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Constipation, Kids & How Prebiotic Fibre Can Help

Dealing with childhood constipation is tough – for both parents and the kids themselves.  Understanding a little more about it can help.

If your child suffers from constipation it is all consuming, the stress and anxiety at toilet times can be overwhelming.  Then there is dealing with the little accidents and managing expectations of what you can do as a family and what they can do with friends due to the limitations of the condition.  It can be so difficult – all you wish for is that you and they could be happy and free from the constant, ongoing pressure that constipation brings.

The first thing to know is that you are not alone, so many kids and families are going through this and are there to help.  The second thing is that there are a multitude of different options to consider in terms of how you manage the condition – one of which is through managing diet.

constipation in context

CONSTIPATION IN NUMBERS

Childhood constipation is relatively common – it’s just not necessarily openly talked about.  It’s highly likely someonw you know is going through the same issues, you just don’t know it.

According to NICE (National Institute for Health and Care & Excellence), In the UK, 30% of children aged 4–11 years will have constipation lasting less than 6 months, and 5% will have constipation lasting more than 6 months.  Peak incidence of constipation is at the time of toilet training (typically around 2–3 years of age) [Afzal, 2011] although it can occur with kids of all ages.

It accounts for 3–5% of general paediatric consultations [Mutyala, 2020] and more specifically 10–25% of paediatric gastroenterology referrals.

It’s also believed that many instances of constipation are not reported parents don’t realise what they are dealing with.  Given how common it is  it’s surprising that the definition of constipation isn’t clearer, particularly when it comes to soiling.  It’s also serious, untreated it can have social, psychological and educational consequences that require prolonged support.

The message is clear – constipation is very common in children, it affects 1 in 3 children, even babies. Don’t wait for it to get better by itself. TAKE ACTION!

CONSTIPATION DEFINITION

Constipation is a reduction in the frequency of bowel movements, often characterised by the passing of large, hard stools resulting in straining and pain.

Normal frequency of bowel movements in children ranges from an average of four per day when first born to two per day at 1 year of age. Passing between three stools per day and three per week is usual by around 4 years of age.

The NHS have a very clear definition of constipation; essentially if two or more of the following clinical features are present it indicates that a child is constipated:

  • Less than three stools per week (unless exclusively breastfed, as this can reduce frequency).
  • Hard, large stool.
  • ‘Rabbit droppings’ stool.
  • Overflow soiling in children older than 1 year of age (commonly very loose, smelly stools, which are passed without sensation or awareness).

The Troo version of the Bristol Stool Chart can help understand the various stool types and is especially suitable for children.  You can download this by clicking on the chart opposite.

how to treat constipation

ERIC, the Children’s Bowel & Bladder Charity has lots of helpful information, including their recommendation for how to treat constipation:

  • Keep a Poo Diary for 2 weeks: what it looks like, how much, where it goes.
  • See your GP: Take the poo diary and tell them all your child’s symptoms.
  • The GP should examine your child and ask questions to find out if the constipation could be caused by an underlying condition.
  • The GP should prescribe a macrogol laxative like Movicol, Laxido or CosmoCol which softens poo and helps move it along (as per NICE Guidelines). 

In addition to this we would highly recommend incorporating the natural ways to improve bowel health (detailed below) into your treatment plan.  ERIC also has some good advice on taking laxatives:

  • The macrogol must be mixed with the right amount of water first, but then other food/drink can be added – read: How to prepare macrogol laxatives.
  • Most children start with disimpaction – this means taking lots of medicine to clear out the backlog of poo – read: A Parent’s Guide to Disimpaction.
  • When the bowel is clear they will need to keep taking a smaller dose each day to keep their poo soft and moving along.
  • Your child might need to stay on laxatives for a long time, but don’t worry, laxatives won’t hurt them. However, in the long term, undertreating constipation will.

We do highly recommend visiting the ERIC  website as they have really helpful resources – we love their guide to helping get a poo in the loo and couldn’t resist including it here!

ERIC GUIDE TO GETTING A POO IN THE LOO

  • Get there at the right time – 20 to 30 minutes after meals and before bed.
  • Sit in the right way – feet flat and firmly supported on a box or stool, knees above hips.
  • Secure sitting position – they might need a children’s toilet seat.
  • RELAX to let the poo out. So keep toys, games and books beside the toilet.

TRY TO MAKE EACH TOILET SIT ‘ACTIVE’ BY ALTERNATING PLAY ACTIVITIES AND EXERCISES:

  • Massaging the tummy in clockwise circles, and rocking forwards and backwards on the toilet can really help.
  • Laugh/cough/blow to help push down with the tummy muscles.
  • Make it a fun time! Look at ERIC’s Toileting Reward Chart for more ideas to motivate your child. A 10 – 15 minute toilet sit should be long enough.

natural ways to improve bowel health

Taking advice from your GP and/or Health Professional is always advised; but there are other, more natural, complementary options to consider to improve a child’s bowel movements in both the short and longer term.

 The 4 key things actions that can help are:

  1. Eating enough FIBRE
  2. Eating enough vegetables and fruit
  3. Drinking enough water
  4. Moving around (especially when it’s near toilet time)

EATING ENOUGH FIBRE

According to the NHS, Kids under the age of 16 don’t need as much fibre in their diet as older teenagers and adults, but they still need more than they get currently:

  • 2 to 5 year-olds: need about 15g of fibre a day
  • 5 to 11 year-olds: need about 20g
  • 11 to 16 year-olds: need about 25g

To put this into context Troo Spoonful of Fibre has 8g of fibre in 2 teaspoons; Troo Porridge+ has over 8g of fibre in a 50g bowl (2x as much as standard porridge).  An apple has 2.4g fibre whilst there is 1.9g fibre in a slice of wholemeal bread.

EATING ENOUGH VEGETABLES & FRUIT

Vegetables in particular are a fantastic source of fibre as well as other vital vitamins and minerals, but they are seldom at the top of a kid’s favourite foods.  Try to make vegetable fun and keep putting them on the plate until they become expected (even if they are not always all eaten).  Don’t be ashamed of hiding vegetables in sauces and soups – make a huge pot of tomato-based soup with tonnes of hidden vegetables on a Sunday (carrots, aubergine, courgettes, celery) and then use this as a base for Spaghetti Bolognaise or Chilli later in the week.  Stirring in a couple of spoons of  Troo Spoonful of Fibre adds a gentle sweetness, a luxurious smoothness and LOADS of fibre.

Fruit is good too – but is not as vital as the veg.  Fruit that is higher in fibre includes strawberries, raspberries, green bananas and passion fruit.

DRINKING ENOUGH WATER

Lots of things impact on how much liquid a child needs to drink  – age and gender as well as weather, physical activity and diet (especially if they are increasing fibre consumption).

However a rough guide is that children aged 4 to 13 should aim to drink approximately 6-8 glasses of fluid a day, with younger children needing a bit less (e.g. 150ml glass for a 4-year-old and 250ml for an older child).  Water is the best choice, but a little natural cordial or a herbal tea or your choice of milk (dairy or plant based) counts too.

MOVING AROUND

Movement usually comes natural to children, but is especially important for kids with bowel issues particularly in the time after a meal and before going to the loo.  We’re not talking about an exercise class here, maybe a quick game of chase, a walk outside for some fresh air or even a few minutes with a hula hoop can do the trick.  As well as encouraging the bowel movement, it can also help the child focus and stop them getting distracted when it comes to toilet time.

how can troo help?

Delicious Troo cereals and syrups are packed with fibre (including prebiotic fibre), much more than standard cereals and syrups that you find in the supermarkets.  But that’s not all – the ingredients in Troo have been scientifically proven to help with constipation.  The research is so strong that the European Food Safety Agency (EFSA) have authorised products including these ingredients to say:

  • THE PRODUCTS CONTRIBUTE TO NORMAL BOWEL FUNCTION BY INCREASING STOOL FREQUENCY
  • THE PRODUCTS CONTRIBUTE TO AN INCREASE IN FAECAL BULK WHICH IMPROVES BOWEL FUNCTION
  • THE PRODUCTS HELP IMPROVE GUT HEALTH

We are really proud that our products have rigorous science to prove their effectiveness. 

There are specific studies that have shown the effectiveness of the chicory fibre (inulin) in helping kids with constipation as well as boosting their overall gut health and health & wellbeing. 

University Hospital Sant Joan de Reus Constipation Study

Researchers from the University Hospital Sant Joan de Reus in Spain undertook a study with children aged 2–5 who had 2 g of chicory inulin twice daily or a placebo (maltodextrin), stirred into yogurt or soft cheese over a six-week period.   They discovered that the chicory root fibre softened the stools of the constipated children and was as well tolerated as the placebo.

Prebiotic Fibre, Gut Health & Immunity

Chicory inulin can also do more than just improve bowel function – as it is a prebiotic fibre it has an important role in nourishing the gut bacteria, promoting the growth of bifidobacteria in kids which brings with it all kinds of additional health benefits.

For example a Research Study undertaken at the University of Pécs, Hungary uncovered that giving kids aged 3-6 6g of chicory inulin daily (like that found in Troo cereals & syrups) during winter time reduced high fevers requiring medical attention and lowered  incidences of sinusitis.  The kids taking the prebiotic fibre had more immunity-boosting bifidobacteria in their microbiome.  6g of chicory inulin can be found in one teaspoon of Troo Spoonful of Fibre or one bowl of Troo Porridge+ / Troo Granola+.

Troo FAQ's

The chicory inulin (prebiotic fibre) in Troo has been scientifically proven to help increase the frequency of bowel movements of children.  It also helps to soften stools making them easier to pass.

The oat fibre found in Troo Porridge and Granola also helps to increase faecal bulk which helps reduce constipation.

Troo Spoonful of Fibre, Troo Porridge+ and Troo Granola+ can all help with constipation.

We always say start off slowly when adding fibre to a diet and this is specially important for children.

For Troo Spoonful of Fibre, start off with a couple of grams, that's a quarter of a teaspoon.  Work up to a teaspoon per day.

For Troo Porridge and Granola we'd recommend starting on a small bowl, say 25-30g and working up from there.

Buy from the Troo shop at eattroo.com.

You can also buy Troo in Holland & Barrett, Booths, Waitrose and Amazon and other small health stores across the UK and Ireland.

Our fibre syrup is water soluble and heat stable.  This means you can add it to hot and cold food and drink.  You can add it to a milkshake, smoothie or hot chocolate.  Drizzle it on porridge, yoghurt or ice cream.  Spread it on toast or crumpets.  Add it to soups or sauces.  You can even eat it off the spoon.

You can find recipes here.

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