Constipation may present itself with large, firm and painful stools. This can be associated with infrequent stooling, abdominal pain, cramping, nausea and decreased appetite. It can be severe enough to cause rectal bleeding, stool retention, and impaction with stool leakage. 

Acute as well as chronic constipation should be evaluated by the primary care provider to obtain a history, perform a physical exam, and make treatment recommendations, as sometimes there is a need to rule out organic causes of constipation.

So what are some organic causes of constipation? The causes are mainly attributed to lack of fluid and/or fiber intake.

How much fluid intake should occur?

Adequate amounts of fluids should be provided. Infants derive their fluids solely from breast milk and/or formula for the first 4 to 6 months and should be fed on demand. The American Academy of Pediatrics recommends exclusive breastfeeding until age 6 months.

Once solid foods are introduced between 4 to 6 months of age it is important to offer additional water and quickly transition to fiber-rich foods including barley, mixed grains, sweet potatoes, and fruit.

The minimum fluid intake per day depends on the child’s weight, and ranges from 16 oz for a 5 kg infant and 32 oz for a 10 kg infant. The toddler and older child should have frequent access to water throughout the day, allowing adherence to physiologic thirst mechanisms.

How can the family help the child drink more water?

Have water be their first choice for quenching their thirst. This helps them to avoid developing habits of thirst quenching with sweetened beverages. Make water more attractive with fun, individual cups or adding a mint leaf or slice of lemon for flavor.

What is fiber?

Dietary fiber consists of…

• Soluble fiber that attracts water and forms a gel-like texture. Examples of foods with soluble fiber include fruits, oats, barley, and legumes like beans or peas.
• Insoluble fiber that does not get absorbed. This bulks the stool and works as a broom, sweeping stool particles down and out. Examples of foods with insoluble fiber include wheat bran, rye and other grains.

Dietary fiber, in conjunction with appropriate water intake, will keep stools comfortable, moving and easy to pass. It also contains healthy nutrients and vitamins.

How much fiber is recommended?

The Consensus conference on dietary fiber in childhood recommends 5 grams of fiber a day under age 2 and 5 to 10 grams plus age in years for older children. For instance, if your child is 10 years old, he should get 15-20 grams of dietary fiber per day.

If the child is resistant to natural sources of fiber, various over-the-counter fiber supplements are available.

How do I read the nutrition label for fiber?

When you look at the Nutrition Facts list, fiber is listed under “Total Carbohydrates” as “Dietary Fiber” and is measured in grams. Good sources of fiber have at least 3 grams of fiber per serving. Excellent sources of fiber have at least 5 grams of fiber per serving.

How can the family help the child eat more fiber?

If you believe your child is not getting enough fiber, it is probably true. Here are some things you can do to ensure he gets more fiber.

• Fiber-rich choices and plain water need to be offered early on to allow the child to acquire a taste for it.
• Offer the child a variety of high fiber foods during the day rather than giving only one or two high fiber foods. Include granola bars, fruit bars and fig cookies. Snack choices like fruit baskets or veggie plates should be out and visible to the child to entice appetite for it.
• Offer fresh fruit with skin on, like apples, pears, and prunes.
• Offer raw veggies and tomatoes with a healthy choice of dips (low-fat yogurt, bean, hummus, or cheese dips).
• Offer unsalted nuts, seeds, and popcorn
• Mix high fiber cereal with a cereal your child likes or add chunks of fresh or dried fruit, bran, flax seeds, or sesame seeds.
• Cook mostly whole grain pastas, breads, and cereals.