Written by Elisabeth Kraus, MiT and Aubrey Phelps, MS RDN LDN INFCP CLC
All of parenting is a bit of a ‘trial by fire,’ but that is never more true than when you find yourself worried about your tiny person’s pooping habits.
Pooping, as gross as it is, is a really important indicator of how your child is tolerating their nutrition, and is something to watch as you make changes to what they eat and how they eat it. This is particularly true while weaning from tube feeds to oral eating. Some children, as we know, need more support than others when it comes to keeping a regular bowel regimen
Simply put? When we change what goes in (what a child eats and how a child eats), we should absolutely expect changes in what comes out. What we don’t want, however, is for those changes to devolve into constipation because once again, if nothing is coming out, then you should expect nothing to go in. So let’s take a look at the different factors relating to managing constipation, and how we might problem solve through a wean.
When dealing with constipation, our focus is on three primary factors: fiber, fluids, and encouraging digestive motility (how food moves through the digestive tract). Let’s tackle them one at a time:
Hydration
Fluid plays an integral role in keeping your child regular! If hydration is inadequate, there’s not enough fluid in the large intestine to be pulled into the stool in order for your child to pass it easily. In other words? A lack of sufficient fluid means that stools become hard and difficult to pass.
So, the natural question becomes, “How do I know if my child is hydrated enough?”
We measure hydration by watching a child’s demeanor/energy levels, urination, tears, stooling, and your impressions of their overall health (as well as any specific guidelines from their medical team). Specifically, adequate hydration is indicated by your child having 4-5 good pees in a 24-hour period, alongside regular, soft stools. If, while weaning, you start to notice less urination than this, or if you see that stools are becoming too hard to pass comfortably, work with your weaning team to add in some fluid flushes while facilitating more opportunities to drink and to eat hydrating foods.
Fiber
If your weaning child is showing great interest in eating solids, then fiber is another way that we can help to keep things moving. Fiber helps to “bulk up” the stools, getting enough into the large intestines so that they can be pushed out.
So, alongside increasing hydration through drinking opportunities and extra fluid flushes, if you notice changes in your child’s stooling, work with your weaning team to find ways to add fiber to the foods your child is already enjoying. Ground flax seed or chia seeds, for example, can be added to or made into a pudding! Fruits that are high in sorbitol content bring more fluid into the stool, so adding prunes, pears, peaches, and dates might really help! And, you may consider limiting dairy products and highly processed foods that are low in fiber.
Motility
Motility deals with the way and speed at which food moves through your child’s digestive system, and if that begins to slow down, your child could end up constipated. So alongside fluids and fibers, we may encourage you to add some healthy fats like MCT oil, coconut oil and olive oil to your child’s diet because they encourage bowel motility.
Your team may steer you away from offering foods like bananas, rice, and processed grains (white bread, etc.) because they can slow down transit time, which can result in constipation. Instead, we may direct you towards other supplements like ginger or chamomile because they support good motility. Many people like to add those to purees, making goods like ginger applesauce, chamomile pearsauce, or popsicles from strongly brewed tea that has honey or maple syrup as a sweetener.
Other ideas that might help? Find ways to add a probiotic to your child’s diet, or with the help of your team, consider a magnesium supplement (like CALM). Epsom salt baths can help to relax the tummy, as well as regular tummy massages. And of course, your team can always help you to know if prune or pear juice, either through the tube or mixed into formula, will help to keep things moving.
And if none of this does the trick, we’re happy to coach you through working with your medical team to consider other interventions (like laxatives) because at the end of the day, keeping your child’s body comfortable is one ticket to a successful wean!