How to Help Your Child’s Constipation Naturally

It’s so heartbreaking to see your child struggle with constipation and not know how to relieve it.  Luckily, there are a few things you can do to get to the bottom of it (no pun intended).

First, let’s focus on constipation as a new and short-term problem.  If it’s been going on for many weeks or longer than that, please see below under “Chronic Constipation” because there are a few different causes to think about in that situation.

What are the concerns about Miralax®? 

MiraLAX® is a laxative that is available over-the-counter. The active ingredient is polyethylene glycol, which helps to move water into the colon and keep it there. This softens stools and stretches the wall of the bowel, which can trigger the urge to poop. MiraLAX® is often recommended by doctors for children because it tends to be gentler than other laxatives on the market.  However, it is not FDA-approved in children less than 17 years old, and long-term studies in children are limited.

There are concerns about polyethylene glycol, the active ingredient in it, related to its close relationship to antifreeze (which contains ethylene glycol). In fact, the Food and Drug Administration (FDA) disclosed that Miralax® does degrade into small amounts of ethylene glycol. 

Many parents have reported neurologic and psychiatric side effects from Miralax® use.  Some of the reported effects include behavioral changes such as tics, obsessive-compulsive behavior, anger, aggression, anxiety and depression.  

Parental advocacy and concern over these cases prompted the FDA to fund a study through Children’s Hospital of Philadelphia (CHOP) to study its safety in children, but the study has still not been completed yet.[1]

Which natural treatments can you use instead?

1. Increase dietary fiber

Ideally, fiber should come from whole foods (fruits and vegetables) in your child’s diet.  I wouldn’t recommend routinely adding isolated fiber products to increase fiber.  Great sources of fiber that can help with constipation are peaches, prunes, and pears.  There was even a study that confirmed prunes really are helpful in relieving constipation. [2]  Other very effective fiber-rich foods include dates and beets. 

There are general recommendations on how much fiber each child should get per day, but I don’t find those to be accurate.  Each child responds differently to fiber.  Some thrive on higher fiber diets, and some do not tolerate as much fiber.  You need to observe your child’s response to fiber when you are trying to adjust the amount in their diet.

For children with chronic constipation worsened by fiber, please refer to the section of this article on chronic constipation.  Those children usually have chronic gastrointestinal issues, such as small intestinal bacterial overgrowth, that are affecting their response to fiber. They need that separately addressed in order to relieve constipation.

2. Increase fluid intake

Make sure your child is drinking enough fluid!  Dehydration is a common cause of constipation in children.  Too much fiber can actually cause children to be more backed up if they don’t drink water or other fluid along with eating the fiber.  This is especially important when they are very active and in warmer weather, as they need extra fluids those days.

Again, there are fluid intake recommendations based on children’s weights.  However, it also depends on if they are losing fluid (e.g. due to illness, activity, or heat), so it can change from day to day and is not solely dependent on weight and age.

I think it is more helpful to base the increase in fluid not on a goal number but on how your child responds to increased fluids.  Make sure they are drinking enough that they are peeing several times per day and (for kids who use the potty where the pee is visible to you) that the pee is light yellow.

2. Probiotics

Probiotics have been found to help with both constipation and diarrhea.  If you want probiotics that contain fiber, great dietary sources are sauerkraut or fermented beets.  Make sure the sauerkraut is fresh (homemade or the kind you find in the refrigerated section of a store).  Shelf-stable sauerkraut is a totally different beast with no probiotics in it (because it is pasteurized, which means it is heated to a point that it kills all bacteria).

Did you know that one serving of sauerkraut has a lot more probiotics in it than any probiotic supplement? It also contains probiotics that resist stomach acid, so they can survive to reach your intestines (which is a problem for most probiotic supplements) [4]. 

I have no affiliation with either brand, but here are two reputable sources: Food and Ferments and Real Pickles.  You’d be surprised by how most toddlers love these tangy, fermented foods!  You can introduce fermented vegetables into a baby’s diet as early as 10 months old.

Another fantastic probiotic is kefir, ideally raw milk kefir, which is better tolerated than pasteurized dairy.  Children who don’t tolerate pasteurized dairy may not have a true sensitivity or allergy to dairy but may just be sensitive to the pasteurized cow’s milk proteins. Pasteurization significantly alters the proteins and may create a sensitivity. (5, 6, 7, 8). 

There are many farms that sell raw kefir; you can locate ones that deliver to your area or to your home here.  If you don’t have access to kefir, you can easily make your make your own, or try unsweetened yogurt.  For kids over one year old who want sweetened yogurt, you can stir in raw honey, which has natural probiotics in it as well.  Of course, kefir and yogurt should only be given if your child tolerates dairy (please see note above about considering raw dairy before assuming dairy is a problem).  For kids who truly cannot tolerate dairy, you can try water kefir or beet kvass as alternative probiotic drinks.

If you are looking for a probiotic supplement, just remember there is a huge variation in quality. Most probiotics out there are ineffective, which is just one of the problems in studies looking at whether or not probiotics are helpful in constipation.  One that I recommend for kids under 3 years old is Klaire Labs’ Ther-biotic, which I have found to be very effective for constipation.

For children 3 years old and older, Seed makes an effective probiotic.  Both Klaire Labs and Seed’s probiotics are in powder form that can be mixed into yogurts, smoothies or other food.  For infants, you can also place a tiny bit of (Ther-biotic) powder on breast or bottle nipples.

For children who are under heavy immune suppressing medications (e.g. certain types of cancer treatment or medications for recipients of organ transplants), please check with your doctor regarding probiotic supplementation before starting.

3. Prebiotics

Prebiotics are starches that our own body does not digest but that feed beneficial bacteria in your colon and promote growth of beneficial bacteria. [9,10].  Prebiotics can be beneficial in constipation, so consider increasing prebiotics in your children’s food.  [11] Examples of potential sources of prebiotics include raw honey, blueberries, blackberries, garlic, onion, beets, nectarines, white peaches, grapefruit, dried dates, cashews and breast milk [12.13].

For children with chronic constipation who experience worsened symptoms with prebiotics, please refer to the section at the end of this article on chronic constipation.  Those children usually have chronic gastrointestinal issues such as small intestinal bacterial overgrowth that are causing them to do worse with prebiotics. They need that separately addressed in order to relieve their constipation.

4. Magnesium

If your child has constipation that is not relieved by fiber, fluids or probiotics, you can try giving magnesium.  It is safe to supplement for children (without a history of kidney dysfunction) because most of us are deficient in magnesium due to decreasing magnesium levels in our food supply from changes in our soil quality. 

There are studies in children and adults showing that magnesium is helpful in relieving constipation (short-term and long-term) though most of these studies used magnesium oxide or magnesium hydroxide [14 15]. However, I would recommend magnesium glycinate, which is more easily absorbed.

The recommended doses of magnesium supplementation for children are:

1-3 years old: 65 mg per day

4-8 years old: 110mg per day

9-17 years old: 350 mg per day

5. Stress management

Stress can definitely contribute to constipation in kids16, 17.  We need our “rest and digest” hormones (our parasympathetic nervous system) working well to digest our food.  When we are under constant stress, we have overactivation of our fight-or-flight response (sympathetic nervous system).

This imbalance between our sympathetic and parasympathetic nervous systems can cause a variety of digestive issues, including constipation.  Helping kids manage their stress is definitely a big topic to be covered in a whole separate article, but some effective ways of reducing stress in kids include:

• Spending time in nature 18,
• Free unstructured play,
• Creating art,
• Reading books or telling stories,
• Doing yoga for (there are a lot of great resources out there like board books for young kids) and
• Practicing mindfulness (check out this great book on mindfulness activities for children by Thich Nhat Hanh).

6. Create a routine

Especially for kids having trouble with toilet training or school-age kids who don’t like to poop at school, they may hold in their stool.  This, of course, makes it even harder for them to go later.  To prevent this, you can set a time about 15-20 minutes after meals for them to sit on the potty for a few minutes to try to poop. 

This capitalizes on a natural reflex (the gastrocolic reflex) that promotes intestinal contractions when food enters the stomach. (You may have noticed that young infants usually have a very strong gastrocolic reflex and often poop while nursing or right afterwards). 

Do not have them sit for longer than 5 to 10 minutes.  Having the child sit longer than that can put them at risk for eventual hemorrhoids.  If they haven’t pooped in those 10 minutes, sitting there longer usually will not help them go.

7. Positioning

For kids who are using an adult potty, make sure they have a stool like a squatty potty that they can rest their feet on to get their knees up, which puts their pelvic floor in a better position.  It moves the muscles in the pelvic floor and the rectoanal canal into a position that allows stool to pass more easily.  Using a stool to help children raise their knees so they’re in more of a squatting position enables them to empty their bowels more completely, more quickly and with less straining.

Chronic constipation

The most important place to start is finding out why your child has had constipation for so long.  There is most likely an underlying issue. If your child has had constipation for more than a few weeks, just giving laxatives or even just focusing on short-term natural solutions will not address the root cause of the constipation.  You may want to consult a functional medicine provider to assess further.  Some things that can cause chronic constipation and may not be explored by conventional medical providers are:

• Dysbiosis (an imbalance of good and bad bacteria in the gut), which is probably the most common cause
• Small intestinal bacterial overgrowth (SIBO)
• Yeast overgrowth
• Parasite infection (which is often missed by routine stool studies)
• Increased intestinal permeability (aka “leaky gut”)
• Food intolerances (usually as a result of one of the other causes mentioned above)
• Thyroid problems (not as common in children)
• Celiac disease

If your child is found to have any of these underlying causes, treating those problems should resolve the constipation. 

Take-home points

• Consider increasing fiber and fluid intake
• Include probiotics in your child’s diet
• Try including prebiotics in your child’s diet
• Consider magnesium supplementation
• Help your child manage any stress
• Set a schedule
• Set them up for success with a stool for squatting
• If the constipation has been going on for more than a few weeks, get to the underlying cause by working with your health care practitioner!