Children with autism are at higher risk of gastrointestinal problems, including constipation. For many young children, this can manifest as feeding problems, such as:
- Strong food aversions.
- Preferences for a very limited diet.
- Rituals and repetitive behaviors around meals.
- Tantrums around being fed.
If the child rejects many types of food, their diet will be limited, and this can make constipation worse.
It’s a good idea to first check with your child’s doctor to confirm there are no physical issues present. Then, behavior therapy can help. A behavior therapist can help to expand your child’s willingness to eat a wider range of food, including fruits and vegetables, to support digestive health.
What Is Constipation?
Constipation is a digestive problem that affects bowel movements.
Signs that you are experiencing constipation include:
- Fewer than three bowel movements in one week.
- Stool that comes out lumpy, dry, or hard.
- Bowel movements that are difficult or painful to pass.
- A sensation that not all stool has been passed.
Who Is Most Susceptible to Constipation?
Almost everyone experiences constipation sometimes, although some people are more susceptible to it than others.
Some individuals experience chronic constipation, which can affect their physical health. Constipation is not considered a disease by itself. It is usually a symptom of other conditions, which may be temporary or chronic.
While genetics, age, and gender are associated with a higher risk of constipation, there are common triggers for constipation that can affect anyone. These include:
- Insufficient fiber intake.
- Certain dietary supplements.
- Certain prescription medications.
- Underlying health problems that impact the gastrointestinal system.
Changing your diet so you eat more whole fruits, vegetables, and whole grains can reduce constipation. If you have an underlying risk factor for constipation, you need to be more mindful about your diet and lifestyle in order to reduce its frequency and severity.
How Constipation Affects Children With Autism
People with autism are more susceptible to gastrointestinal problems like constipation compared to neurotypical individuals.
Research is just beginning into the connections between this developmental disorder and digestive struggles. Some recent medical research suggests that the link between digestive problems, autism, and feeding problems in young children is so strong that issues with meals can potentially be part of the diagnostic criteria for autism.
Scientists suggest that both internalizing and externalizing behaviors can indicate gastrointestinal distress in children on the autism spectrum, especially if they struggle with communication and cannot otherwise tell their parents or caregivers that they are uncomfortable.
One study found no significant difference in overall gastrointestinal symptom incidence in people on the autism spectrum, but it did show increased constipation compared to the control group (33.9% compared to 17.6%).
Another study suggests that about 50% of children with autism report having constipation. Many children with autism develop such severe or inadequately treated constipation that it can result in an admission to an urgent care or emergency room, but the overall prevalence of this issue is not known.
Some research indicates that there are differences in the digestive systems of people with autism compared to neurotypical individuals. These differences include the types and amount of gut bacteria in the microbiome, which can change how food is digested.
For children with autism, struggling to digest certain foods could lead to physical discomfort, resulting in feeding problems and other behavioral issues.
For example, a study found that people with autism and nausea from digestive problems were 11% more likely to act aggressively. The study found that younger children, between 2 and 5 years old, were more likely to display aggressive behaviors when they suffered upper gastrointestinal issues. In contrast, older children, between the ages of 6 and 18, were more likely to become anxious and experience lower gastrointestinal issues, including constipation.
Improving Constipation in Children With Autism
If your child has autism and develops constipation, there are several things you can do to help them feel better. The first step is to introduce dietary changes.
- Increase the amount of fiber in their diet, especially through foods like fresh fruits and vegetables.
- Lower amounts of some digestive irritants, including some dairy products like milk or cheese.
- Avoid foods that are high in sugar or “vitamin-enriched” drinks because they can make constipation worse.
- Increase how much water and other liquids they drink so they stay hydrated.
- Talk to your pediatrician about adding a fiber supplement if necessary.
There are also behavioral changes you can make to support your child’s overall health, including their digestive health.
- Regular exercise: Consistent body movement mean various organ systems work better, including the digestive system. Children who exercise regularly will also be hungrier, which can make it easier to introduce healthier foods into your child’s diet that will support their digestive health.
- Bowel habit training: As part of toilet training, find ways to help your child understand that they should go to the bathroom as soon as they feel the urge. Children with autism may need a routine or specific, clear rules to remind them. Set a specific time a few times per day to go to the bathroom. This can help them to relax on the toilet. Allocating a specific time for this practice helps your child associate bowel movements with feeling better, so they should hold stool much less often.
- Daily medicines: If your child learns better eating habits and has good toilet habits but still struggles with constipation, talk to your child’s pediatrician about how a prescription medication might help. These medications are reserved for very serious cases of chronic constipation. Treatment may last at least six months. Laxatives are the primary medicine to improve bowel movement frequency and quality. Do not give your child laxatives without talking to their doctor first, even if they are over-the-counter medicines.
Constipation is uncomfortable, and this can manifest in your child developing worse behavioral struggles because they cannot communicate what is going on, especially if they are very young. The right medical care can help your child overcome constipation before it becomes damaging.
The most common approach to managing autism symptoms is behavior therapy, and the skills built in therapy can translate into virtually every area of a child’s life. If your child is suffering from constipation, let your ABA therapist know. A child’s discomfort can factor into their behavior greatly, and the therapist or technician may change the therapeutic approach in some sessions to account for this.
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- Rigid-Compulsive Behaviors Are Associated With Mixed Bowel Symptoms in Autism Spectrum Disorder. (June 2014). Journal of Autism and Developmental Disorders.
- Constipation Burden in Children With Autism Spectrum Disorder: Emergency Department and Healthcare Use. (November 2018). Journal of Pediatrics.
- Relationship Between Gastrointestinal Symptoms and Problem Behaviors in Autism Spectrum Disorder. (June 2019). University of Missouri-Columbia.
- Guide for Managing Constipation in Children: A Tool Kit for Parents. (April 2013). Autism Speaks.
- Constipation in Children With Autism and Autistic Spectrum Disorder. (April 2011). Pediatric Surgery International.
- Management of Constipation in Children and Adolescents With Autism Spectrum Disorders. (August 2012). Pediatrics.
- In Autism, the Importance of the Gut. (June 2013). The Atlantic.
- Children With ASD Improve Insomnia, Constipation Symptoms Using Family-Driven Goals. (August 2018). Infectious Diseases in Children.