Constipation is a very common complaint in children with developmental, gastrointestinal, immune system and/or neurological conditions. Children with autism spectrum disorder (ASD) are nearly 4 times more likely to have at least one digestive symptoms with constipation being the most common issue. Some of the factors that may contribute to this increased gut issues in children with ASD are highlighted below : genetic variations, dysbiosis = imbalance of gut bacteria, immune dysfunction, food sensitivities, digestive enzyme deficiencies, to name a few.
Read on to learn if your child is constipated and how to help your child manage constipation at home.
Is My Child Constipated?
Babies and toddlers up to 4 years old are diagnosed with functional constipation if they have 2 or less bowel movements per week for at least 1 month OR 2 or more of the following symptoms based on the Rome IV criteria:
- Holding in stool
- Painful or hard bowel movements
- Passing large stools
- Having a large amount of stool in the rectum
- For toilet-trained toddlers: having accidents (incontinence) at least once a week or passing large stools that might clog the toilet
For children older than four, functional constipation is diagnosed if, for at least one month, they have 2 or more of the following symptoms :
- 2 or less bowel movements in the toilet per week
- At least one episode of stool leakage (fecal incontinence) per week
- Holding in stool
- Painful or hard bowel movements
- A large amount of stool in the rectum
- Passing large stools that may clog the toilet
A “normal poop” may be different for each child. One might have a pattern of several stools daily, whereas another might have a pattern of one every other day or every third day. If a child usually goes every third day and passes the stool without difficulty or pain, then it may not an issue for that child. However, if there’s a hard stool every third day that is painful to pass, then this may be a concern. The particular concern with a hard poop is that it can result in a fear of elimination and a decreased appetite.
Dietary Treatments for Constipation
Increase Fiber Intake
More than half of children with constipation have a low fibre diet well below the recommendation. Many kids with autism can still effectively manage their constipation through dietary changes and by eating foods high in fiber.
Fiber is an important component of our diet. It is the indigestible part of plant foods, such as fruit, vegetables, whole grains, nuts, seeds, and legumes (beans, peas, lentils, chickpeas) and this bulks up the stool, which passes through the colon more easily. Fiber works like a sponge, pulling water through the intestinal wall into the colon. A lack of sufficient fibre in the diet will cause the stools to be harder and more difficult to pass, creating pain which causes children to further withhold their stools.
The recommended daily fibre intake based on the child’s age and gender :
- Age 1-3 years old : 19g fibre
- Age 4-8 years old : 25g fibre
- Age 9-13 years old – Males: 31g; Females: 26g
- Age 14-18 years old – Males: 38g; Females: 26g
Certain foods can be especially helpful with constipation :
- fruits such as kiwifruits, prunes, apricots, apples, raisins, oranges, apples, pears, berries
- wheat bran, oatmeal, ground flaxseed, soaked chia seeds, beans
Increasing Fluids
Hydrate! Fiber without adequate fluids can worsen constipation. Sufficient fluids are needed in the diet for the fibre to be effective. Generally water is the best fluid and can be offered anytime, ideally 1h before eating times to avoid this affecting your child’s appetite for food.
Adequate Total Water per Day:
- Age 1 to 3 years old : 5-6 cups
- Age 4 to 8 years old : 7-8 cups
- Age 9 to 13 years old : 8-10 cups
Too much cow’s milk intake (typically more than 2-3 cups per day) can cause constipation and for some, replacing milk with other food/fluids can help with constipation.
Tips to Get Children with Autism (or picky eating) to Eat More Fiber
Children with autism often have feeding challenges that may impact what they may accept eating in their diet. They may have specific preferences (typically simple carbs, foods low in fiber and high in saturated fats) and aversions to various textures, temperatures, flavors, colors, and smells. This eating pattern can ultimately impact their gut health and overall nutritional status.
When introducing new foods to a child with autism always remember:
1. Identify Your Child’s Sensory Profile
When trying to get your child to eat new foods, you’ll want to take their sensory preferences into account. Think about the foods that your child does like eating – what textures, colors, flavors and temperatures are those foods?
For example if you’re trying to introduce pear and your child’s sensory profile is pureed texture, you can try offering it as a pear sauce or take the skin off or cut it into small pieces.
2. Make Small Changes
Think about what your child likes to eat, then think of small changes you can serve that food item. For example, if your child likes to eat granola bars in the package – unwrap and offer the exact granola bar in a bowl in front of your child and gradually fade out the packaging. This will make it easier to try a different granola bar in the future. Check out our blog on some high fiber granola bar options.
3. Only Introduce One New Food At a Time
Add a small portion of a new food item to your child’s plate next to food that your child already really likes. Starting with just one new food at a time in a small portion (ie. 1 baby carrot) alongside a preferred or safe food (ie. vanilla yogurt) can help reduce overwhelm at mealtime.
4. Be Consistent in Introducing New Foods
By consistently adding a new food to your child’s plate you will help your child see that this is a normal part of their mealtime routine.
5. Avoid Unnecessary Restrictions
A gluten-free/casein-free (GFCF) diet – ie. avoiding gluten (a protein found in barley, rye, oats, wheat) and casein (a protein in dairy products) is sometimes followed in hopes to improve autism symptoms; however, there is little evidence that a GFCF diet is helpful at all for autism symptoms and no evidence of it helping with any gut symptoms. With this population more prone to feeding difficulties and selective eating patterns, any dietary restrictions should be done with caution and in consultation with a dietitian.
What if My Child Doesn't Like Drinking Water?
There are other ways to get fluid even if your child doesn’t like to drink water.
Some high water content foods are:
- Melons
- Strawberries
- Broccoli
- Celery
- Cucumbers
- Lettuce
- Yogurt
- Cottage cheese
- Gelatin
- Smoothies
- Frozen pureed fruits
What Else to Consider Besides Fiber and Water to Help with Constipation?
Increase physical activity
Regular exercise and active play can help increase intestinal movement and help with constipation. It is recommended that children and youth get at least 60 minutes a day of moderate-to- vigorous intensity physical activity (ie. walking to/from school, active play, biking, swimming, soccer, martial arts, tennis).
Create a toilet routine
Incorporating a regular toilet routine can be very helpful for children with Autism, as they typically thrive on consistent routine! Toilet time scheduled 15–30 min after meals will also take advantage of the natural intestinal movement. This can also help the the child learn to recognize normal body sensations that are associated with the need to poop. If your child is still using a diaper, do all diaper changes in the bathroom and ensure it is a super positive experience with lots of praise for being in the bathroom.
Are There Any Supplements that can Help with Constipation?
Probiotics may help improve constipation symptoms and improve overall gut health long term. Lactobacillus and Bifidobacillus probiotic strains have been researched for constipation although more evidence is needed to provide recommendations on type, dosage and duration of probiotics.
Gut issues such as constipation can affect your child’s appetite and how they’re feeling on a day to day basis. For children with ASD, constipation can sometimes lead to or be interpreted as behavioral outbursts as the constipation issue can cause discomfort, pain, frustration, anxiety, and/or stress. Constipation should be dealt with early to prevent further health problems and feeding difficulties.
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