Child Constipation - What to try before Meds

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**Disclaimer: This information should be used for informational purposes only and should not be taken as direct medical advice. Always consult with your physician first before beginning and new supplements.

Did you know that frequently and regularly moving bowels is one of the best indicators of a child’s overall health and wellness? That’s because the immune system literally resides in the gut!

Regularly moving the bowels is evidence that food is being broken down, digested and that the vitamins and minerals a child consumes in their food are being absorbed and assimilated properly. Besides nutrient absorption, emptying the bowels every day helps to remove excess toxic waste from the body.

And since our immune system resides in the digestive track, its so important to have an abundance of healthy living bacteria present here too.

Many children are missing this beneficial bacteria in their digestive tract as a consequence of antibiotic over-use within the first few years of life. The over-use of antibiotics reduces the numbers and diversity of commensal bacteria, which can allow pathogenic or parasitic microbes an opportunity to thrive in. (6)

Healthy gut bacteria feeds a healthy immune system, but there’s something even more incredible about the digestive system; the presence or absence of healthy bacteria in the gut can directly affect and modulate a child’s affect and mood!

You heard me right, a healthy and robust gut bacteria ecosystem = a happy and healthy child.

THE GUT-BRAIN CONNECTION

New research coming out over the last several years has discovered how intricately tied the digestive track is to the central nervous system (CNS). We have learned that neurotransmitters that are responsible for modulating our mood (like GABA which calms the nervous system and serotonin which gives us a sense of well-being and happiness) are created right inside the gut lining itself! Isn’t that incredible?!

The gut-brain axis (GBA) consists of bidirectional communication between the central and the enteric nervous system, linking emotional and cognitive centers of the brain with peripheral intestinal functions. (1)

Simply put, the state of a child’s gut directly affects a child’s mood and emotions via many different physiological pathways.

To put all of this into perspective for you, Ill give you a few real life examples of how this bidirectional Gut-Brain-Axis communication works.

1. Did you know that upwards to 95-98% of the brains feel good neurotransmitter serotonin is made in the gut lining?

2. Or did you know that chronic stress (a neurological/psychological symptom) can cause altered intestinal permeability??

Those are just two examples of the bi-directional communication between the gut and the central nervous system (CNS). There’s also the role of the vagus nerve, the Neuroendocrine (gut hormone) signalling, Production of Microbial Metabolites and many others which you can read more in-depth about here.

THREE MAIN PILLARS THAT ENCOMPASS A HEALTHY GUT:

So to put it simply, there are really three main pillars that encompass a “healthy gut”

1. Intestinal cell wall integrity:
   This is how tightly bound the cellular membrane junctions in the gut lining are. If the gut cell membranes have been compromised, food proteins easily seep into the blood stream causing over-reactive immune responses and consequently, food allergies.
   
   Signs and symptoms of “leaky gut” syndrome are: diarrhea, constipation, weak immune system, nutrient deficiencies, brain fog, fatigue, food allergies, autoimmune conditions, skin rashes like eczema acne or rosacea.

2. Higher ratio of healthy to unhealthy bacteria:
   The ratio of healthy to unhealthy bacteria significantly impacts neurological function as well as well as immunological function. Although gut bacteria isn’t all that simple (being that there are billions and billions of bacteria in our gut), we want more beneficial bacteria than harmful bacteria. Overgrowth of harmful bacteria and yeasts in the gut like candida and clostridium are common in children today, especially those who have experienced over-use of anti-biotics.
   
   Signs and symptoms of bacteria over-growth or candida are: oral thrush, recurrent urinary tract infections, skin and nail infections/fungus, digestive issues, fatigue, mood disorders like anxiety, depression irritability. itchy ears or severe seasonal allergies and strong sugar, dairy or refined sugar cravings.

3. Regularly moving the bowels:
   As I stated previously, regularly moving the bowels is a good sign of proper food break down, nutrient absorption and waste and toxin removal. If your child isn’t moving their bowels at least once a day, this is not considered “normal.”

So if your child isn’t moving their bowels regularly, its definitely something that needs to be addressed. But don’t panic! There’s so many natural ways to help a child’s digestive system other than resorting to medications.

HOW COMMON IS CONSTIPATION?

Constipation in children is a common health problem affecting 0.7% to 29.6% children across the world. (2) The prevalence of GI symptoms in children with Autism Spectrum Disorder is even higher, ranging from 23% to 70% (3).

Constipation in children can be defined as fewer than 2 or 3 bowel movements a week, also commonly associated with painful or labor intensive bowel movements. Children who struggle with chronic constipation can also deal with fecal compaction, a more dangerous situation that may require hospitalization.

PROBLEMS WITH THE STANDARD TREATMENT PROTOCOL

The most common treatment protocol for a child with backed up or impacted bowels is to start polyethylene glycol or PEG 3350- also known as MiraLax, to alleviate constipation symptoms.

The biggest red flag I see with using MiraLax is that the FDA has not approved long-term use of PEG3350 in children aged younger than 17 years of age, but the laxative is used off-label widely in clinical practice. Aside from that, its very common for parents to use MiraLax regularly, even though it was only ever recommended for and studied for its short term use.

Furthermore, the FDA received numerous reports of adverse events including neuropsychiatric symptoms in children taking PEG 3350, which included tics, anxiety, rage, paranoia, phobias, mood swings and depression. Some children may be more susceptible than others to experience adverse events to PEG 3350, especially in cases of younger children who are using it at high doses for long-term use.

In response to such a high volume of adverse neurophsychotic events, a citizen petition from the public to investigate and re-evaluate the safety of PEG 3350 was submitted to the FDA. In 2008, the FDA conducted a study to test for impurities. The most concerning conclusion from the safety testing were finding trace amounts of ethylene glycol (EG) and diethylene glycol (DEG) in all 8 batches tested, which are ingredients found in antifreeze and pose neurotoxicity to children. (7) In 2011, a report from the FDA (4) also concluded that neurphsychotic events were noted in MiraLax users, but stated "no action is necessary at this time based on available information."

Due to citizen push-back and the influx of adverse neuropshycotic events, there is a multi-center research group effort being conducted to study the adverse events reported to the FDA regarding MiraLax. Additionally, the Children’s Hospital of Philadelphia (CHOP) is currently conducting an NIH-funded study to monitor its long-term affects on pediatric patients as well. (8)

Regardless of all of this information, many physicians still recommend this product to young children.

I believe the jury is still out on whether to use MiraLax to safety treat constipation in young children.

While I can’t give an answer as to why we are so quick in the medical field to prescribe, I will share with you a few less-invasive, more natural, root-cause fixes you can try with your child who is chronically constipated.

I guarantee there is something on this list that is going to positively impact your child’s digestion one way or another.

Reminder: This information should not be taken as direct medical advice. Always consult with your physician first before beginning and new supplements.

CHILD CONSTIPATION: WHAT TO TRY INSTEAD OF MIRALAX

1. Add in ground flax and increase volume of fibrous fruits and vegetables:
   
   Start by offering a fruit and a vegetable at every meal and snack. Your child may or may not eat them every time, but offering them frequently is what is important. Smoothies in the morning are such a great way to get in a bulk amount of fiber first thing in the morning (when the digestive track needs it the most). Spinach, a daily greens powder (I like this one the best which also includes a probiotic and enzymes which help with food breakdown), frozen blueberries and frozen broccoli are all great places to start with adding fiber to breakfast smoothies.

   
   Another thing to consider is to add ground flax seed to your child’s menu. Flax seeds are not only an excellent source of omega-3 fatty acids, but they also function to lubricate, clean out and normalize the digestive tract. Some ways to offer flax seed is: ground in oatmeal/cereal, mixed into apple sauce, 1-2 tsp added to a breakfast smoothie.

2. Add a daily probiotic:
   
   A daily probiotic is crucial for healthy immune and digestive health. It can also be a pathway to overcome a case of yeast of bacteria overgrowth like candida or clostridium. This is my favorite probiotic that my kids and I both take every day. Start with one tablespoon a day and work yourself up to a higher dose if you need to.

3. Increase water intake by 2-fold:
   
   Go ahead an increase your child’s fluid intake by double. Use a rubber-band around the water bottle to encourage your child to drink more. Ex. “Can you drink all the way to this line?”

4. Supplement with Magnesium:
   
   Magnesium plays a crucial role in digestion. Muscles within the digestive tract, including the intestinal wall, are relaxed by magnesium, which improves digestion. Magnesium also helps to counterbalance stomach acid and advances stools through the intestines.
   
   This is my favorite magnesium supplement for kids. My kids take one a night, as magnesium aids in sleep as well.

   
   Another less invasive option to increase magnesium levels in children is to do a daily epsom salt bath. The minerals in the epsom salt bath absorb transdermally (through the skin). This is my favorite epsom salt brand.

   
   A third option for getting in magnesium in babies and children under the age of 4 is this baby and kid safe magnesium lotion.

5. Remove conventional dairy:
   
   Many children find relief from constipation when they eliminate or reduce conventional dairy and add in fibrous vegetables. Conventional dairy can be inflammatory to the bowel system in many cases. Because the homogenization and the pasteurization process kills off the enzymes, healthy bacteria and vitamins in milk, this makes milk difficult for the body to recognize and digest.

   
   This is a simple fix that can yield amazing digestive results. If your child eats a lot of dairy, it can be difficult at first so start slow. Start by simply reducing the amount of dairy your child eats and then gradually switching to more dairy free products.

6. Remove gluten:
   
   Even if your child doesn’t have celiac disease, their digestive system could still benefit from reducing or eliminating gluten. In many people, gluten can cause the gut cells to release zonulin, a protein that can break apart the tight junctions holding your intestines together (aka “leaky-gut”). You can read more about gluten’s affects of the digestive tract here.
   
   It can seem overwhelming at first to start a gluten-free diet with a child. My advise is to start very slowly. Switch to very similar products your child likes but look for gluten free options until you find one you child enjoys. Small changes at first as to not overwhelm the child and the cargiver are always best. I used to find it overwhelming to think about going totally gluten free. But now I find their are so many gluten-free options out there that I find a lot of freedom in that, and my kids do too!
   
   Here are some of my favorites gluten-free products:

7. My favorite gluten free bread

8. My favorite gluten free pasta brand (made out of quinoa)

9. My favorite gluten free cauliflower pizza crust

I hope you found this article helpful and insightful! Please let me know if you have any questions or comments in the comment box below.

-ASHLEY

SOURCES:

1. Carabotti, M., Scirocco, A., Maselli, M. A., & Severi, C. (2015). The gut-brain axis: interactions between enteric microbiota, central and enteric nervous systems. Annals of gastroenterology, 28(2), 203–209.

2. Rajindrajith, S., & Devanarayana, N. M. (2011). Constipation in children: novel insight into epidemiology, pathophysiology and management. Journal of neurogastroenterology and motility, 17(1), 35–47. doi:10.5056/jnm.2011.17.1.35 (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3042216/)

3. Chaidez, V., Hansen, R. L., & Hertz-Picciotto, I. (2014). Gastrointestinal problems in children with autism, developmental delays or typical development. Journal of autism and developmental disorders, 44(5), 1117–1127. doi:10.1007/s10803-013-1973-x

4. FDA Adverse Event Report: https://www.fda.gov/drugs/fda-adverse-event-reporting-system-faers/potential-signals-serious-risksnew-safety-information-identified-adverse-event-reporting-system-aers-1

5. https://www.drug-injury.com/drug_injury/2018/01/miralax-study-projected-to-be-completed-this-year.html

6. Rege & Graham. The Simplified Guide to the Gut-Brain Axis – How the Gut and The Brain Talk to Each Other. <https://psychscenehub.com/psychinsights/the-simplified-guide-to-the-gut-brain-axis/>

7. The Use of Polyethylene Glycol in the Pediatric Population Report by the Department of Health and Human Services. https://grants.nih.gov/grants/guide/rfa-files/RFA-FD-14-088.html#_Part_2._Full

8. NIH PEG 3350 Study: https://heuckeroth.research.chop.edu/peg-3350-study