Tips to Help Improve Your Child’s Digestive Health

Childhood ConstipationThe reported prevalence of constipation within the paediatric population varies from 14% to 29%.  This can be a difficult experience for both the child and parent. The goal of this blog is to provide some strategies and tips to help improve your child’s digestive health.

The Rome Criteria has been established to help with the diagnosis of constipation in children and must include at least two of the following symptoms at least once a week for a minimum duration of one month:

  1. Two or less defecations in the toilet per week in a child with developmental age of at least 4 years
  2. One episode of fecal incontinence per week
  3. History of retentive posturing or stool retention
  4. History of painful or hard bowel movements
  5. Presence of large fecal mass in rectum
  6. History of large diameter stools that can obstruct toilet

Persistent constipation can cause your child to complain of abdominal discomfort, abdominal bloating, decreased appetite, excessive gas, and lethargy.  There are other medical conditions that can mimic these same symptoms and therefore the first step is to see your child’s paediatrician for a thorough assessment and proper diagnosis. 

If your child’s symptoms are primarily a result of constipation, there are many strategies that can be implemented to help improve your child’s digestive health.  When a child is not properly emptying their bowels, pelvic floor physiotherapy not only teaches them how to optimize their pelvic floor muscle function to promote full evacuation of stool but we also educate children on the mechanics of their entire digestive system.  This empowers children with the knowledge that they are not powerless when it comes to their poo problems.  Instead they are provided with strategies in their daily lives that can help prevent and resolve constipation.

What is happening when a child becomes constipated?

When a child is constipated, an excess amount of stool accumulates and is stored in the rectum.  Normally, the rectum is empty except for those few minutes just before one sits down to have a bowel movement.  There are many possible reasons why a child may suppress their urge to have a bowel movement.  Some are too busy or distracted with something that interests them more than going to the bathroom.  Some children avoid the bathrooms in their school because they are dirty.  They may even be afraid to empty their bowels because previous bowel emptying experiences have been painful or uncomfortable.  The problem is that the avoidance of a bowel movement only allows the stool more time to sit in the colon where more water is absorbed from the stool and this results in a drier and firmer stool.  Not only does the stool dry out, but chronic over-holding causes the pelvic floor muscles to be squeezed really tight.  This tension makes it really difficult for the child to fully relax those muscles; this is an essential part of the mechanics needed to help stool flow easily through the anus and into the toilet.    As the stool accumulates in the rectum, it gets much bigger in size and the muscles in the rectum become overstretched and weakened thereby making it much more difficult for a child to push stool out of the anus.  The liquid stool from above is also able to seep through and bypass the backed up train of solid stool causing leaks.  Another term for this is encopresis.

It is ideal for the entire digestive tract to operate smoothly, continuously, and efficiently.  This ensures the chain of food that eventually turns into stool is properly broken down, nutrients absorbed, and waste is eliminated in a timely fashion.   The slower the process takes, the less efficient the system is and the more water is absorbed from the stool along its path through the colon.  The stool accumulates, dries out further and results in a much more difficult and potentially painful passage through the anus.   This only leads to a child being much more inclined to suppress the need for a bowel movement in the future, further exacerbating constipation.

The following tips are encouraged to help facilitate an environment that fosters healthy digestion in children:

Tip #1 – Chew Chew Chew

Gray’s anatomy describes the digestive tract as a “musculo-membranous tube, about thirty feet in length, extending from the mouth to the anus, and lined throughout its entire extent by mucous membrane.”  Optimal digestion truly starts at the mouth.  The food we eat is mechanically ground up by our teeth and saliva provides the chemicals and lubrication needed to dissolve the food into smaller particles that make it easier to swallow and move down into the esophagus.  This is a perfect opportunity to encourage our children to be “mindful eaters”.  In other words, SLOW down and chew A LOT until the pieces in your mouth are small and of a pasty consistency that is smooth enough to swallow.  The longer your child chews the food before swallowing, the smaller the pieces are before entering the stomach.  This aids in the digestive process and helps improve the absorption of nutrients into the body.  

Tip #2 – Eat and be Present in the Moment

Encourage a routine of eating around the table as a family with no electronics such as phones or television.  These devices are distracting and inhibit children from focusing on body signals that tell them they are full.  It is also very helpful to take time for the meal as opposed to finishing it quickly to get to a lesson or sporting practice.  Meals that are rushed tend to promote large chunks of food to enter into the stomach and therefore make it harder for your body to break down the food you eat.  This can lead to digestive issues such as abdominal discomfort, bloating, gas, and cramping. 

Tip #3 – Exercise and Digestion

Exercise can help your child's digestive healthMany studies associate a higher incidence of childhood constipation with decreased physical activity and increased sedentary behaviours.  Your child’s digestive health may be positively impacted with moderate intensity exercises such as jumping, skipping, hopping, dancing, and even walking boosts blood flow to the gastrointestinal tract.  This increases digestive enzyme production and stronger intestinal contractions which decreases the time it takes for food to move through the system.  The faster food moves through the tract, there is less opportunity for water to be absorbed from the forming stool which helps promote a softer and smoother stool consistency for evacuation.  Active play should be encouraged several times throughout the day but it is best to avoid high intensity exercise immediately after a meal as this can divert blood flow away from the digestive organs and supply the muscles and heart instead.   The benefits of regular physical activity has been shown to improve mood and decrease stress levels.  It is also attributed with decreased tension, anxiety, and depression.  These ideal mental health states further support our digestive function and is described in more detail below: 

Tip #4 – Healthy Mind aids Healthy Digestion

There is an information “superhighway” that uses an extensive network of neurons and hormones to communicate between our brain and our digestive system. This superhighway is referred to as our enteric nervous system (ENS) and is ultimately tasked with controlling the workings of the gastrointestinal system from releasing enzymes that break down food to the amount of blood flow that helps promote nutrient absorption to elimination.  The part of the nervous system that activates the sympathetic “fight/flight/freeze” and parasympathetic “rest and digest” response interacts and communicates with the ENS.  When a person is stressed enough, the upregulated sympathetic nervous system can cause a slowing down of digestion so that the body diverts its energy to facing a perceived threat.  When digestion slows, symptoms of abdominal discomfort, bloating, gas, and constipation may result.    

In the time of a global pandemic, children are experiencing significant changes to their lives and routines.  Their extra curricular activities are restricted and feelings of isolation, anxiety, and stress are at an all time high.  Setting up mealtimes in a quiet and calm environment can foster openness and an opportunity for family to talk about their day.  Getting into a regular practice of deep breathing, yoga, positive affirmations, or guided body scans in the evenings can help decrease the sympathetic state and promote the parasympathetic system of optimal rest and digestion.  

There are so many positive changes that we can introduce into a child’s life to help promote and optimize their body’s digestive processes.  It starts with talking to children about how their body works to take in nutrients and promote growth.  Encouraging active play boosts blood flow and oxygenation to the cells that make up our digestive tract.  When we prioritize family time and create an environment in the home that is peaceful during and after eating, it is easier to foster an atmosphere of positive emotions and moods to further support this system.    

 

References:
Greenfield, B.  (2014).  Beyond Training: Mastering Endurance, Health & Life.  Victory Belt Publishing Inc.

Sothern et al., 1999, ‘The health benefits of physical activity in children and adolescents: implications for chronic disease prevention’ Eur J Pediatrics, 158: 271-274

https://www.health.harvard.edu/newsletter_article/stress-and-the-sensitive-gut

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1647395/

https://positivepsychology.com/mindfulness-for-children-kids-activities/

https://www.hopkinsmedicine.org/health/wellness-and-prevention/the-brain-gut-connection

https://journals.lww.com/jpgn/FullText/2013/12000/Preschool_Physical_Activity_and_Functional.15.aspx

Paediatric Functional Gastrointestinal Disorders Course.  Pelvic Health Solutions.  Sandalcidi PT, RCMT, BCB-PMD.  2019.

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