WebMD Medical News
Brenda Goodman, MA
Laura J. Martin, MD
Sept. 26, 2011 -- Everyone poops, says a popular children’s book, but that’s not always an easy task for kids who struggle with chronic constipation.
Now new research finds little evidence that many of the dietary and behavioral changes parents and doctors use to relieve the problem -- like having kids drink more water or take probiotic supplements -- do much good.
There was some evidence that fiber supplements may help. Other non-drug remedies, like exercise, acupuncture, and yoga, haven’t been tested, study researchers report.
The best solution, researchers say, maybe be adding more fiber to kids’ diets. The research was published in the journal Pediatrics.
An estimated 3% of children in Western countries have chronic constipation, or have fewer than three bowel movements a week for at least two weeks.
When the bowels do move, stools are often large, hard, or painful, which can be distressing to kids and parents. Children with constipation often also end up with a related problem, fecal incontinence, which causes them to leak stool or have accidents.
“It’s very devastating for a child who should be toilet trained to be having these issues,” says Lisa Feinberg, MD, a staff physician in the department of pediatric gastroenterology at Cleveland Clinic, in Ohio. “For some kids, it really can ruin their lives.”
And for some, it doesn’t go away. Researcher say 30% of kids who develop chronic constipation before age 5 will continue to struggle with it after puberty.
The researchers could only find nine studies representing 640 children that were of high enough quality to be included in the review.
Of those, three studies found some evidence that treating constipation with fiber supplements could help.
About 70% of kids in one study weren’t getting enough fiber in their diets to begin with, so researchers think adding fiber may be most helpful for kids who don’t already eat enough fruits, vegetables, and whole grains.
"Increasing fiber in the diet is preferable, instead of fiber products, if a child is not receiving enough," study researcher Merit M. Tabbers, MD, PhD, a pediatric gastroenterologist at Emma Children's Hospital in Amsterdam, says in an email to WebMD.
The American Dietary Association suggests adding five to a child’s age to get the number of grams of dietary fiber he or she should eat daily.
Other dietary methods didn’t appear to be any more effective than placebos for relieving pain or constipation. These included having kids drink more water or other fluids, and giving them probiotics (friendly gut bacteria) or prebiotics, food ingredients that are thought to encourage the growth of friendly gut bacteria.
One study of behavioral therapies offered little evidence that therapy, education, or rewards from the child’s pediatrician could help.
Researchers found no studies of exercise, acupuncture, massage, chiropractic treatments, yoga, or multidisciplinary treatments that combined several approaches.
Hayat M. Mousa, MD, a pediatric gastroenterologist at Nationwide Children’s Hospital in Columbus, Ohio, says that probably the best option for kids who have problems with constipation is a combination of fiber and laxatives.
Feinberg advises parents to use laxatives with a doctor’s help. That way the doctor can keep an eye on things in case medications alone aren’t enough to fix the problem.
SOURCES:Tabbers, M. Pediatrics, October 2011.Lisa Feinberg, MD, staff physician, department of pediatric gastroenterology, Cleveland Clinic, Ohio.Hayat M. Mousa, MD, pediatric gastroenterologist, Nationwide Children’s Hospital, Columbus, Ohio.
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