Constipation Matters (Part 2): Prevention Tips for Toddlers


Constipation Prevention Tips –

To prevent constipation in adults, the 3 ‘Fs’ are usually recommended: Fluids, Fiber and Frequent Exercise/Activity. Well, it’s the same for babies and toddlers as well. Some time ago, I had posted an entry on some tips for combating constipation in babies (see post Constipation Matters (Part 1): Prevention Tips for Babies). Here is the follow on post with more tips for toddlers:

Even if a toddler is already established and used to drinking water, as a parent you can still encourage frequent water intake by offering fluids at meals, water with snacks and making sure water is readily accessible with a water bottle or cup at hand in the play area at all times. The toddler will then know that there is always water available when she wants or needs it, and can regulate his/her own intake. Some days I go into the play area and see the water cup untouched and other days a third or more of the water in the sippy cup (non-spill of course) gone within a few hours! So it is really difficult to predict when or how much your toddler will want to drink on any given day. But reminders to drink water throughout the day and role modeling lots of water drinking yourself definitely helps! Sometimes I also have little water drinking competitions with my daughter, to see who can finish a cup of water faster. She enjoys this but of course you need to make sure she doesn’t drink so fast she chokes on the water!

Some recommend not giving a toddler too much bran and bran containing foods as the high fiber content may possibly fill the child up more and make the child less hungry for other foods, compromising his/her nutritional intake. Personally I don’t think this is true. When my toddler was 17 month old, she ate Shredded Wheat squares, Total Cereal flakes, brown rice, whole wheat pasta and whole wheat bread, and still had room for foods like milk, fruits and vegetables. So I think it is safe to switch completely to whole grain products and breakfast cereals. The key I find is to watch the amount of crackers and Cheerios a child can get at snacks as well as his/her overall milk intake during the day, as these have a greater likelihood of filling the child up and making him/her less hungry to eat properly at meals. In fact, at around 15 months of age, I cut out giving milk at snacks (but I still give 3-4 ounces at meals) as I found that it was affecting her intake at lunch and dinner. Don’t forget that fiber comes from providing lots of fruits and vegetables into the diet too. These can be fresh, frozen or dried (examples are dried figs, raisins and apricots). Just ensure your toddler has a higher fiber intake with an intake of plenty of water!

Frequent Movement/Activity
I don’t think parents need to worry about this one! It’s probably more about how to restrain excessive activity and movement…Toddlers with their newfound freedom and independence love to move and explore on two feet the surrounding environment, not to mention climb, crawl, dance and play. So let them!


Constipation Matters (Part 1): Prevention Tips for Babies



If you ask me, I think babies have a tougher time dealing with constipation than toddlers. For one, they can’t really tell you what’s wrong apart from wailing, while a toddler at least (for the most part) can communicate a bit better about what’s going on. And I think parents have an easier time dealing with constipation in a toddler than in a baby. It’s much easier to get a toddler to drink more fluid or to be more active. But it’s tougher to get a baby that can’t even crawl or sit up yet to move more. Note though that babies often strain, get red in the face and cry when trying to pass a stool, but this does not necessarily mean the baby is having constipation.

To prevent constipation in adults, the 3 ‘Fs’ are usually recommended: Fluids, Fiber and Frequent Exercise/Activity. Well, it’s the same for babies and toddlers as well.

In general breastfed babies tend to get plenty of fluid (think of the more watery portion of the breast m
ilk at the beginning of a breastfeed session) and are seldom constipated. However be aware that depending on age, breastfed babies tend to have a wide variety of normal stooling patterns (from a few times a day to once a week!). While formula fed babies may be more regular (e.g., once a day or so), they may experience slightly thicker and firmer stools, so offer water in a bottle regularly in between formula bottle feeds.

Starting at 9-10 months of age, offer your baby a free flow sippy cup of water with meals and at frequent intervals throughout the day. This way, he/she will not only get used to the taste of water, but will also get used to drinking it often in the course of a day. This shouldn’t affect your breastfeeding, but if you’re worried, you can offer the water after a breastfeeding session instead of right before it.

Once baby starts solids, you can begin to add some fiber into your baby’s diet. Some have said that baby rice cereal can be constipating, and this can be true if you offer your baby a lot of baby rice cereal daily since there’s hardly any fiber in it. So instead of only offering baby rice cereal, you can focus on offering more pureed fruits and vegetables like butternut squash, avocado, and mango as first foods to your little one. However, you may have to increase the fiber content in your baby’s diet gradually as some babies have digestive systems that need a little bit more time to get comfortable handling a higher fiber load.

Frequent Movement/Activity
This may be a bit more trickier for babies, especially if they are young and haven’t even learned to lift up their heads yet! But you can still employ ‘baby massage’ techniques to help relax baby’s body and possibly help move down gas and stool in the digestive tract. Taking baby’s legs and doing some ‘cycling/bicycling’ motions a few times a day could help too. But don’t worry, all too soon, baby will sitting and crawling, and then pulling up to a stand. Getting active is something that will come naturally and instinctively!

Qn of the Month: Help! Baby May Be Constipated…What Can I Do?

First, what is considered constipation? According to the American Academy of Pediatrics (AAP), a baby is more likely to be having constipation if he/she displays the following signs and symptoms: being excessively fussy; spitting up more; unusually hard stools or stools containing blood; a big difference in bowel habits or bowel patterns; straining for more than 10 minutes without success.

Before I talk about some strategies that may help, I want to mention two key points. First, while many babies may follow the ‘book’ in terms of stooling and wet diaper patterns, this may not always be the case for some babies. For breastfed babies, especially, there can be a wide range of normal, with baseline stooling patterns varying from a few times a day to some only going once a week. This is fine, as long as feeding is not affected, and the baby does not seem bothered. Second, prevention (fluids, fiber and frequent movement) is easier and still better than treatment. For more on that, see some upcoming posts dealing with this topic.

Now here are a few simple strategies that may help your little one:

  • Food: If your baby has started on solids, you can try mixing in a bit of home or commercially prepared prune puree or a tiny bit of diluted prune, pear or orange juice into your baby’s food
  • Fluids: For an older baby, you could offer fluids like water more frequently during the day (in between breast or formula feeds). For a younger baby, you could offer some water after a breastfeed, so as not to impact the breastfeeding, as well as add a bit more liquid (expressed breast milk, formula or water) into his/her solids. Just make sure that you don’t compromise the texture too much. It is still important to make the texture appropriate to your baby’s age and abilities, so that it won’t be a choking risk.
  • Movement: A bit of bicycling/cycling motion with the legs (with baby on his/her back and facing up) a few times a day can always help!
  • If medicine is really needed, the doctor may prescribe something like lactulose. Don’t worry, lactulose mainly works by just helping to draw water into the gut to help with softening and moving the stools along baby’s gastrointestinal tract.

Lastly, I just want to mention that some bowel pattern changes are normal. For example, over time as my little one got older and began to eat more solids, her stooling also gradually changed. At first it was a few times a day, then there was a transition period with the introduction of solids, so that it eventually became once a day, or once every other day. As she started to eat more, of course the quantity was also a lot more (and as my husband would say, “More pungent!”). And let’s not forget that teething is another factor, often making stools looser/more frequent during those periods!