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Constipation is a common condition.

When children become constipated it may mean they:

• Do not pass stools as frequently and may strain when passing stools
• Have pain when passing stools
• Do not feel that their bowels are fully emptied
• Get frequent sharp tummy aches

The symptoms of constipation can vary; some children will only experience it for a short period of time. For others, it can be a long term condition that can cause significant pain and discomfort.

Symptoms of constipation

As well as infrequent bowel movements a child with constipation may also have other symptoms such as:

• Loss of appetite
• Lack of energy
• Foul smelling wind and / or stools
• Stomach pains and discomfort
• Generally feeling unwell
• Being irritable and / or unhappy

Causes of constipation

These are some of the causes of constipation in children:

• Not eating enough fibre
• Not drinking enough
• Side-effects of medicines
• Problems with toilet training

Dietary treatment of constipation

To help relieve constipation there are two main aspects of the diet that need to be looked at in more detail:

• Fibre
• Fluid

What is fibre?

• Fibre is the part of food that cannot be digested
• It is found in plant foods such as cereals, nuts, vegetables and fruits
• Fibre absorbs water as it passes through the gut; it swells up like a sponge to make stools softer and easier to pass
• The extra bulk also helps the gut muscles to work more effectively
• It is usually the skins, pips and seeds of foods which contain the most fibre
• When increasing the fibre content of your child’s diet it is important to do this gradually, only making one change at a time
• Unprocessed bran should not be given to help relieve constipation as it can cause bloating and wind

Why more fluid?

• Increasing fibre in the diet will only help relieve constipation if enough fluids are taken
• Your child should drink six to eight cups of fluid every day, such as water, no added sugar juice, pure unsweetened juice (diluted) or milk. This can vary with age and weight of the child so the dietitian can advise on the exact amount of fluid needed
• Avoid full sugar drinks such as cola, lemonade and orangeade as the sugar can cause tooth decay. Low sugar drinks can also damage your teeth
• For children who find it difficult to increase the amount that they drink, try to include foods with high fluid content such as gravy, sauces, soups, yogurts, custard, jelly, ice lollies, fruits, vegetables and salads

How to eat more fibre?

The Eatwell Guide shows how much of what we eat overall should come from each food group to achieve a healthy, balanced diet.

Examples of how to achieve more fibre in the diet by following the Eatwell guide are shown on the next pages.

Potatoes, bread, rice, pasta and other starchy carbohydrates

• Eat skins on potatoes, either boiled / jacket potatoes or potato wedges
• Choose wholemeal pasta / brown rice
• Choose wholemeal, wholegrain or Granary varieties of bread / rolls / pitta breads / chapatis / naans
• If using white bread choose one with added fibre
• Seeded breads such as those containing sesame and sunflower seeds are high in fibre
• Wholegrain breakfast cereals e.g. Weetabix / Shredded Wheat / Shreddies / porridge / Ready Brek / muesli / Oatibix
• Wholemeal crackers and crispbreads e.g. Ryvita, Krackerwheat / oatcakes

Fruit and vegetables

• All fruit and vegetables contain fibre including fresh / frozen / tinned / dried

Beans, pulses, fish, eggs, meat and other proteins

• All pulses contain fibre e.g. dahl / lentils / chickpeas / peas /mushy peas / red kidney beans / baked beans
• Nuts are a good source of fibre
• Whole nuts should not be given to children under five years due to the risk of choking or if there is a known allergy.

The following foods are included outside of the Eatwell guide as they are higher in energy (calories) but they can still be enjoyed in small amounts less often.

Cakes and biscuits

• Choose cakes and biscuits that contain dried fruit or oats e.g. scones / fruit cake / carrot cake / flapjack / malt loaf and biscuits such as digestives / Hobnob

Tips to increase the fibre content of the diet

It can be difficult to increase the fibre content of the diet.

Here are some practical tips to help increase fibre in your child’s diet:

• Vegetables / beans or lentils can be added to stews /casseroles / soups / lasagne / minced meat dishes
• Add chopped or dried fruit onto breakfast cereals
• Make fruit smoothies – blend fruit with milk and / or yogurt and add a handful of oats
• Make a fruit crumble or pie, using half wholemeal flour and half white flour to make the pastry or crumble
• Put salad into sandwiches
• Offer vegetable sticks with a soft cheese dip as a snack.
• Add extra vegetables to the top of pizza
• Offer fruit and dried fruit as snacks
• Wholemeal pasta can be used in lasagne / macaroni cheese and in other pasta recipes

Meal suggestions

Breakfast

• Shreddies with raisins and milk
• Weetabix with chopped banana and milk
• Cereal bar and banana
• Wholemeal toast with margarine and marmalade
• Porridge / Ready Brek made with milk and dried fruit e.g. raisins / sultanas

Main meal

• Wholemeal roll / bread / pitta with ham and tomato / tuna and sweetcorn / egg and salad
• Baked beans on wholemeal toast
• Vegetable pizza and salad
• Lentil soup with wholemeal bread / roll
• Fish fingers, mashed potatoes and peas
• Jacket potato and beans / tuna / cheese
• Chilli con carne with brown rice
• Spaghetti bolognese with wholemeal pasta
• Stir fry chicken and vegetables with brown rice / noodles
• Meat casserole with vegetables and jacket potato
• Fish, chips and beans / peas

Desserts and snacks

• Fruit yogurt / fromage frais
• Malt loaf
• Fresh fruit / dried fruit
• Fruit cake / wholemeal scone
• Cereal bar
• Digestive biscuit / Hobnob / fig roll
• Flapjack