Constipation is a condition characterized by difficult and/or infrequent bowel movements. Stool is often dry and hard and could be pellet like. Constipation is not only uncomfortable, it also reduces the efficacy of toxin elimination from the body and signals that there may be an underlying health issue. That’s because constipation is often not an illness on its own, but rather a symptom of something else going on.
Constipation happens to almost everyone sometimes, so it is helpful to know how to treat constipation gently and naturally.
How Often Should My Child Have A Bowel Movement?
What is a healthy frequency of bowel movements? Every day? After every meal? Several times per week?
In integrative medicine, we generally hope to see a bowel movement at least once per day or after every meal. In conventional medicine, a frequency as low as four bowel movements per week is considered acceptable as long as the individual is otherwise healthy and not experiencing any discomfort or difficulty.
In infants, a normal defecation pattern sometimes takes a while to develop, and so gaps of a couple of days between bowel movements aren’t cause for concern if: your baby’s stools are normal consistency (soft and mushy), your baby doesn’t appear to be bloated or in pain, and your baby isn’t straining to pass a bowel movement.
Causes of Constipation
The most common causes of pediatric constipation that I see in my office are:
- Dehydration
- Lack of fiber in diet
- Lack of healthy bacteria
- Stress in general (often in response to changes in routine, traveling, etc)
- Stress around going to the bathroom
- Food intolerances
- Diet changes (for example the transition from breast milk or formula to solid food, or times of overindulgence like holidays, vacations, etc)
- Poor gut health
However, constipation can also be caused by more serious underlying conditions including irritable bowel syndrome, irritable bowel disease, thyroid and other endocrine issues, nervous system conditions, diseases of the large bowel, developmental conditions, poor gut health, and pain in the anus or rectum.
Sometimes stool assessments can be helpful. I’ve used Genova and Great Plains Laboratories. If you contact them, they can put you in touch with an integrative doctor who can guide you through the process and help with treatment decisions.
Constipation with overflow accidents is associated with psychiatric concerns and sexual abuse in children, although it happens in children who don’t have psychiatric concerns or abuse as well.
Treatment of Constipation In Children
When treating constipation in children, it is important to evaluate the cause of the imbalance. Looking into how the constipation developed will often let me know what causes are involved. Very often two or more of the causes listed below are present at the same time and need to be addressed.
Diet, Microbiome, & Hydration
Carefully looking at diet, lifestyle, and the onset of constipation will often give clues as to whether diet, microbiome, and hydration will need to be addressed. I grouped these three things together because they are interrelated and usually need to be addressed together.
A diet low in fiber is a good indication that improving diet and fiber intake will be helpful. Antibiotic use or c-section birth indicates that probiotics could be needed. Signs of dehydration indicate that more attention needs to be paid to proper hydration.
Dietary Fiber For Treatment Of Constipation
Insoluble fiber helps bulk up stools and reduces constipation. Soluble fiber is more helpful for treating diarrhea, but can be helpful to moisten dry stools. Both types of fiber support a healthy microbiome, but soluble fiber is more impactful.
Most unrefined plant-based foods contain a mix of both soluble and insoluble fiber. My top choices are chia seeds, ground flax seeds, gluten free oats, berries, pears, apples, potatoes, sweet potatoes, beans, quinoa, barley, avocado, nuts, prunes, popcorn, and vegetables.
Increasing fiber in the diet can sometimes cause bowel problems to become more pronounced because increasing fiber can disrupt the balance of the microbiome. When prescribing fiber, I recommend gradual rather than abrupt increases. I also often recommend a probiotic at the same time.
Increasing fiber without increasing hydration can worsen constipation, especially when taking fiber-rich seeds like flax or chia. Hydration is essential to healthy bowel movements.
Relaxation For When Stress Causes Constipation
When constipation shows up around transitions and changes, stress is a likely culprit. This includes constipation that begins when changing day cares or schools, around transitions of any type, in relation to parental stress, around exam-time, when experiencing conflict with friends, etc.
Working with your child to help find ways to manage and reduce stress and anxiety is important for their mental-emotional health and resilience. There are strategies to help reduce the burden of stress on their bodies as well.
Chamomile tea is a favorite treatment of mine for mild stress-induced constipation in everyone from babies to adults. Chamomile tea is soothing to the gastrointestinal tract and nervous system, it is hydrating, and preparing and enjoying the tea can be a grounding and connecting ritual to share with your child. Peppermint or licorice teas are good alternatives for children who don’t enjoy chamomile.
For longer term or more serious stress and anxiety in children, look for a supplement that contains chamomile, hops, or valerian Hops or valerian are powerfully relaxing to the nervous system. Also look for a supplement with lobelia, which helps reduce the fight-or-flight sensation caused by an activated sympathetic nervous system.
Magnesium is also helpful when constipation is caused or worsened by stress and/or anxiety. Magnesium helps constipation in two ways: first it helps to relax the muscles of the bowel, second it pulls water into the bowel to soften and bulk the stool. Warm epsom salt baths also help with relaxation, as can an abdominal massage with castor oil.* In infants, legs can be gently cycled after the bath and massage.
*Castor oil stains fabric, so be aware. I don’t recommend castor oil internally for constipation.
Addressing Stress Around Toileting
Stress around toileting is common in people of all ages. In toddlers, it can be the result of stressful potty training techniques. In kids, it can be because of sensory issues in the bathroom, a fear of toilets, or stress in certain environments (eg school or daycare).
This stress can be compounded or caused by painful bowel movements that start to occur as a result of constipation. Magnesium can relax the intestines and may help with reducing painful bowel movements.
Healing stress around toileting takes patience, creativity, and compassion. Problem solving around how to make the bathroom a relaxing and safe place should occur. Creating routines encouraging bowel movements at the beginning and end of the day may also be helpful.
Treating Constipation Caused By An Unhealthy Gut, Food Intolerances And Diet Changes
When constipation is caused by poor gut health, food intolerances and/or diet changes, the digestive system is often too weak and inflamed to move food through the system in a healthy way.
If a food intolerance is suspected, it is wise to address it. Probiotics and other gut-healing strategies may be needed.
If a temporary diet change has caused constipation, it is best to return to an anti-inflammatory style of eating as soon as possible. Nux vomica is the homeopathic remedy that I have found most helpful for constipation caused by overindulging in rich foods.
If a change from breast milk or formula to solid food is causing constipation, I find that magnesium, warm baths, abdominal massage, and gentle leg cycling can be helpful (as described above).
For acute treatment of constipation in infants, children, and sensitive adults, look for a supplement containing yellow dock root (strengthens digestion and stimulates bile), licorice or marshmallow (mild laxatives that soothe and heal irritated mucous membranes while moistening stools), and peppermint spirits (relax tense intestines and provide relief from gas, bloating, and cramping).
Summary
When treating constipation in children and infants, it is important to find and treat the root cause. The most common causes of pediatric constipation that I see in my practice are dehydration, low fiber diet, lack of healthy gut bacteria, stress and anxiety, stress about toileting, food intolerances, poor gut health, and dietary changes.
Probiotics enhance gut health overall and are often an effective treatment for recurrent or habitual constipation. Natural laxatives (licorice and marshmallow) may help treat acute constipation while magnesium may be helpful when stress is impacting bowel function.
References:
2022 ICD-10-CM Diagnosis Code K59.00: Constipation, unspecified
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(PDF) Chamomile efficacy in patients of the irritable bowel syndrome
