Improving nutrition (increasing fiber and fluid intake, etc.) is a primary concern in all cases of constipation regardless of the etiology.

Fiber

The child’s diet should be adequate in fiber, without exaggeration. Large amounts of fiber and a sharp increase in their intake can cause discomfort and bloating. Foods rich in fiber are fruits, vegetables, legumes, nuts and whole grains. There are 2 categories of fiber, soluble and insoluble fiber.

Adequate fiber intake for children

Kranz, S et al 2012

Liquids

Fluid intake is also important in the case of constipation. Fluids in combination with the consumption of fiber increase the volume of feces. In this case, the recommendation is to get enough fluid and not overdo it. Adequate intake is achieved not only by water intake, but also by consuming infusions such as tea or chamomile, milk, fruits, vegetables and their juices (preferably freshly squeezed). All the above can contribute to adequate fluid intake during the day.

WHO Water Requirements, Impinging Factors, and Recommended Intakes

However, apart from diet, the choice of appropriate medication (stool softeners, osmotic and stimulant laxatives), the use of enemas and the modification of the child’s behavior concerningits toilet habits, are important factors in improving or restoring constipation.

Increasing physical activity is a recommendation of most guidelines. Mild intensity exercise does not affect stool quality, but it does seem to improve the quality of life of people with constipation.

Modifying the child’s behavior (regular toilet visits and not avoiding defecation, etc.), as well as psychological support in cases where necessary, is an important step in managing constipation.

There are cases of children who have stool incontinence (encopresis) even after gaining toilet skills. This is a serious problem in children that can be caused by conditions that can disrupt the control of bowel movements (spina bifida, Hirschsprung’s disease or anorectal abnormalities, neurological diseases, etc.).

This problem can cause children great embarrassment, social problems, and can be a major problem for the whole family.

In these cases, diet plays an important role in the overall treatment. Recommended diet (constipating diet):

• without dairy and vegetables
• with fruits such as: peeled apples and banana
• white bread, pasta, cereals and rice, peeled potatoes
• red meat, fish, poultry, eggs
• fats and oils (such as margarine, oil, butter) in small amounts in cooking
• sweets e.g. jellies and granites without sugar

Once the child starts the special diet and positive results are shown (no longer having accidents), then the integration of new foods can begin. More specifically, every 3 days 1 new food can be added to the list of consumed foods. If after consuming the “new” food the child does not have an “accident” this means that the food he tried can be included in his daily diet. Thus, for each new food that will be included in the program, the same procedure should be followed. In case diarrhea occurs after consuming a new food, then it is better not to consume it.

Stool incontinence is usually a problem that requires a combination of diet, medication, enemas, pelvic muscle floor physiotherapy, psychosocial support and other methods.

When a specific treatment regimen is identified for each patient individually, it is necessary to record in a diary the frequency and composition of the stool, in order to determine a treatment regimen for the patient and to avoid recurrence of constipation or fecal incontinence.

A special program has been created for the Nutritional Guidance of Children with constipation and fecal incontinence in the Interactive Electronic Platform “NUTRINET”.

In cases of complex constipation or fecal incontinence, it is necessary to include the patient in the “BOWEL MANAGEMENT PROGRAM“

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• Greenwald, B. J. (2010). Clinical practice guidelines for pediatric constipation. Journal of the American Academy of Nurse Practitioners, 22(7), 332-338. 

• Kranz, S., Brauchla, M., Slavin, J. L., & Miller, K. B. (2012). What do we know about dietary fiber intake in children and health? The effects of fiber intake on constipation, obesity, and diabetes in children. Advances in nutrition (Bethesda, Md.), 3(1), 47–53. https://doi.org/10.3945/an.111.001362 

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• Tabbers, M. M., DiLorenzo, C., Berger, M. Y., Faure, C., Langendam, M. W., Nurko, S., … & Benninga, M. A. (2014). Evaluation and treatment of functional constipation in infants and children: evidence-based recommendations from ESPGHAN and NASPGHAN. Journal of pediatric gastroenterology and nutrition, 58(2), 258-274.

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