Constipation and picky eating – a marriage needing a divorce!
If our child is constipated, they may be reluctant to eat, eat less than usual and not be hungry at mealtimes. Wow doesn’t that sound like picky eating!
Constipation and picky eating can be very chicken and egg. If we are constipated, it’s uncomfortable and the last thing we can feel like doing is stuffing more food into an already overfull space. But if we have a child that is eating a limited diet then constipation is often the result.
Although this is not my area of excellence, I have seen what an impact constipation has had in our family and I know it affects many of the children in the families I work with. Given our experience, I have spent time figuring out what is happening and what we can do and wanted to share some of my findings.
Please do not use this in the place of medical advice. If you do have a child who is constipated please do get them checked out by your medical provider. If I’d known earlier what I know now, I’d have hit the help button way sooner!
What is constipation?
Constipation is generally defined as fewer than three bowel movements per week. Stools are hard and difficult to pass and can require excessive straining and time spent on the toilet. If we have older children, this may go under the radar so it’s important to keep our eye on the ball.
What happened to us
We have been through this in my house and it’s an awful experience for everyone. One of my boys is sensitive to wheat and used to get tummy aches when he was little and ate too much. One Christmas holiday when away, my husband insisted on toast every morning for breakfast (not usual for us). My sons joined in and all seemed fine.
We returned from holiday only to find that my son had ongoing stomach-ache. I left it for a while thinking it would go away once we were back in routines. Bad mistake! The pain got so bad we took him to the doctor and the verdict was severe constipation.
Totally missed the signs leading into this. Once we knew what was happening, it then took weeks to get him back to normal.
It’s since happened again so I am eagle-eyed any time we travel, and the diet is likely to be different. Third time around I was all over it before it could build into a major problem.
What causes constipation?
1. Dehydration – the purpose of the large intestine is to balance the water content within our body. If we haven’t drunk enough, our body will absorb more moisture from our food, leaving the waste material drier.
More water absorption can also occur if food is moving more slowly through the system. Lack of physical activity, for example, can slow down processing.
2. Too little fibre – many of the foods that do bulk out the stool and make it easier for it to move through the system are not top of the list for picky eaters.
3. Processed foods – unfortunately many of the foods that are favourites for picky eaters, like white bread can contribute to constipation.
4. Intolerances – if like my son, there are foods that the body has difficulty digesting, and dairy is often a culprit, this can be constipating.
5. Stress – a challenging patch emotionally can affect the way the whole body functions. Changes in routine and travel can bring it on too.
6. Hormonal changes – tweens and teens often have dramatic shifts in hormones which can play havoc with the system, especially when combined with a limited diet.
7. Medical issues – it’s important to rule out something going wrong that is bigger than just food choice.
8. Medication – even over the counter drugs like Panadol can be constipating.
9. Not going regularly – if a child doesn’t go, and instead holds on, this can cause backing up. Similarly, not letting all the waste come out when on the toilet can have the same effect.
10. Being constipated – having discomfort when going produces a reluctance to go, which in turn makes the problem worse, which then causes more pain when you do go. A vicious cycle!
If constipation continues for a while, the bowel can become distended and stretched. Firstly, this can affect feeling and therefore acting on the need to go and secondly, it can affect the efficiency of bowel function. Returning the bowel to normal once stretched may take time.
11. Poor chewing – not chewing properly and swallowing large chunks of food can impact digestion and, as it’s one big long tube, therefore bowel movements too.
What are the signs of constipation?
1. Large, hard stools.
2. Pebble-like stools.
3. No bowel movement for three or more days.
4. Pain when having a bowel movement.
5. Blood around the stool (could be a sign of anal tears).
6. Tummy pain.
7. Urinary tract infections, wetting pants or bedwetting that is not usual for our child.
8. Liquid stools. If there is impaction often runny diarrhea looking poo can leak out down the side of the harder stuff. It can also cause toileting accidents.
What can we do to help?
1. Water – water and more water. Making sure our child is drinking enough water during the day. Sometimes this is a challenge and especially when the weather is cooler.
2. Fibre – adding foods that are higher in fibre helps to bulk out the stool and move it through the system. However, there is a delicate balance required in this. If our child is already severely constipated, fibre can make the impaction worse.
If our child is not currently eating high fibre foods, then adding more gently and over time is advisable rather than suddenly increasing.
3. Flushing foods – there are foods that help to relieve constipation (see section below for suggestions).
4. Exercise – movement helps to speed up the processing. It can also be helpful to get the bowel moving short-term so sitting on the toilet after exercise is a good time to go.
5. Squatting – sitting on a toilet is NOT a great position for a comfortable bowel movement. A footstool in front of the toilet so we can raise legs up and be in more of a squat position can really help with straining.
6. Warm baths – a warm bath can help relax all the muscles and make movement more comfortable.
7. Timing – going at the same time every day/every other day can be helpful. Creating a routine so after exercise, bath or eating (all good times), sitting on the toilet and making an attempt.
Children are often uncomfortable going when away from home, which can create a problem. Having a routine at home so they are not missing cues or holding on is a good idea.
8. Probiotics – working on our gut so digestion is more efficient can be helpful.
9. Massage – there are specific exercises and massages that help with constipation. Rubbing the tummy in a clockwise motion, following the direction of the large intestine can offer relief, if done regularly. Look for information as to how to do this effectively: https://www.healthline.com/health/massage-for-constipation-relief
The link to the article also discusses perineal massage.
Bending the knees, lifting the legs, and moving them in an anti-clockwise direction can also be helpful.
10. Avoiding foods – which can be really tough if our child has a limited diet, but there are foods that can exacerbate the situation.
Foods that can make constipation worse
Reducing the quantity of some of these foods could be helpful, especially if we can balance the diet a little by adding items that help move things through the system.
1. Dairy – milk, cheese, and ice cream.
2. Fried foods
3. Fast foods
4. Processed grains like white bread, crackers, and pretzels
5. White rice
6. Cakes, pastries, and cookies
7. Red meat
8. Yellow bananas
Foods that help constipation
Many of these are not, admittedly, top of the list of favourite foods for fussy eaters, but getting creative there are ways that some can be added to the diet.
1. Prunes – the dried fruit version can be a win for picky eaters. If not, adding to baking either as an alternative to sweeteners or, cut into pieces is fine too.
Prune juice can be added to cereal, milk, smoothies etc.
2. Plums, peach, figs and apricots – or their dried equivalents.
3. Apples and pears.
4. Kiwifruit – Kiwicrush can be easier. A popsicle version?
5. Citrus fruit.
6. Spinach, broccoli, and other greens.
7. Sweet potatoes.
8. Beans, peas, and lentils. There are quite a few sweet recipes that use beans. Lentils can be added to mince dishes.
9. Ripe bananas – perfect to add to smoothies or baking.
10. Chia, hemp or flaxseeds. These can be ground and sprinkled on foods or added into baking. I add chia seeds to fruit purees to thicken them. I also add ground flaxseeds as a binder in meatballs etc.
Bliss balls can be a good way to add both dried fruit and ground seeds.
11. Wholegrains – this could be cereal, bread, pasta, oats, or crackers.
12. Oat bran – I add this to cereal and use as a thickener in sauces.
13. Kefir – I use part kefir and part milk for cereals etc. It can be added to smoothies etc.
There is also powdered fibre that is tasteless and can be added to food or drink.
However, if we are adding more fibre we also should be mindful of needing more water too!
Constipation is something to be avoided as best as practicable, especially if we have a picky eater but as the two go hand in hand sometimes this is a challenging balancing act.
If you’d like to learn how to gently add more foods to your child’s diet, Winner Winner I Eat Dinner is a great place to start: https://theconfidenteater.com/winner-winner-i-eat-dinner/
Judith is an AOTA accredited picky eating advisor and internationally certified nutritional therapist. She works with 100+ families every year resolving fussy eating and returning pleasure and joy to the meal table.
She is also mum to two boys and the author of Creating Confident Eaters and Winner Winner I Eat Dinner. Her dream is that every child is able to approach food from a place of safety and joy, not fear.