“It all leads back to constipation.” I had an attendee during my residency that said that all the time!
Kid has belly pain? Constipation. Kid having behavioral issues at school? Constipation. 5 year old wetting the bed again? Constipation. Obviously this is an exaggeration but it is fair to say- constipation is VERY common in kids and it is one of the most common complaints I see from patients (and parents!) in my office.
I am not going to share medical advice on constipation today. Please call your pediatrician if:
- Your kid Is having so much discomfort he/she is crying.
- Your kid has never had normal poops.
- You see any blood in their stool.
- Your kid’s stool patterns change abruptly
- Your kid is having pain that is waking them up from sleep.
Got that? Good.
Now if this is bread and butter constipation (aka not a medical condition and ‘normal’) and you want to change some things quickly- your pediatrician will almost always suggest you make some lifestyle modifications. So let’s get to it!
What is a normal amount of time between poops?
It all depends on the consistency of the stool when it comes out. Does your child go 5 days but the stool comes out soft and they are not straining? Then they are not constipated. Breastfed babies can go up to 14 days without stooling and it can be totally normal!
What should my kids poop look like?
It depends on your kids age and what they are eating. Exclusively breastfed babies should have yellow seedy soft stools. Babies on formula (before solids) should also have soft stool but it can be a little bit more tan or darker. Once kids start eating solids the color can be anywhere from tan, yellow, brown to green and still be normal. It should be the consistency of toothpaste or soft molding clay. Is your child having stools shaped like balls? They are probably constipated.
Have you ever heard of the Bristol Stool Chart?
If no, you’re missing out! It is harder to make out shapes when kids are still in diapers, but in general, this chart is super handy. This image is from Stanford and is hilarious! You want your child to ideally have stools Type 3 and 4! Types 1 and 2 suggest they are constipated. Types 5-7 suggest their stool is loose (more on those another time)
Ok so my kid is backed up… now what do I do about it?
There are three things you should focus on: fluids, food, and fun (ok technically the third thing is exercise but three “f” words sounded better so just work with me).
First F: Fluids
For babies – usually breastmilk and formula fits their hydration needs. However, sometimes when the weather is hot or they are more active they might need extra and could fall behind. Try not to stick to strict feeding schedules in those times if your baby is having hard stools and might need more fluids.
For toddlers and older kids- offer them water throughout the day. Don’t get too stressed if they don’t take it all but continue to offer it.
A good tip is to check the pee, if it is coming out clear or really light yellow it means your kid is getting enough fluid.
Second F: Food.
My pediatrician told me to increase fiber in their diet. How do I do that?
Yup the next step is food, specifically fiber rich foods. Traditionally prunes have been used, but not all kids like prunes. Some of our favorite tips for increasing fiber rich foods are:
- Encourage P fruits: prunes, plums, peaches and pears (especially with the peel on) have lots of fiber and can help with constipation
- Switch your white breads to 100% whole wheat, bran, or rye or oats bread
- Switch from white rice to brown rice
- Serve warm oatmeal in the morning. Try the old fashioned kind. (Watch out: the instant kind doesn’t have as much fiber and has more sugar)
- Does your kid love fruits? Try raw apples with the peel on them (if old enough to not choke). Other good sources of fruit fiber are: kiwis, oranges, clementines and strawberries.
- How about veggies? Try broccoli, brussels sprouts, sweet potatoes, cauliflower, tomatoes, & any type of squash for an extra fiber punch.
- Is your kid a carb lover? Try baking with whole wheat flour, switching to whole wheat pasta, or mixing in FiberOne cereal to their favorites.
- Add a fiber punch to household favorites. Add ground flaxseed to applesauce, yogurt, or another favorite food.
- 0.5oz to 1 oz of prune juice for a baby also often does the trick.
Last F: FUN! Really?
Right, fun. Get your kids moving! Go out for long walks, encourage them to run around the yard, play tag with them or throw around a ball. Moving around will help get their guts get moving! Have a constipated baby? Bicycling their legs or having them do tummy time will also help.
Remember the best way to manage constipation is to try and prevent it from happening.
We know that is easier said than done in some kids that avoid all fruit and veggies. But do your best to keep encouraging and keep offering all foods. You will be amazed… the 55th time you serve broccoli might be the time they actually try it.
Got other tips to share?