Dietary advice for children with constipation

What causes constipation in children?

Children often become constipated because they do not eat enough high fibre foods, and / or they do not drink enough fluid.

Fibre, sometimes called roughage, is the indigestible portion of plant foods.

If there is too little fibre and fluid in the gut, stools may become harder, drier and more difficult to pass.

Ensuring your child eats a well-balanced diet including sources of fibre and drinking adequate amounts of fluid may help to ease constipation and prevent further episodes of constipation.

What constitutes / is a well-balanced diet?

For a well-balanced diet, it is recommended that foods from the five different food groups illustrated are eaten in the proportions shown in the Eatwell guide below.

Increasing the fibre and fluid content of your child’s diet should be a gradual process. It is best to make only one change every two to three days.

It is particularly important to ensure your child has plenty to drink when increasing the fibre content of their diet.

The following lists ways in which you can increase the fibre and fluid in your child’s diet.

Foodstuffs

Bread

• Wholemeal, granary, rye and seeded bread.
• Higher fibre white breads are also available, for example Hovis® Best of Both, Allinson® High Fibre White Bread, Kingsmill® 50/50 bread, Kingsmill® hi fibre white bread.
• Indian breads such as chapatti, phulka, roti and parantha (made with wholemeal flour).
• Raisin/ fruit breads, teacakes / scones with dried fruit.

Breakfast cereals

• For example: Weetabix, Oatibix, bran / oat flakes, Shredded Wheat, Shreddies, porridge and muesli, Fruit and Fibre, Granola, raisin/ apricot wheats.
• Add dried fruit and /or nuts for extra fibre.
• Do not use raw bran as it can inhibit the absorption of other nutrients.

Pasta and rice

• Whole-wheat spaghetti, lasagne, pasta macaroni .
• Brown rice.
• Please note: whole-wheat versions of pasta and rice usually take longer to cook.

Cakes and biscuits

• Cakes and biscuits made with wholemeal flour, oats, nuts and dried fruit.
• For example: Digestives, fig rolls, Hobnobs, wholemeal flapjacks, muesli bars, granola bars.

Crackers and crispbreads

• High fibre / seeded crisp breads, crackers.
• Oatcakes.
• Rye crackers.

Potatoes

• Sweet potato.
• Eat the skins wherever possible.

Fruit and vegetables

• Aim for five portions per day. One portion is equal to what fits into the palm of your child’s hand.
• All types – fresh, tinned or frozen.
• Eat the skin wherever possible.
• Dried fruit.

Pulses, nuts and seeds

• Peas, beans (including baked beans), lentils and sweetcorn.
• Add to casseroles, soups, stews, rice and pasta dishes.
• Whole nuts and seeds should not be given to children under five, as young children can easily choke on them. Try instead ground or puréed nuts and seeds for example smooth peanut butter, tahini (sesame seed paste) or ground almonds.

Drinks (fluids)

It is important to keep up a good fluid intake to help with constipation. Aim to have most of this fluid as water but you can include very dilute squash/ fruit juice.

Avoid concentrated fruit juices and sugary / fizzy drinks where possible as they contain few nutrients and are bad for the teeth.

Tea and coffee should not be given to children under five as they can reduce the absorption of iron from food.

Offer six to eight drinks per day around meal and snack times. More might be needed in very hot weather or if very active. The following is a guide as to how much to drink per day:

(American dietary recommendations from Institution of Medicine (2005) Dietary reference intake for water, potassium, sodium chloride, and sulphate. Washington DC: The National Academies Press.)

You may find it useful to measure your commonly used cups and drinking bottles so that you know how much each contains.

What if my child has a poor appetite?

It is not uncommon for children with constipation to have poor appetites. If this is the case, it might be helpful to offer your child small regular meals and snacks.

If you are concerned about the nutritional value of your child’s diet, please contact the paediatric gastroenterology nurses on 01223 274757 who can refer them to the dietitian.