Keeping Kids Regular: How to Treat and Prevent Constipation

What does the word “regular” bring to mind? Probably nothing special. Regular might sound pretty blah, but in my 20 years of working with kids I’ve found that they often appreciate the qualities of consistency and simplicity that regularity imparts to their lives, helping them feel more confident and in control.

Being regular can apply to our routines, our way of life, and yes, even our bowel movements. And while these might seem unrelated, the newest science indicates that they are, in fact, interconnected: our environment affects our bodies, our gut affects our mood, our mood affects our physiology, and taking steps to adjust in one area helps us gain health in the others. Like so many health issues, nutritional habits and lifestyle routines are the best routes to attaining optimal regularity!

FEEL IT IN YOUR GUT

We are becoming increasingly aware that the gut and the brain are connected, and it turns out being “regular” benefits both the health of our bodies and our minds. Take anxiety for example: along with depression, anxiety ranks at the top of mental health issues for kids, with an estimated 20 percent of children experiencing significant anxiety. A 2014 analysis of ten studies revealed that patients with irritable bowel syndrome (IBS)—one symptom of which is irregular bowel function—had significantly higher levels of anxiety and depression than healthy controls. And in 2015 it was confirmed that when anxiety is treated, bowel function in IBS patients tends to regulate.

The Scoop on Poop

The stool is a primary pathway through which the body flushes waste. When that exit route is clogged, waste backs up and ferments, generating even more waste products (called endogenous waste) which can pass through the lining of the gut and interfere with hormonal, neurologic, and immune function, and exacerbate skin conditions. Stagnant stool also irritates and inflames the intestinal lining, increasing its permeability, and has been linked to myriad health conditions ranging from ADHD to depression to cardiovascular disease. Further, excessive permeability of the gut wall has been shown to contribute to allergies and autoimmune disease. Regulating bowel function can help relieve inflammation in the gut and, in turn, inflammation elsewhere in the body, including the brain.

Constipation is now so common in kids it’s considered normal, and it’s not that surprising considering our often sedentary and junk food-filled lifestyles. Lack of regular exercise leads to low tone in the bowel muscles and poor blood flow to the intestine. Overconsumption of sweetened and processed foods that we often eat too quickly or on-the-go contributes to slow, inefficient digestion. And many of the common medications we take state that constipation is a typical side effect. It’s no wonder constipation-related visits to hospital emergency rooms are steadily increasing! Irregular bowel movements may be common, but it’s a serious problem leading to pain and discomfort, interfering with quality of sleep and concentration, and can contribute to reduced appetite and nutrient intake. In fact, even mild constipation can be a significant strain on your child’s physical and mental health. (Age matters: Here's what your infant's poop says about their health.)

REGULAR AS CLOCKWORK

If your child suffers from constipation, the good news is there are a few simple strategies you can implement that can help ease the way into regularity!

Downtime

It’s no secret that today’s kids are under more stress than ever. Too much of it puts their bodies into a constant state of “fight or flight,” causing their nervous system to inhibit rest, relaxation, and digestion hormones like acetylcholine, with the end result commonly being a bout of constipation. Reducing stress, allowing for time for relaxation, and creating a predictable schedule can help let your little one let go.

Anxiety Busters: Amino acids like GABA and nutrients like zinc and B6 have been known to help calm the anxious mind, which can also bring regularity to the bowels. B6 and zinc, along with folate, convert tryptophan into serotonin, which is also involved in motility and fluid control of the bowels. Eggs, salmon, turkey and nuts are high in serotonin-producing tryptophan, and including pumpkin seeds, shellfish, leafy greens, beef, beets and broccoli will provide the important co-factor vitamins and minerals to help better process tryptophan.

Mealtime

Purchase the cleanest whole food you can afford, focusing on easier-to-digest foods that nourish the gut like berries, lightly cooked colorful vegetables, stewed apples, and meat stock. Avoid chemicals, emulsifiers like polysorbate 80, and environmental pollutants like glyphosate that have been shown to disrupt the gut microbiome, cause low grade inflammation, and deplete the body’s nutrient stores.

Foods That’ll Move You

Avocado
Salmon
Beans
Apples with skin, especially when stewed slightly
Kiwi
Yogurt or kefir
Eggs (if tolerated)
Nuts
Pumpkin seeds
Leafy greens
Beets
Broccoli
Pumpkin
Cabbage
Pure water
Herbal teas, especially fennel, licorice, nettle, ginger, and peppermint

Digestion Obstruction: Gluten and non-fermented cow’s dairy are hard to digest and may contribute to an irritated digestive tract and slowing down digestion. Try taking those out for a while to ease digestive stress.

Make sure your child is getting 1-2 litres of water a day to ensure their bowels are flowing and their digestive lining is healthy.

Tasty Thirst Quencher: Fermented coconut water kefir is another way to hydrate which brings the added benefit of microbes critical to well-functioning digestion. Various studies have shown kefir to successfully modify the microbiome and relieve symptoms ranging from IBS to eczema to infection and has also been shown to reduce inflammation. This bubbly, refreshing drink is best given in the morning. (TIP: Add some fresh squeezed lemon into the drink for added vitamin C and enzymes!).

Allow sufficient time for meals and encourage your child to sit, breathe, and chew to improve the efficiency of digestion. Try setting a minimum time frame for meals and arranging for restful activities post-meal to help suppress the fight-flight state and activate the release of those rest, digest, and grow hormones. Create a tranquil atmosphere at the dinner table using calm music or diffusing essential oils, and spend time as a family talking about your day.

Play Time

Kids aren’t getting enough play and it’s affecting their bodies in more ways than one. Regular outdoor play—running, skipping, jumping, and twisting—also reduces anxiety and stress hormones for many kids while also physically moving the bowels.

TAKE IT ON THE REGULAR

Adding a few supplements may be also be helpful. Pick one or two of the following as a starting point and give them a few weeks to do their work. You may find you need to play around with a few before finding the ones that work best for your child’s particular situation. Note: If your child is on medication, check with your doctor first about supplements as some of them can interfere with medication.

Magnesium brings water into the colon and relaxes the muscles in the digestive lining. Increasing magnesium-rich foods like avocado, black beans, and salmon can help, but giving a supplement is often a more efficient solution. The oxide form of magnesium will flush the colon the fastest but should only be used short term as it is poorly absorbed and its laxative effect can lead to mineral deficiencies. Magnesium citrate and glycinate also work and are better absorbed by the body. Start with a low dose, given several times a day, and increase the amount until stools soften. Once the bowel is clear, reduce the magnesium.

Zinc is involved in the synthesis of the digestive enzymes that break apart proteins, fats, and carbohydrates as well as the synthesis of hydrochloric acid in the stomach. A deficiency of acid or enzymes could be rendering inadequate digestive function and contributing to constipation. Liquid zinc is highly absorbable and easy to give to children. Be mindful that high doses of zinc can interfere with nutrient balance, so you’ll want to consult with a practitioner if giving beyond 15 mg a day, or if your child is younger than five.

Vitamin C is a natural laxative and, like zinc, helps stimulate the production of stomach acid. It’s best to give this as a supplement in the morning as it can raise energy levels and interfere with sleep. Start with a low dose and increase until stool softens.

Slippery Elm eases constipation and soothes irritated mucous membranes. It is both mucilaginous when combined with water, and high in nourishing antioxidants, often working well in conjunction with magnesium. You can buy it as a powder and mix it into apple sauce starting with a teaspoon per day.

Back Up Plan? Pharmaceutical laxatives are often offered as a first-line option for constipation relief. There are different kinds, so be sure to get all the information you can from your healthcare provider, and use extreme caution when using any laxative containing polyethylene glycol 3350 (also called PEG). This should be used as a short-term, last resort strategy only.

In 2012 the FDA was petitioned to further investigate the safety of PEG for use in children after growing concern over a lack of safety data and increasing reports of possible neuropsychiatric side effects like depression, rage, anxiety, paranoia, tics, seizures, OCD, and mood swings. The study was approved in 2014 and was supposed to be done by 2018. By the end of 2018, 1,115 reports of "psychiatric disorders" suspected to be related to PEG had been reported to the FDA, and over 30,000 concerned parents have joined the Parents Against Miralax Facebook group to voice their concerns about neuropsychiatric side effects of PEG. (At time of print, the promised safety study has not yet been completed).

Being regular is far from boring! It can bring the consistency and predictability kids need for good health and function. Work with your healthcare provider to leverage the powerful tool of nutrition to help calm your child’s mind, heal their body, and help get things moving again!