Children who don’t like fruit and veg are 13 times more likely to be constipated

Primary school children who don’t like eating fruit and vegetables are 13 times more likely to develop functional constipation than children who do, according to a study in the December issue of the Journal of Clinical Nursing. Drinking less than 400ml of fluid a day also significantly increases the risk.

Dr Moon Fai Chan, assistant professor at the National University of
Singapore, teamed up with Yuk Ling Chan, from the Hong Kong Polytechnic
University, to study the diet and toileting habits of 383 children aged from
eight to ten from a school in Hong Kong.

Fifty-one per cent were boys and children who were on regular medication or
who paid regular hospital or clinic visits were excluded. Seventy per cent of
the children who took part in the study were ten-years-old, 22 per cent were
nine and eight per cent were eight.

“A number of studies have suggested that functional constipation - which is
due to dietary habits, environmental habits and psychosocial factors rather
than a particular health problem - is getting worse among school-age children” says Dr Moon Fai Chan from the Alice Lee Centre for Nursing Study at the University.

“It is estimated that functional constipation accounts for 95 per cent of cases
of constipation affecting children once they pass infancy. The condition has
serious consequences, as it can cause a wide range of distressing emotional and physical problems such as stress, soiling, problems at school, damaged self-confidence and reduced social interaction.”

Key findings of the study included:
• Seven per cent of the children who took part suffered from functional
constipation and there were clear dietary differences between the children
who did and did not have problems.
• Girls were more likely to have functional constipation than boys (8.2 per
cent versus 6.6 per cent) and nine-year-olds were more likely to report
problems (13.3 per cent) than eight-year-olds (10 per cent) and ten-yearolds
(5.2 per cent).
• Children who only drank 200ml to 400ml of fluid a day were eight times
more likely to experience problems than children who drank 600ml to
800ml and 14 times more likely than children who drank a litre or more.
• Children who said they did not like fruit or vegetables were 13 times more
likely to suffer from functional constipation than children who did.
• Nine out of ten children refused to use the school toilets for bowel
movements and the figure was the same for children with and without
constipation.
• The biggest problems with school toilets were that children preferred to go
at home. They also cited lack of toilet paper and dirty toilets.
“When we compared our findings with previous studies we found that the
levels of functional constipation among Hong Kong school children was higher than those in the USA and UK, but similar to Italy” says Dr Chan.

The authors have made a number of recommendations that they feel would
help to tackle the problem. They suggest that:
• Primary schools should work with healthcare professionals to make
children more aware of the problem, with regular healthcare education
sessions in classrooms and at assemblies.
• Parents need to be educated about functional constipation so that they
can spot problems in their children and make sure that their diet provides
sufficient fluid, vegetables and fruit. They should also remind their children
to pay regular toilet visits at school.
• School tuck-shops should stock high-fibre snacks such as popcorn, fresh
food and dried fruit, instead of crisps and sweets.
• Children should be encouraged to drink plain water during lessons and
drinking fountains should be installed.
• School toilets should be more user-friendly, private and well stocked with
paper so that children feel more comfortable using them.
“We hope that this study will help to raise awareness of functional
constipation, which can cause children real physical and emotional distress
and seriously affect their quality of life” says Dr Chan.

• Investigating factors associated with functional constipation of primary school children in Hong Kong. Chan MF and Chan YL. Journal of Clinical Nursing. 19, pp3390-3400.
(December 2010). DOI: 10.1111/j.1365-2702.2010.03366.x
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