In working with children with various forms of Sensory Processing Disorder, I've come across a common theme: Constipation.
Upon identifying concerns, it is important to consult with your Pediatrician and/or Pediatric Gastroenterologist to confirm that the problem is not related to any other underlying medical condition(s).
In cases of constipation, there can be multiple, often co-existing causes. Many children with SPD (sensory processing disorder) have poor eating habits due to oral sensitivity and eat only 'white foods' or similar low fiber foods. In addition, these children are often scared to relieve themselves and withhold due (but not limited) to:
- Increased physical awareness of bowl movements and related discomfort due to super sensitive tactile systems
- Fear of falling into the toilet due to poor balance
- Fear of the noises in the bathroom ie: the 'flush', pipe noises etc.
- A desire to control the environment.
Some children also present with hypotonia (low tone) and have difficulty digesting food in an efficient manner.
Constipation is terribly uncomfortable. Think of the way you feel when you are constipated. Words such as bloated, moody, sick, nauseous, sluggish and crampy may come to mind. Children with SPD who are constipated often complain of stomach pain and can become even more emotionally sensitive and are often explosive.
Dealing with food sensitivities and related constipation can be difficult but real progress can be made with effort and dedication. The following is a list of strategies I have found to be helpful.
- Decorate the bathroom with your child by hanging up pictures, placing favorite books or stuffed animals nearby, adding music. Try creating an environment that is as appealing to the child as possible (put this in perspective- we all enjoy our own bathroom comforts and reading our materials-don't we?!)
- Make sure the child is comfortable and posturally stable on toilet by placing a stool under his her feet and/or using a toilet insert
- Have child choose and decorate the plastic exterior of the toilet insert
- Have the child sit on the toilet for 10 minutes at least twice a day
- Talk to the child about his/her toileting schedule including what he should expect ie: how long he will sit on the toilet. Prepare the child with your expectations.
- Explain to the child the natural physical consequences of withholding (ie: stomach pain)
- Include the child in the process ask him/her for ideas to increase cooperation and success
- Praise, praise, praise and positive reinforcement. Start with praise for behaviors such as relaxed sitting on the toilet and/or tasting healthy new foods. Chart progress and reward
- Have the child consistently look at and evaluate the quality of his/her stool (ideal stool should be medium brown, the color of plain cardboard with the consistency of toothpaste, approximately 4 to 8 inches long. There should be little gas or odor)
- The importance of Eating Meals Together as a family cannot be emphasized enough. Children see others eating a variety of foods in a relaxed setting and over time become motivated to participate.
- Encourage the child to start by smelling and tasting a small bit of food. Most times, repeated exposure to an undesired or new food is required before a 'picky' child is willing to eat.
- Use appealing adjectives for healthy food such as sweet, tasty, delicious, fragrant, yummy, beautiful, crunchy, fantastic, and savory. Studies have shown that this increases the desire and perceived tastiness of the food
- Include the child in food and menu preparation. Teach the child about the health benefits of good food
- Increase the child's daily fiber and water intake by using strategies listed above
- Talk with your pediatrician about giving your child a stool softener such as Miralax