Childhood Constipation and Chemical Laxatives for Children
Many kids suffer from constipation. Thankfully, it’s usually temporary. Making a few changes to their diet and bathroom routine often helps them get back into a more comfortable rhythm, without having to resort to chemical laxatives. As Hippocrates said, “Let food be thy medicine and medicine be thy food.”
What is constipation?
We all have our own unique bowel habits. What’s normal for one child may not be the same for another. You know your kids best, but in general constipation is defined by having:
- Fewer than three bowel movements each week
- Hard and/or dry stools
- Unusually large or difficult-to-pass stools
Many kids struggling with constipation will complain about tummy aches. Some might even have bloating, fever or vomiting. And, it’s not uncommon for kids with constipation to soil their underwear with bits of poo.
What causes constipation?
Constipation is caused when waste moving down the digestive tract doesn’t get enough water to remain soft, or when the lower intestinal muscles aren’t doing their job to move the waste down and out.
If your child struggles with constipation, it’s important to remedy the situation quickly because constipation may become a self-perpetuating problem. Kids tend to hold in hard stool because it’s uncomfortable to pass. The longer the poo remains inside, the harder it becomes, making it even more painful to pass. And the longer the large stool stretches the lower intestine, the weaker these muscles become.
Many kids develop constipation from not getting enough fluids or fiber in their diet. Remember, we’re all unique individuals. What is ‘enough’ for one child may not be ‘enough’ for another. Other times, an imbalanced microbiome may be to blame. Every day we’re learning more about the role our gut bacteria plays on overall wellness. Sometimes, the cause is emotional.When some toddlers and school-agers become stressed or upset, their intestines may pay the price. This can result in either diarrhea or constipation. New foods or milk may also cause constipation, especially in infants.
If your child is struggling with constipation, it’s important to address all the possible reasons and take the appropriate steps to get your little one pooping regularly again.
Chemical laxatives for kids
I’m receiving many questions about using chemical laxatives in children. Products such as Miralax (polyethylene glycol or generic Glycolax) are often used “off-label” to help kids struggling with constipation. Some parents are being told to give their children these chemical laxatives for weeks or months at a time even though the label says for ages 17 and up, and not for use for more than 7 days at a time. No wonder parents have questions!
“Off-label” means the drug isn’t approved for this particular use. This is actually quite common in medicine. Most of the time, there is no problem, and after further testing and experience, the medication becomes approved. Of course, that isn’t always the case.
I seldom use chemical laxatives to treat constipation. I’m not comfortable using it off-label. This doesn’t mean it’s not safe. It just means that I haven’t used it enough to be comfortable. If your doctor is confident with it, and you trust him/her, then go with that. But keep in mind that chemical laxatives are simply drugs addressing the symptoms, and not the cause of the constipation. I prefer to suggest diet and lifestyle changes.
Osmotic laxatives, such as Miralax and Milk of Magnesia, work by pulling water into the stool, making it easier to pass. Overuse of these laxatives may reduce or weaken the intestine’s ability to contract. This may make their constipation worse or cause dependence, meaning there’s a chance your child may become reliant on the medication to have bowel movements. Overuse may also cause dehydration, diarrhea and an electrolyte imbalance.
What should parents do to help their child with constipation?
Try to solve the issue by getting to the root cause of the problem. Consider making these changes before resorting to chemical laxatives.
- Provide more water or fluids. Give your child an extra 2 or 3 glasses of water each day. If they’re not water-lovers, add a little juice (¼ juice, ¾ water) for natural flavoring.
- Choose high-fiber foods. Fiber helps strengthen bowel function, but most kids (and adults) don’t get enough in their diet. In fact, most kids only get about half of the fiber that is recommended. Include more fresh fruits, vegetables, nuts and beans in your child’s diet. Add 5 to your child’s age to get their minimum recommended daily fiber intake. Adding 10 is even better. In other words, a 6- year-old should consume 11 to 16 grams of fiber daily, and a 13-year-old should have at least 18 to 23 grams.
- Supplement with fiber. Getting enough prebiotic soluble fiber, even with the most nutritious diet, is a challenge so this is one area where a supplement is smart. Just choose your brand carefully because some can cause gas, cramping and bloating. We recommend Sunfiber (also found in Regular Girl) because it’s gentle on bellies. It soothes both occasional constipation and occasional diarrhea without any excess gas or bloating. Plus, it mixes invisibly into most drinks and foods. Picky eaters won’t even know it’s there!
- Include natural laxatives daily. Apricots and the four P’s – prunes, pears, plums, and peaches – usually exert a laxative effect. Eat strained prunes on high-fiber crackers and drink pear and apricot nectar daily. This smoothie is also a great option.
- Avoid caffeine-containing foods and beverages, such as chocolates, colas and energy drinks. Caffeine is a stimulant, so it can encourage a bowel movement. But it may also lead to dehydration, having the opposite effect.
- Encourage more exercise. Walk, run, skip, dance and jump with your kids. Moving can help stimulate the bowels.
- Tell your kids to peek and tell. Teach your kids to look in the toilet bowl before they flush, and to let you know if things aren’t quite right. This handy kid-friendly poo chart can help you start the conversation.
- Relax! Help your child associate bathroom time with something positive so they don’t worry and inhibit the process. Sing silly songs or play a little game. Kids are more likely to poo when relaxed.
Like many pediatricians, I have spent countless hours discussing gut concerns with parents, from what goes in the top (food) to what comes out the bottom (poo). I’ve written a book sharing what I’ve learned, both in the clinic and with my own children and grandchildren. Dr. Poo, The Scoop on Comfortable Poop provides more tips on managing constipation and other digestive issues in children.
Dr. Bill Sears
Dr. Sears, or Dr. Bill as his “little patients” call him, has been advising busy parents on how to raise healthier families for over 40 years. He received his medical training at Harvard Medical School’s Children’s Hospital in Boston and The Hospital for Sick Children in Toronto, the world’s largest children’s hospital, where he was associate ward chief of the newborn intensive care unit before serving as the chief of pediatrics at Toronto Western Hospital, a teaching hospital of the University of Toronto. He has served as a professor of pediatrics at the University of Toronto, University of South Carolina, University of Southern California School of Medicine, and University of California: Irvine. As a father of 8 children, he coached Little League sports for 20 years, and together with his wife Martha has written more than 40 best-selling books and countless articles on nutrition, parenting, and healthy aging. He serves as a health consultant for magazines, TV, radio and other media, and his AskDrSears.com website is one of the most popular health and parenting sites. Dr. Sears has appeared on over 100 television programs, including 20/20, Good Morning America, Oprah, Today, The View, and Dr. Phil, and was featured on the cover of TIME Magazine in May 2012. He is noted for his science-made-simple-and-fun approach to family health.