Some children struggle with constipation and/or diarrhoea. Find out more about what causes these, when to contact your GP and key changes that can be made to the diet to help reduce symptoms. Read more about allergies and food exclusions if you're concerned your child may have an allergy, intolerance or Coeliac Disease.

Constipation

Constipation is a common problem experienced by many children and young people and often has a significant impact on daily life for families. Constipation is defined as 'chronic' if it lasts for longer than 8 weeks.

  • Difficulty, straining or pain when having a bowel movement. Sometimes a small amount of blood can be present
  • Less than 3 bowel movements a week
  • Stools that are hard, large and/or pellet or ball like
  • Soiling - due to liquid stool leaking past a blockage of hard stool
  • Other symptoms include tummy ache, unsettledness, nausea and decreased appetite

 

When no disease or illness is causing the constipation this is 'idiopathic constipation' and is often due to a combination of factors, such as:

  • Withholding stools
  • A family history of constipation
  • Toilet training issues
  • Changes in diet such as starting weaning, inadequate fluid or fibre
  • Lack of exercise
  • Some medications e.g. codeine, iron supplement, seizure medications, and antihistamines

A GP may prescribe a laxative as treatment alongside making changes to the diet.

Fluid: Adequate fluid in the diet helps keep stools soft and makes them easier to pass. Fluid intake should be mainly from water and milk, with a small amount of fruit juice (max 150ml/day). No added sugar squash may also be given. Check out our Healthy Childhood for advice on fluid requirements by age.

Fibre: Fibre helps increase the bulk of stools and helps absorb water making them softer and easier to pass. A rough guide to fibre requirements is: child's age + 5g (appropriate for children over 2 years). Some ideas to increase dietary fibre include:

  • Starchy Carbohydrates: Increase wholegrains e.g. cereal, oats, brown bread, pasta and rice
  • Fruits and vegetables: Offer with each meal and snack - such as adding extra vegetables to sauces. Can include fresh, frozen, tinned or dried
  • Beans, pulses and other plant proteins: Include in meals. Offer seeds, nuts or nut butters as a snack (consider choking risk and allergies if applicable)

Treat foods (cakes, biscuits, crisps etc.) often contain very little fibre and are not recommended daily. If offering treats, choose options with wholegrains and/or dried fruit.

  • Encourage daily exercise to help with bowel movements
  • Encourage a regular toileting routine
  • Keep toilet training calm, relaxed and positive. A sticker or reward chart may help to praise and encourage children for using the potty or toilet. Do not punish accidents

Toddler diarrhoea

Toddler diarrhoea is the most common cause of persistent diarrhoea in children aged 1-5 years old. This is when children have 2 or more loose, watery stools per day for at least 3 weeks. Stools are generally foul smelling and often contain undigested foodstuffs (commonly vegetables) which can be seen in stools within a few hours of consumption. Children with toddler diarrhoea are otherwise well and growing well.

Diarrhoea can be a symptom of many illnesses (e.g. infection or food allergy/intolerance). If there are other symptoms or concerns about your child's growth, speak to your child's GP who can look into other causes.

It is not clear exactly what causes toddler diarrhoea but it is thought that children often have an immature gut and so food moves through the gut more quickly (called a rapid gut transit time). A role of the bowel is to absorb water and when food moves through the gut quickly, a lot of the water remains and the result is watery, loose stools.

There is no medical treatment for toddler diarrhoea, but changes to the diet may help. Toddler diarrhoea normally resolves between the age of 2 and 5 years.

The 4Fs - Fat, Fibre, Fluid and Fruit juices

Fat: Increasing dietary fat can relieve symptoms as fat can help slow down the transit time of food in the gut. Guidelines for children under 5 are to get around 35% of their daily energy intake from fat;

  • Include full fat dairy products like whole milk, cheese, yoghurt, rice puddings
  • Add butter, margarine, oil, avocado, nut butters or cheese to snacks and meals
  • Choose proteins higher in fat like red meat, sausages and eggs
  • Treat foods (cakes, biscuits, crisps etc.) can be used in moderation, but are generally high in sugar and unhealthier fats (saturated fats)

Fibre: Fibre can help act as a sponge and soak up the excess water in the gut. If your child has a low fibre diet, this will not happen effectively and can result in loose stools. However, too much fibre passing thought the gut can irritate the gut and cause diarrhoea. A rough guide to fibre requirements is: child's age + 5g (appropriate for children over 2 years). Depending on your child's diet, you could try adapting the amount of high fibre foods (increasing if diet is very low in fibre and decreasing if very high). Foods high in fibre include:

  • Wholegrain carbohydrates e.g. cereal, oats, brown bread, pasta & rice
  • Fruits and vegetables: Including fresh, frozen, tinned or dried
  • Beans, pulses and other plant proteins

Fluid: Too much fluid in a child's diet can lead to an increase in the fluid in the large bowel and result in more watery stools. Fluid intake should be mainly from water and milk. Sugary drinks, fruit juices, and no added sugar drinks may worsen diarrhoea. If giving fruit juice limit to 150ml/day and dilute with water. Check out our Healthy Childhood for advice on fluid requirements by age.

Healthy dietary changes can be continued once your child's symptoms resolve including consuming adequate fibre and fluid. However you may remove the focus on additional high fat foods once your child's symptoms have resolved.