Occasional mild constipation can happen to anyone – often it is due to a stressful event, interruptions to your routine, or diet (maybe you were traveling, or you just went a little crazy with the cheese plate). But generally, as long as you get back to you normal routine or diet, or the stress subsides – the constipation will resolve and you will be feeling normal in a day or so. If you have ever had occasional constipation, you know the feeling – discomfort, bloating, feeling full, gassy and sluggish. Now imagine what it would be like to feel that way most of the time. Chronic constipation is hte #1 cause of kids’ belly pain, and a common reason to miss school and activities. In addition – being constipated can impede the body’s ability to detoxify. When constipation is ongoing or chronic, it generally is a signal that something is amiss somewhere in the digestion and elimination process – with the organs, the nerves, and anywhere along the gastrointestinal tract.
In some cases, constipation can become a medical emergency. According to this article by Dr. Mercola – Constipation Emergencies are on the Rise, “there was a 42 percent increase in ER visits for constipation in the US between 2006 and 2011.” If chronic constipation goes on for a long time, it could leads to a blockage, also known as fecal impaction.
Not everyone agrees on the definition of constipation – some experts say as long as you “go” 3 times a week, you are fine. But most natural & holistic health practitioners say anything less than 1 daily movement is constipation. You should look before you flush, because another way to identify constipation is by the quality of the stool – even if you are passing stool – if they are hard, little pebbles – it is considered constipation. (see below Bristol stool chart). Another consideration is when you are not completely emtpying the bowel – incomplete evacuations are another sign of constipation. Also – if someone has to strain every time they go in order to pass the stool – this is another sign of constipation. The ideal situation is to have at least one complete evacuation of the bowel daily with a type 3 or 4 bowel movement on the Bristol Stool chart – which is a smooth and easy to pass stool. Some people may pass more than 1 daily.
Chronic constipation can be caused by a long list of issues including:
For constipation sufferers – the tasteless and odorless over the counter medication Miralax seemed to offer an easy solution to the problem – just stir it into a glass of water or juice, and drink it down – problem solved, right? Not so fast…although doctors have been recommending it as a safe solution for constipation in kids for years, prescribing Miralax is not FDA approved for use in children, so giving it to kids is an “off-label” use. And giving it to anyone for longer than a week is also off label. Miralax’s label – says that it is for use in people age 17 and over, and not for more than 7 days (without a doctor’s orders).
The research on the long-term safety of propylene glycol (PEG) use in kids is limited at best. And there have been concerns regarding the safty of Miralax’s use in children for several years. According to the NY Times, “the Empire State Consumer Project, a New York consumer group, sent a citizen petition to the F.D.A. on behalf of parents concerned about the increase in so-called adverse events related to PEG that health professionals and consumers have reported to the F.D.A. over the past decade.” According to this NY Times article, tests conducted by the F.D.A. in 2008 on eight batches of Miralax, found tiny amounts of ethylene glycol (EG) and diethylene glycol (DEG) in all of the samples – which are ingredients in antifreeze. Despite being conducted in 2008, the results of the tests were not disclosed to the public. The article also said that taking Miralax for long periods of time could lead to developing “acidic blood.”
Since the start of 2017, a growing number of parents have come forward complaining of a myriad of psychological, behavorial, and neurological symptoms that they have been linked to the active ingredient propylene glycol (PEG) found in Miralax and some other laxatives – these side effect include tics, stuttering, anger/aggression, depression, anxiety, memory issues, obsessive-compulsive behavior, and more. There is a Facebook group called Parents Against Miralax that has grown from about 2,000 to over 18,000 members in just a few weeks time.
Many doctors are still recommending it as a safe option, while others are questioning the safety. “Every pediatric GI physician, I would guarantee you, has told a family this is a safe product,” said Dr. Kent C. Williams, a gastroenterologist at Nationwide Children’s Hospital in Columbus, Ohio. Now, he worries, “it may not be true.” According to the NY Times, “Scrutiny for Laxatives as a Childhood Remedy.”
Many kids and families have been using Miralax without being told of the potential risks, and having never been offered any natural alternatives to try first. Now with the possible side effect concerns – a lot of parents are scrambling to find a safe & natural alternative to Miralax – that works.
The good news is there are lots of natural alternatives that are safe, effective, and offer lots of positive health benefits.
Note: Do not expect constipation to resolve overnight – take your time and implement changes very slowly and gradually to allow the body to adjust. Any major changes made to the diet or with supplements are best done on the weekend when the child is not rushing out of the house, and can be near a toilet in case they happen to get loose stools, and home relaxing in case there is any discomfort, gas, or bloating. Kids under the age of 4, or with a medical conditions (such as kidney disease), or currently taking medications – should speak to their pediatrician or specialist before implementing any of the below suggestion. The content of this article is not to be construed as medical advice. – all information provided in this article is general and not specific to individuals. Contact your doctor or specialist with any questions about how this information pertains to you, your child.
Studies show that most kids are not replenishing enough fluids each day, making them chronically dehydrated. Without proper hydration, the stools can become hard and difficult to pass (Type 1 and 2 on the Bristol chart). Overtime this situation can become chronic constipation. Just correcting hydration alone can potentially solve the constipation problem for certain kids!
When constipation is chronic, going on an allergy elimination diet is a very good idea. Undiagnosed food allergies or sensitivities can cause inflammation, digestive troubles, problems absorbing nutrients, and constipation. It is also important to discover a food sensitivity because they can lead to damage in the small intestine, and many other very serious health issues overtime. I generally recommend keeping a food journal for a few days before starting the elimination diet, during the elimination period, and after. Download this Food Mood Journal for free.
Almost any intolerance to a food could cause constipation, two of the most common culprits are dairy and gluten:
Test – Don’t want to do an elimation diet, or would rather just test? A food intolerance panel can be run to identify food intolerances as well – such as the ALCAT test.
Cutting back on sugary and processed or “enriched” foods will not only benefit digestion – but it will benefit weight, energy, and overall health too. Processed foods lack enzymes, fiber and nutrients. Diets that are highly processed and sugary not only can lead to constipation, but can also lead to inflammation in the gut and an overgrowth of candida, which is a yeast. Also – the more sweet foods a child eats, the less they will enjoy unsweetened foods like vegetables, so getting rid of the sugar for a little while helps to reset the taste buds and metabolism. High sugar consumption also raises our triglycerides, blood sugar, and increases our risk of many diseases. Read: 20 Reasons to Break up with Sugar to learn more.
Increasing foods that are naturally rich in fiber, vitamins and minerals like fruits and vegetables will help to get the digestion moving better. Some particularly good foods for constipation include: prunes and other dried fruits, pears, kiwis, blueberries, cooked beets, cooked sweet potatoes, cooked oatmeal, and (well hydrated) chia seeds.
If you want to get “things” moving – get moving!! Exercise is really important for overall health and digestion. Kids have more reasons than ever to be sedentary – lots of screentime, homework, etc. Kids who are not out being active can suffer from sluggish digestion. In addition to promoting regularity, exercise also benefits our mood, weight, energy, and sleep. So turn off the screens and get moving!
Healthy fats help to lubricate the colon and keep things moving. My favorite fat for constipation is coconut oil. It is antiviral, antibacterial – so it will help to improve the bacterial balance in the colon, and it also does not require bile salts for digstion – so those with a sluggish gallbladder will still be able to digest it well. It is also metabolism-boosting and easily converted into energy. Any adult that has tried a Bulletproof coffee (which has 1-2 Tablespoons of coconut oil, plus 1-2 Tablespoons of grass fed butter in it) can attest to the fact that eating a lot of coconut oil and butter can make you “go!” Other healthy fats that benefit digestion and metabolism include grass fed butter, flax oil (not for cooking), olive oil, and avocado oil.
Some ways to get coconut oil into the diet are – adding it to smoothies, stir into oatmeal, cook with it, and making these “coconut oil chocolates”:
It is important to make sure your child has enough time each morning to sit and relax on the potty before going off to school. Even if you have to wake them up earlier in the morning – make sure they have plenty of time after breakfast to sit on the potty. Morning is one of the most optimal times to have a bowel movement. Sometimes kids will “hold it” at school, traveling, or if they are out in public. Some teachers might restrict bathroom breaks, to limit disruptions to the school day. If your child suffers from urinary tract, constipation or digestive troubles; make sure to inform the teacher so he knows to not to restrict your child’s access to the bathroom. If the teacher does not agree, bring your issue to the principal, there is a disabilities act that prevents kids who have continence issues from being restricted from using the bathroom.
The modern toilet is not designed to put our bodies into the ideal position for moving our bowels. Raising the feet up onto a stool or a Squatty Potty can be very helpful in getting the anatomy in the right position to make a bowel movement. Especially little kids whose feet don’t even reach the ground – they need a little support. The Squatty Potty comes in two sizes, to fit the individual just right and get them into the right squatting position for optimal bowel movements. It also stores neatly under the toilet when not in use. If you don’t want to invest in a Squatty Potty – you could stack up some books, or use a little step stool – but once you do – you will see how great it is to get in the right position and you will want the Squatty Potty – because it can be washed clean, and fits perfectly next to the potty. As they say “try the stool for your stools!”
Too much calcium and not enough magnesium can lead to constipation (it also has been linked to increased risk of heart attack, due to calcifications of the arteries). As many as 70% of Americans are deficient in magnesium. This can result in constipation, headaches, sore muscles, nerve troubles, restless legs, nervousness, and even increased fractures. Taking magnesium before bedtime is helpful with constipation. For some kids, taking magnesium before school is also helpful – as magnesium is called “the calming mineral’ – so it can help them to be calm in school.
Seek out foods that are rich in magnesium – like dark leafy greens, nuts, and seeds. If you are craving chocolate, it could be your body telling you that you need magnesium, because cacao (the main ingredient in chocolate) is one of the highest known food sources for magnesium. Most people also will benefit from taking a magnesium supplements, such as Natural Calm (for ages 4 and up). Magnesium can also be absorbed via the skin by soaking in an epsom or Dead Sea salt bath – I particularly like this brand Dead Sea Warehouse‘s salt bath product – it is very high quality and affordable. Another option is using magnesium oils – which can be applied topically.
If your bowels are feeling sluggish, vitamin C supplements can be a wonderful way to get the bowels moving. Chewing one or two of these vitamin C gummies on an empty stomach in the morning, might just be what is needed to produce a bowel movement (BM). – they are 125 mg each. For older kids, you might want to find a capsule, powder, or liquid vitamin C with 500 mg./serving. Vitamin C (like magnesium) can be taken to bowel tolerance* (the amount needed to produce a BM). If the stool is loose*, just take less vitamin C. If the vitamin C bothers the tummy – look for a buffered brand, or take with food (it will have less of an effect of moving the bowels however if taken with food). If tummy upset occurs from taking vitamin C, 1 glass of water with a 1/2 teaspoon of baking soda mixed in might help reduce the acidity of the vitamin C. Learn more here: vitamin c for constipation.
* Taking too much magnesium or vitamin C can lead to diarrhea, so you want to gradually increase it over several days. If diarhea does occur – make sure to give your child an electrolyte replenisher and fluids – I like Scratch Labs electrolyte replenisher packets, or Nuun tablets. Make sure to back off and take less magnesium and vitamin C if this does occur.
Most Americans do not get nearly the amount of fiber they need each day. There are 2 types of fiber – soluble and insoluble. Soluble dissolves in water, creating a gel. Insoluble fiber passes through undigested, so it adds bulk. Adding too much fiber to the diet too quickly is not a good idea – it can cause discomfort, and can even make the constipation worse, especially if fluids are not increased along with the added fiber. So make sure to drink extra liquids as well when increasing dietary fiber, especially soluble fiber because it needs to soak up water in order to work. Adding in too much fiber, too fast, without enough fluids could not only cause discomfort, gas and bloating – it could even potentially cause a blockage – especially if there are already hard stools stuck in the colon. If a stool has not been produced within the past day, before adding in fiber to the diet – consider using an enema or suppository to make sure the colon is clean first – this will make a blockage less likely to develop from the added fiber. And remember to add the fiber in gradually.
Ideally before adding in any bulking fibers (insoluble fiber)… the bowels should have moved and be fairly cleaned out. If all of the above steps have been implemented and the bowels have not been moved. It is a good idea to do a thorough bowel “clean out.” Often, doctors will prescribe Miralax for this. But there are many other ways to achieve a clean out without Miralax. A glycerin or liquid pediatric suppository or an enema may be used at this point. If a suppository or enema is chosen, it is important for everyone to remain calm and not to appear embarrassed – the child often will mirror our behavior and attitude, and if they are tense – it can make it more uncomfortable. Using a little coconut oil as lubrication can make it significantly more comfortable. (Read: How to give a child an enema in 5 Steps).
Approximately how much fiber should my child get each day? It can vary from person to person – but a general guideline for kids ages 3-18 is to add the number 5 to your child’s age, and in general, that is the number of grams of fiber they need daily – so an average 11 year old, should have about 16 grams of fiber per day. A 6 year old needs about 11 grams. Recommednations for an average adult are to get about 25 grams each day. But again – this can very from person to person. Through experiementation – find what works for you and your child – and try to have a balance of soluble and insoluble fibers.
Some good fiber sources:
We need to balance out the bacteria in our gut – probiotics boosts the good bacteria, which is very important for healthy digestion, a balanced weight, and a strong immune system. Fermented and cultured foods and drinks such as kefir and yogurts can provide natural probiotics, or you can add a probiotic supplement to the daily routine. Prebiotics are also helpful – because they are food for the probiotics. Prebiotics are founnd in certain fibrous foods, and supplements.
There are instances when taking probiotics or prebiotics may not be a good idea – at least initially. If someone has Small Intestinal Bacterial Overgrowth (SIBO), that means that there is bacteria growing in the small intestine, this can lead to bloating and distention when carbohydrates are eaten. If you suspect that your child may have SIBO ( gas, bloating after eating carbs), then you might want to seek out a SIBO specialist to have them evaluated and treated – they may or may not think probiotics are a good idea. Once the SIBO is resolved, probiotics may or may not be appropriate for repopulating the gut to prevent further dysbiosis. Some of the supplements mentioned above have probiotics and prebiotics
Read The Importance of Good Bacteria to learn more.
The body naturally produces hydrochloric acid (HcL) and enzymes to digest foods, which are needed to break food down for absorption and digestion. If we are low on stomach acid or enzymes, food may not get properly broken down for digestion, so it will be harder to pass through the digestive tract, and also the body will absorb less of the nutrients. If you suffer from acid reflux, you might think that you need to reduce the acid in your stomach. But usually, it means you do not have enough acid or enzymes.
Constipation can stem from issues with motility. When the migrating motor complex or the vagus nerve re not working optimally – this can lead to slow motility. If that is the case, stimulating the vagus nerve can help to get things moving again. Singing, vigorous gargling, gagging, and deep breathing can stimulate the vagus nerve. Or you can use a device called Nervana – which stimualtes the vagus nerve through the ear. In addition to improving motility, stimulating the vagus nerve can help with reducing stress and anxiety, and promoting a calm feeling and good sleep.
One of my favorite ways to sneak lots of good nutrition, fiber and hydration into a glass are smoothies. Especially good for picky eaters – smoothies are a great way to sneak in healthy ingredients!
Orange Dream Smoothie:
Makes one 8 oz. smoothie
Essential oils can be very helpful for dealing with the discomfort of constipation and helping resolve digestion issues. I like a product called Digest Zen from DoTerra. Peppermint essential oil is also very helpful when there is bloating or discomfort. But please be aware that essential oils are very powerful – even one drop is powerful – so always be sure to keep them out of young children’s reach. When using topically, always use a carrier oil (coconut works wonderfully). You can put a tablespoon of coconut oil into a little container – and add a few drops of essential oil like Dgest Zen – and then rub that on the belly as needed. You could also order or make your own DigestZen rollerball that has the carrier oil in it. Another topical remedy to consider is castor oil. Just rub a little castor oil on the right side of the abdomen (this is the liver area) before bedtime.
Realize that digestion issues may take a while to resolve, and it might be a good idea to slowly ease into the changes. If the constipation and digestion issues continue to persist, it might be prudent to schedule an appointment with a holistic or integrative practitioner to see if there is an underlying issue that needs to be addressed – such as an infection, parasites, SIBO, or another issue.
And just remember that if allowed to go on for a long time or get severe, constipation can become a medical emergency. According to this article by Dr. Mercola – Constipation Emergencies are on the Rise, “there was a 42 percent increase in ER visits for constipation in the US between 2006 and 2011.” If chronic constipation goes on for a long time, it could leads to a blockage, also known as fecal impaction. Or in rare very severe cases – constipation that has gone on too long – could lead to sepsis, a very dangerous infection. So it is important to not allow a child to go more than a a few days without eliminating – you may need to use an enema or a glycerin suppository to prevent a blockage if a child has gone more than a couple days without having a BM, and is getting very uncomfortable, is not eating well, and is not able to produce a stool on his/her own. If this is happening – please seek medical attention right away/have your child evalated by a gastroenterologist or pediatrician.
* Please note: the content in this article is for children ages 4 and up, and without any kidney disorder. This content is not to be construed as providing medical advice. All information provided in this article is general and not specific to individuals. Persons experiencing problems or with questions about their health or medications, should consult their medical professional. Persons should carefully read the labels of all foods and supplements, and those who are taking prescription medications should consult a doctor before taking the above foods, herbs, vitamins or supplements to be sure there are no interactions. Linked articles are provided for further resources and information and should not be construed as medical advice.
Drug for Adults Is Popular as Children’s Remedy – Previous title for this article was: “Miralax – a popular cure but never approved for children”
Article written by Nutritionist Sara Vance, author of the book The Perfect Metabolism Plan A regular guest on Fox 5 San Diego, you can see many of Sara’s segments on her media page. She also offers corporate nutrition, school programs, consultations, and affordable online eCourses. Download her free 40+ page Metabolism Jumpstart eBook here.
©2015, all rights reserved. Sara Vance.
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