Dr Phil Kieran: What can I do to help my child have regular bowel movements?

We would all like to find a way for our kids to eat more vegetables and higher-fibre foods so they can manage their bowel movements without relying on medicated solutions. This is not always the case.

My six-year-old is neurodivergent and has had constipation since he was about two. I’m giving him an OTC stool softener as recommended by the GP and ensuring he drinks plenty of water. He’s a picky eater — so he won’t touch vegetables unless they are blended into a sauce. I put fruit in his lunchbox every day, but it mostly comes back uneaten. Is there anything else I can do to encourage regular bowel habits?

Children and vegetables. I don’t think there is any greater point of conflict in the history of parenting. For children with additional sensory considerations, this issue can be even more problematic.

With neurodiversity, some of the sensations that most of us take for granted can be difficult to interpret, and responding to these can manifest in strict dietary preferences and aversions to certain tastes or textures.

The food difficulties are widely discussed and pretty well known, but the constipation you are dealing with is also quite common. This can be attributed to dietary restrictions, but it can also be due to the way children with sensory concerns perceive the sensation of gut movement and passing a stool.

We would all like to find a way for our kids to eat more vegetables and higher-fibre foods so they can manage their bowel movements without relying on medicated solutions. This is not always the case. Often, GPs recommend stool softeners as a reliable way to help children pass stools more easily and frequently. This treatment has a number of benefits. Firstly, it separates treating the constipation from any discussions around dietary issues. Secondly, the longer the stool stays in the large intestine, the drier and harder it becomes. This means that when they go to the toilet, making a bowel movement can be sore. This, in turn, leads to a fear of passing stool, causing the child to hold on for longer to avoid the soreness.

By softening the stool and keeping it soft for an extended period, you help to break the association of pain and bowel movements.

Lastly, by increasing the frequency of bowel movements, we help to develop a healthier bowel habit overall.

The factors that encourage a regular and easy bowel habit include hydration, fibre intake, and regular movement. Trying to maximise these three elements will help to regulate the bowel habit.

Regarding increasing fruit and vegetable intake, the current advice is to offer both with every meal. We also suggest that every meal include at least one item that your child will enjoy eating. They should be encouraged to try the new food item, but shouldn’t be pestered or forced to try it, as this can cause a stronger aversion to the novel food item. The fact that they will eat vegetables if blended into food is also good. Blended fruit or veg isn’t quite as useful to the bowel as when it hasn’t been blended, but it is better than not having these foods in the diet.

I would encourage you to keep trying to increase your son’s dietary range and hopefully, as he gets older, he will become less restricted. For now, I would recommend continuing the stool softener until food intake broadens. These stool softeners do not cause damage to the bowel or, in most cases, create a dependence, so you don’t need to worry about using them for extended periods.