http://yourhealth.calgaryhealthregion.ca/Topic.jsp?GUID={B47A76B8-E5B6-4B92-9DBA-C5AF7A92438B} Constipation in Toddlers 1-3 Years Content Review Date: August 2005 Printable Version / View Related Services Description Constipation is stool that is dry, hard and difficult or painful to pass. The number of times a child has a bowel movement will depend on his or her age, diet and activity level. This can vary from 2 to 3 times daily to once every 4 days. When to get help Call your doctor or go to the hospital if your toddler has dry, hard stool and any of the following: ● blood in the stool ● fever ● vomiting Causes of constipation ● low fibre intake ● low fluid intake ● low levels of physical activity ● avoiding or delaying the body's signal to have a bowel movement ● a genetic disorder that affects the digestive system ● a medical treatment or medication that slows movement in the digestive system Schedule toilet time to help manage constipation Sometimes your child may avoid going to the bathroom, which can cause a drier stool, pain, and can be the beginning of long-term constipation. Schedule a regular toilet time for your child to help him get used to going to the bathroom. You can start by asking your child to sit on the toilet for 5 to 10 minutes after every meal. Put some books in the bathroom for your child to look at while sitting on the toilet. Celebrate with your child after she has a bowel movement. Offer more fluid to help manage constipation You need to offer more fluid to your child if you are also increasing the amount of fibre he eats. If he does not get enough fluid this can actually make the constipation worse. http://yourhealth.calgaryhealthregion.ca/Topic.jsp?GUID={B47A76B8-E5B6-4B92-9DBA-C5AF7A92438B} (1 of 7)9/15/2006 6:08:13 PM http://yourhealth.calgaryhealthregion.ca/Topic.jsp?GUID={B47A76B8-E5B6-4B92-9DBA-C5AF7A92438B} An easy way to tell if your child is drinking enough fluid is to look at the colour of her urine. If it is dark yellow, you need to offer fluids more often. Tips ● Offer at least 2 cups (500 mL) of milk, yogurt drinks, or calcium and vitamin D fortified soy or rice beverages every day. ● Offer water throughout the day when your child is thirsty. ● Have your child try to finish drinking all fluids by 7:00 pm to prevent bed-wetting. Increase physical activity to help manage constipation Daily physical activity can help decrease constipation. Try to add an extra 30 minutes of physical activity to your child's day. Reduce the time she watch videos or television or play video games. Tips ● Take a walk without a stroller. ● Put some music on and dance, dance, dance! ● Take your child outside to play. ● Join or organize a play group in your community. Offer more fibre to help manage constipation Fibre is the part of cereals, breads and other whole grains, vegetables and fruit, beans and lentils that our bodies cannot digest. It is important to include fibre from a variety of foods so that your child gets the right amount of vitamins and minerals. A high fibre diet is used to help prevent and treat constipation. Fibre holds water inside the digestive system and helps soften the stool. Increase fibre slowly to help your child's body get used to eating more fibre. If your child changes too quickly to a high fibre diet he may have gas and may feel full quickly. These feelings will go away as your child gets used to more fibre. High fibre choices The following is a list of foods that can be used to slowly increase the amount of fibre your child eats. For the fibre content of some of these foods, please see "Kid friendly sources of dietary fibre" at the end of this handout. Do not force or beg your child to eat. As a parent, your responsibility is to provide nutritious food choices. Your child is responsible for what and how much she chooses to eat at meals or snacks. http://yourhealth.calgaryhealthregion.ca/Topic.jsp?GUID={B47A76B8-E5B6-4B92-9DBA-C5AF7A92438B} (2 of 7)9/15/2006 6:08:13 PM http://yourhealth.calgaryhealthregion.ca/Topic.jsp?GUID={B47A76B8-E5B6-4B92-9DBA-C5AF7A92438B} You may need to offer new foods many times before your child accepts them. Serve small portions at first (1 tbsp. or 15 mL) and allow your child to ask for more. To increase the fibre in your child's diet, it is important to include cereal fibre in addition to a variety of fruits and vegetables. Wheat bran and oat bran are the best at helping your child avoid constipation. Try to have your child eat at least 1 tbsp. (15 mL) of cereal fibre 3 times a day. Remember: Some foods can cause choking in children under 4 years old. Nuts, seeds, popcorn, raisins, raw vegetables and fruit are high-risk foods. Cook and mash hard vegetables like carrots and corn. Cut fruit into small pieces. Grain products ● whole-wheat pasta ● brown or wild rice ● whole grain breads, crackers, muffins and cookies ● bran or whole grain breakfast cereals with at least 3 grams of fibre per serving, such as 100% bran, bran flakes, Corn Bran Squares and shredded wheat ● cooked cereals such as Red River, Sunny Boy or oatmeal Note: Give 1 cup (250 mL) of fluid with each serving of cereal fibre to ensure your child is getting enough fluid. Vegetables and fruit ● green peas, sweet potato, corn, squash, broccoli and carrots ● pear with skin, prunes, dried apricots, apple with skin, orange, blueberries, raspberries and strawberries Meat and alternatives ● baked beans, refried beans, kidney, romano, pinto, navy or black beans ● chick peas and split peas ● lentils Fibre in packaged foods Packaged foods often provide information about the amount of fibre in the food. Read the "Nutrition Facts Panel" to help you choose foods that are highest in fibre. Look for these nutrition claims on the food package: ● A very high source of fibre has at least 6 grams of fibre per serving. ● A high source of fibre has at least 4 grams of fibre per serving. http://yourhealth.calgaryhealthregion.ca/Topic.jsp?GUID={B47A76B8-E5B6-4B92-9DBA-C5AF7A92438B} (3 of 7)9/15/2006 6:08:13 PM http://yourhealth.calgaryhealthregion.ca/Topic.jsp?GUID={B47A76B8-E5B6-4B92-9DBA-C5AF7A92438B} ● A source of fibre has at least 2 grams of fibre per serving. Tips to add extra fibre Grain products ● Wheat bran and rice bran are tolerated best in cooked products, such as applesauce, hot cereals, pancake mixes, casseroles, meat loaf, burger patties, vegetable dips, yogurt, sauces, soups or coating mixes. ● Oat bran can be used in cooked foods or served on its own. ● Corn bran and psyllium powder can mix easily into foods and do not change the texture of the food very much. ● Mix high fibre cereals such as All-Bran Buds with lower fibre cereals such as Cornflakes. ● Add sliced banana or berries to cereal. ● Replace all or part of the flour in a recipe with whole-wheat flour when baking cookies, muffins or pancakes. Vegetables and fruit ● Offer more vegetables and fruits. Leave the skins and peels on if your child can chew them well. If not, then grate or mash fruits and vegetables and add them to food that will be eaten. Let your child help prepare them. ● Chopped blueberries, raisins, zucchini, pineapple, carrots, dried fruit and nuts can be added to recipes when baking cookies, muffins, breads or pancakes. ● Add vegetables to pizza, casseroles, soups, pasta sauces and meatloaves. Minced carrots, broccoli, spinach, corn or peas can be added to almost any recipe. Mash carrots and corn to prevent choking. ● Cook vegetables in vegetable, chicken or beef stock instead of water to add more flavour. ● Try the following fruit spread recipe. Use this high fibre spread on toast or crackers, added to hot cereal or mixed with cream cheese. Fruit Spread Recipe 1/2 cup (125 mL) raisins 1/4cup (60 mL) pitted prunes 1/4cup (60 mL pitted dates 6 tbsp. (90 mL prune juice 1/4cup (60 mL) natural bran Soak dried fruit overnight in just enough hot water to cover. Pour into a food processor. Add prune juice and bran. Mix well. If the mixture is too thick, add orange juice until a paste consistency is reached. Store in an airtight container in the refrigerator for up to 8 weeks. This recipe makes 1 cup (250 mL) or 16-one tbsp. (15 mL) servings. Milk products http://yourhealth.calgaryhealthregion.ca/Topic.jsp?GUID={B47A76B8-E5B6-4B92-9DBA-C5AF7A92438B} (4 of 7)9/15/2006 6:08:13 PM http://yourhealth.calgaryhealthregion.ca/Topic.jsp?GUID={B47A76B8-E5B6-4B92-9DBA-C5AF7A92438B} ● Mix powdered fibre such as corn bran or psyllium powder into yogurt or a milkshake to make a great snack. Meat and alternatives ● Serve baked beans with whole-wheat toast or a whole-wheat pita. ● Add kidney or other beans to soups, tacos, chili, spaghetti sauce and salads. ● Mix some beans, salsa and cheese and wrap in a whole-wheat tortilla. ● Serve hummus or other bean dips with whole-wheat crackers, mini pitas or vegetables. ● Try split pea or lentil soup or serve bean soup with whole-wheat crackers, bread or pita. ● Serve boiled, pureed, and seasoned red lentils alone, as a dip, or add them to sauces and soups. Kid friendly sources of dietary fibre Below are some grain products and the grams of fibre each contain: ● Kellogg's Bran Flakes, 1 cup (250 mL) - 5.0 ● Powdered psyllium, 1 tbsp.