Constipation Management: Adequate fiber intake

One of the primary approaches to preventing problems with constipation is ensuring an adequate fiber intake. Fiber adds the bulk to stool, which helps it move through the gastrointestinal tract.

Some practical ways to increase a child’s fiber intake:

• Unprocessed bran (add 1-3 Tbsp per day to foods. Provide adequate fluid.)
• Whole grain cereals, breads, and crackers
• Raw, cooked, or dried fruits (especially prunes and prune juice)
• Raw or cooked vegetables, with skin
• Legumes (beans, split peas, lentils)
• Consider use of supplemental fiber products (for example, Unifiber®, Benefiber®, and Metamucil®)

When increasing a child’s fiber intake, ensure that his fluid intake is adequate as well. Increased fiber without adequate fluid can exacerbate problems with constipation.

Consider a child’s oral-motor skills and ability to handle textures. Some of the above suggestions are not appropriate for children who have problems chewing or swallowing.

For children who are tube-fed, formulas with added fiber may help with constipation.

Coordination with a child's occupational or physical therapist can ensure that recommendations to increase fiber are also safe for a child with impaired feeding skills.

How much fiber?

The Dietary Reference Intakes (DRIs) include recommendations for fiber to promote optimal health, including preventing constipation. The Adequate Intake (AI) is based on the energy intakes of typically developing children:

• Children ages 1-3 years: 19 grams total fiber per day
• Children ages 4-8 years: 25 grams total fiber per day
• Boys ages 9-13 years: 31 grams total fiber per day
• Boys ages 14-18 years: 38 grams total fiber per day
• Girls ages 9-13 years: 26 grams total fiber per day
• Girls ages 14-18 years: 26 grams total fiber per day

American Academy of Pediatrics:

• 0.5 grams of fiber per kilogram body weight; maximum 35 grams per day

American Health Foundation (for children older than 2 years):

• “age + 5 grams”; e.g., a child who is 3 years old: 3 + 5 g = 8 g fiber per day
  
• Children with chronic constipation may require more than the usual recommendations, however, avoid levels greater than “age + 10 g.”

Concerns about increasing fiber intake

Fiber intake should be increased gradually. A sudden increase in dietary fiber could cause gas and bloating.