Background
Constipation in children is a very common occurrence affecting roughly 10% of children. It is
characterized by bowel movements occurring less frequently than usual or stool that tends to be
hard, dry, and difficult and painful to pass. The following are common causes of constipation in
children:
• Milk allergy – about 70% of cases of childhood constipation end by eliminating cow’s milk from
the diet and substituting with soy or rice milk
• A low-fiber diet – just like in adults, a high-fiber diet is important for intestinal health

• Certain medications or drugs, such as antacids, opiates and antidepressants

• Various diseases and anatomic abnormalities
• Stool withholding – children may withhold stool because they are stressed about potty training,
are embarrassed to use a public bathroom, do not want to interrupt playtime or are fearful of
having a painful or unpleasant bowel movement

Probiotics for Children

There is some preliminary evidence for probiotic therapy being useful in childhood (and adult)
cases of constipation. It makes sense. After all, bacteria constitute about 30% or more of the
typical stool weight. Rather than using a single strain, my recommendation is to use a multi-strain
formula composed of highly viable and compatible strains including: Bifidobacterium bifidum,
Bifidobacterium breve, Bifidobacterium infantis, Lactobacillus acidophilus, Lactobacillus lactis,
Lactobacillus fermentum and Lactobacillus rhamnosus.
New Data
In a pilot study involving 20 children (average age of 7.4 years) with functional constipation,
daily supplementation with a probiotic (100 million to 1 billion colony forming units of
Bifidobacterium  breve) for 4 weeks was found to significantly increase the frequency of
defecation. Starting out with an average of less than one bowel movement per week improved to an
average of about 5 per week (0.9 at baseline to 4.9); increased stool consistency from 2.6 at
baseline to 3.5; significantly decreased the number of fecal incontinence episodes from 9.0 per
week at baseline to 1.5 in week 4; and significantly decreased the number of abdominal pain
episodes from 4.2 at baseline to 1.9 in week 4.
Previous clinical studies have shown even newborn infants can safely take probiotics at a daily
dosage of up to 9
billion bacteria.

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