Do Too Many Carbs really Clog Kids Up?
Nothing is sure to strike fear in the heart of a parent than a child who can’t poo! Troublesome and relatively common, the causes of constipation in children are often tricky to pinpoint. Adding to the confusion are the many urban myths about foods that cause kids to “get clogged up” and confusing and often unfounded advice about what to do about it.
Problem, or not?
Children’s bowel motions and habits vary greatly. There’s only a poo problem if it’s a problem for your child. In other words, if your child only passes a bowel motion every few days but it’s a soft, moist poo that he passes easily then there’s not a problem! We are all individuals and our bowel habits vary greatly. Kids don’t necessarily poo like clockwork each day.
These are the symptoms you might notice if your child is constipated:
Irritability or more unsettled than usual
Sore tummy, abdominal pain or cramps that tend to come and go
Poorer appetite that usual
Straining when trying to do a poo
Unable to pass soft, moist bowel motions regularly (at least every 1-3 days)
“Holding on” behaviour like such as squatting, crossing legs or refusing to sit on the toilet to avoid doing a painful poo
Encopresis is the medical term for faecal incontinence or soiling that occurs in children who are past the age of toilet training. When children have been constipated for a long time, hard poo builds up in the rectum. The bowel and rectal muscles can become so stretched that the child no longer feels the sensation of “needing to go”. Liquid poo then flows around the hard, stuck poo and causes soiling. Encopresis is accidental and beyond your child’s control. They aren’t “being naughty” when this happens. It’s important to seek help and support from a health professional such as your GP or Paediatrician if your child has encopresis. An Occupational Therapist with experience in encopresis can also be extremely helpful to re-establish toileting routines, and of course a Dietitian to review dietary intake.
So why do kids get clogged?
Here are some of the main culprits …
1. Natural tendency for slow gut movement (slow transit time)
A child’s gut is still developing and many children have what is known as “slow transit time” which improves with age. This means that the natural peristalsis (or muscular movement) of the gut pushes the digesting food through more slowly. Unfortunately, the longer poo stays in the bowel, the harder it gets!
2. Change in toileting routine
Changes to a child’s toileting routine can cause a previously “regular” child to become constipated, such as beginning to toilet train (especially when there is a fear of sitting on the toilet) or starting at a new school, child care or kindergarten.
3. Busy kids ignore “the urge”
Young kids are often too busy playing and ignore the urge to go to the toilet. If our body sends us a signal that it’s time to poo and we ignore it, we may not get the same reminder urge for some time. Again, the longer poo stays in the bowel, the harder it gets!
4. A sudden change of diet, including introduction of first solid foods
Some parents notice their child becomes constipated “all of a sudden” around the time of introducing solids or other times of change like going on holiday or a new routine. It is normal for consistency of bowel motions to change when solid foods are first introduced. They are often bulkier, a little firmer and smellier, however constipation isn’t normal.
Breastfed babies are much less likely to experience constipation than infant formula fed babies.
5. Insufficient fluid and fibre
The Age + 5 Rule is the easiest way to work out how much fibre your child needs. Simply add 5 to your child's age to get the ideal quantity of fibre per day in grams.
A ten-year-old needs 10 + 5 = 15 gram of fibre each day
A 3-year-old needs 3 + 5 = 8 grams of fibre each day
How much fluid your child needs depends on many things including their age, size, activity levels and even the weather – we need more water on hot days! As a rule of thumb, toddlers and children up to 8 years old need at least 4-5 cups of fluid each day (800-1000mL) and children 8+ years will need 6-8 cups each day (1-1.5L) as recommended on the Healthy Kids' Website.
6. Too much fibre
It’s rare, but it is possible for some kids to overdo their fibre intake. This usually happens when a child is being offered ONLY very high fibre choices, or is eats too much very high fibre foods e.g. bran, bran flakes. A balance of some higher and some lower fibre choices plus offering plenty of fruits and veggies will help avoid this issue. If you think your child may be getting too much fibre, you can use the handy Age + 5 Rule above to check.
7. Not moving enough
You didn’t really need another reason for limiting screen time, but here’s one anyway. Not moving the body is not good for the bowels. Kids who don’t move much can be more prone to constipation. The more chances kids get to move in enjoyable ways, the better.
8. Holding on /avoiding passing bowel motions - encopresis
Because encopresis occurs after a child has been chronically constipated for some time or after a child has had a particularly painful episode of constipation, it is important to seek help and support from a health professional. Your doctor or health professional may first recommend a course of medication to soften the poo and allow your child’s gut to recover from the pain and stretching. If your child is avoiding the toilet or is fearful of passing poos, it may also be helpful to get support from an OT to overcome this fear.
9. Cow’s milk protein allergy/intolerance
In some cases, constipation can be a symptom of a food allergy or intolerance. One of the most commonly seen of these in babies and young children is Cow’s Milk Protein Allergy or Intolerance (CMPA). Confusingly, this IS in fact an allergy - a reaction to the protein in cow’s milk - however some still use the term intolerance. The allergy usually presents as a range of different gut symptoms including: constipation or diarrhoea, vomiting, or green, frothy or particularly foul smelling poos. If CMPA is suspected, seek help from an Accredited Practising Dietitian to follow a 100% dairy-free diet for at least 4 weeks to check for improvement of symptoms.
10. Other food intolerances and conditions
Tricky to diagnose and often associated with a variety of symptoms, other kinds of food intolerances such as sensitivity to salicylates, amines, glutamates, FODMAPS (fermentable sugars) and gluten can cause “irritable bowel” -type symptoms in adults and children including diarrhoea and constipation. A child with undiagnosed coeliac disease can also present with constipation as one of the symptoms.
However, the presentation is rarely as straightforward as simply constipation. Other symptoms that often go along with food intolerances are: headaches, hives and rashes, eczema, sinus trouble and mouth ulcers. If food intolerances are suspected, it is wise to consult with an Accredited Practising Dietitian who specialises in childhood allergy and intolerance.
What helps to avoid and relieve constipation?
Regular toileting routines - Habits help, particularly for ‘busy” kids and kids who just don’t stop!
Enough water - 4-5 cups/day up to 8 years old and 6-8 cups/day over 8 years old.
Enough fibre (but not too much) - Remember the Age + 5 Rule.
Get moving - Encourage kids to move their bodies as much as possible in ways that are enjoyable for them. Any kind of physical activity helps to move things along in the bowel.
Natural “soft poo” foods - Prunes, Pears and their juices are both excellent food-fighters of constipation as they are high in fibre and are also high in the natural laxative, Sorbitol. Other foods and juices that contain sorbitol (but not as much) are apple and pineapple. Stone fruits and paw paw/papaya can also help. Legumes are helpful, though care should be taken not to give very young children large serves of legumes which can cause an upset tummy. The same goes for brassica veggies like broccoli and brussels sprouts. Include, but don’t overdo!
Fibre supplements - Fibre supplements should only be used to prevent constipation and should NEVER be given to a child (or adult) who is already constipated or impacted. is a gentle, soluble fibre supplement that is usually tolerated well by children as it mixes into water or liquids and it totally tasteless and colourless. Use under the guidance of a health professional.
Slow changes to diet - Children have sensitive tummies and bowels. Transition to any food change very slowly.
Laxatives and other medications - Your pharmacist can help recommend a suitable laxative to get things moving. However, see your doctor if your child needs to use an over-the-counter children’s laxative to relieve constipation more than twice in 12 months.
This or that food is often blamed for causing constipation, however food is a less likely culprit for constipation in kids than in adults.
Beware these constipation myths …
Too many carbs blocks kids up
Although “everything white” such as white bread, pasta and rice isn’t ideal for bowels, a mix of higher and lower fibre grain foods is good for bowels and good for health. 2-5-year olds need approximately 4 serves of grain foods each day (as advised by Australian Dietary Guidelines for Children & Adolescents), ideally at least 50% of these as whole grains such as wholegrain and wholemeal breads, brown rice, couscous and wholegrain pasta. This means at least 2 serves of grain foods should be offered while a child is in long day care.
An example of 1 serve = 1 slice of bread or ½ cup of cooked rice or pasta
Many foods are rich in carbohydrate including grain foods, fruits, starchy vegetables and dairy. So, it simply isn’t true or fair to blame constipation on carbs.
Milk, dairy and cheese are bowel blockers
Rarely a problem unless a child has cow’s milk protein allergy or is having too much dairy and not enough of other foods.
Bananas clog kids
There is some research to say that under-ripe (green bananas) can contribute to constipation but then again, I don’t know too many kids who like to eat green bananas! If your kids enjoy eating ripe ripe bananas they’re unlikely to be the cause.
Having a kid who is clogged up isn’t anyone’s idea of fun. We hope this helps point you in the direction of what may help and what won’t.