice. It tastes better and when warmed and stimulates a bowel movement.
Melanie Potock, MA, CCC-SLP, treats children birth to teens who experience difficulty eating. She co-authored “Raising a Healthy Happy Eater: A Stage-by-Stage Guide to Setting Your Child on the Path to Adventurous Eating” (2015), “Baby Self-Feeding: Solid Food Solutions to Create Lifelong Healthy Eating Habits” and “Happy Mealtimes with Happy Kids,” and produced the kids’ CD “Dancing in the Kitchen: Songs that Celebrate the Joy of Food!” Potock’s two-day course on pediatric feeding is offered for ASHA CEUs. She is an affiliate of ASHA Special Interest Group 13, Swallowing and Swallowing Disorders (Dysphagia). Melanie@mymunchbug.com.