Web RD

Ensure adequate hydration by drinking plenty of fluids.

Consider fiber intake. Both excessive and inadequate amounts of fiber may contribute to constipation. Rich sources of fiber include fruits, vegetables, whole grain products, nuts, seeds, and legumes (beans, peas, soy, lentils).

Not all fibers are effective in constipation, and some (particularly insoluble fiber without enough water) can exacerbate it.

A SLOW increase in fiber to the recommended amounts, along WITH extra fluids, can promote gut health. Recommended intake is 14 g of fiber per every 1000 calories consumed in persons older than 2 years; 12-23 month-olds need up to 19 g per day.

Consider behaviors & changes in routine, such as taking regular bathroom breaks, traveling, stress, illness, and stool-withholding (e.g., readiness for toilet training in children, public bathroom avoidance).

Ensure proper infant formula preparation.

Consider excessive milk intake (limit milk to 24 – 32 oz a day in toddlers & preschoolers) or the possibility of milk protein allergy in children.

Consider diet changes, such as formula change, abrupt switch to formula from breast milk, or introduction of new foods.

Consider using small amounts of 100% apple, pear, or prune juice for osmotic laxation (e.g., 2-4 oz for infants older than 4 months; under 4 months, give 1 oz per age in months, such as 3 oz for a 3-month-old).

Evaluate medication and supplements for possible sources of constipation (e.g., iron, opiates, antacids, antidepressants, anti-epileptics, antihistamines); changes in type, form, dose, or frequency of use may reduce side effects.

The temporary trial of a diet with low fermentable fiber foods (aka FODMAP diet) may help reduce GI symptoms in some people (note that prolonged restriction of foods is not recommended as it can lead to nutrient deficiencies).

Stay hydrated. Sip fluids.

Use oral rehydration solutions as needed (see recipe below & under nausea).

Provide foods that you/the child are willing to eat. It is not necessary to solely use the BRAT diet (bananas, rice, applesauce, tapioca) as it can reduce nutrient intake.

Small, frequent meals may be more tolerated and improve nutrient intake.

Foods lower in fat and insoluble fiber tend to be more tolerated as well as rice, potatoes, chicken, and eggs.

It may be helpful separate solid foods from liquids.

Avoid simple sugars and sugary drinks, greasy and spicy foods, alcohol, sugar alcohols, and caffeine (e.g., full strength fruit juice/ punch, sorbitol).

Some people may need to avoid/limit dairy.

Thicken stools with soluble fiber (e.g., pectin, banana flakes, pears, oatmeal).

Avoid gas-producing, high-fiber foods such as nuts, beans, broccoli, cauliflower, Brussels sprouts, and cabbage during diarrhea.

Slowly stimulate the GI tract by the gradual reintroduction of solid foods, monitoring one food at a time for tolerance as the diarrhea lessens.

Slowly increase fiber intake with additional fluids, especially as diarrhea subsides to promote the restoration of gut health.

Prebiotic foods, such as asparagus, garlic, sunchokes, and chicory root, may be beneficial to gut microbiota and digestive health.

Infants should continue to be breastfed or consume full-strength infant formula.

Consider increasing zinc intake with extended diarrhea, particularly if on a vegan/vegetarian diet or with conditions that cause frequent diarrhea (IBS).

Probiotics may or may not be helpful. Studies vary widely in which type and amount of bacteria used and in their efficacy. Fermented foods (e.g., kimchi, yogurt, and kombucha) may be more tolerated than supplements or powders. Current data does not support the systematic use of probiotics in children or those with immune deficiencies.

Never give over-the-counter antidiarrheal medications to a child without first consulting a pediatrician.

The temporary trial of a diet with low fermentable fiber foods (aka FODMAP diet) may help reduce GI symptoms in some people (note that prolonged restriction of foods is not recommended as it can lead to nutrient deficiencies)

Eat smaller, more frequent meals.

Chew well.

Drink fluids with meals.

Choose lower fat and lower fiber foods until symptoms improve.

Sit upright 1 to 2 hours post meals.

Softer foods may be more tolerated.

Liquid calories may be more tolerated than solids.

Some may find it helpful to consume solids in the morning and liquid meals late in the day.

Walk after eating and get at least 30 minutes of moderate-intensity activities each day. Adequate physical activity can affect stomach motility.

Control blood glucose levels if needed. High blood sugar can lower stomach motility.

Eat smaller, more frequent meals.

No liquids with meals. Wait at least 30 minutes to an hour after meals to drink.

Rest or lie down after eating.

Avoid simple sugars (e.g., fruit, juice, sugary drinks, desserts), especially by themselves.

Slowly adding fiber to the diet can help delay stomach emptying.

Some people may need to avoid or limit dairy.

Consider talking to your healthcare provider if dumping symptoms are frequent as it can cause nutrient deficiencies.

Increase fluid intake. Sip fluids throughout the day.

Alternate bites of foods with sips of liquid while eating.

Choose soft, moist foods; add sauces or gravies to moisten foods.

Limit coffee and tea if they exacerbate dryness.

Use sugarless gum, hard candy, or mints to increase saliva.

Rinse mouth with water + baking soda (1/2 tsp in 8 oz water) every few hours.

Limit cavity-promoting foods, such as sugar, simple starches (e.g., breads, pasta), candy, desserts, and brush teeth after eating them.

Avoid mouthwashes containing alcohol. Use a very soft toothbrush.

Use a cool mist humidifier at night.

Use lip balm or moisturizing products for lips.

Avoid tobacco, alcohol, and cannabis.

Eat slowly and chew well.

Limit chewing gum and carbonated beverages.

Soak, discard water, and rinse legumes well (e.g., beans, lentils) before cooking.

Cook tough vegetables thoroughly.

Focus on lower fermentable foods and limit highly fermentable foods (aka FODMAP diet). Then gradually introduce high FODMAP foods one at a time to determine tolerance. See details of the FODMAP diet at Monash University.

LOW FODMAP food examples (less gassy):

• lentils
• edamame
• tempeh
• tofu
• soy & almond milk
• broccoli
• eggplant
• green beans
• carrots
• zucchini
• tomatoes
• peanuts
• walnuts
• cantaloupe
• kiwi
• oranges
• gluten-free pasta
• quinoa
• rice
• corn

High FODMAP food examples (more gas-producing):

• kidney beans
• peas
• cow milk
• asparagus
• artichokes
• cauliflower
• mushrooms
• garlic
• onions
• cashews
• pistachios
• apples
• cherries
• wheat
• rye
• barley

Identify foods containing gluten (see below)

Read labels carefully for hidden sources of gluten (e.g., starch, yeast extract)

To make up for grain restrictions, eat gluten-free foods that are good sources of:

• fiber
• iron
• zinc
• B-vitamins

Distilled vinegar is rarely made with gluten-containing grains, and when distilled, gluten is excluded from the final product. Malt vinegar, however, contains gluten.

Medications are not required to label gluten status (but supplements have to provide this information). Ingredients such as starch and dusting powders may contain gluten. Contact the pharmaceutical manufacturer to confirm gluten status.

Eat slowly in a calm, relaxed pace.

Sit down while eating.

Remain upright after eating. Avoid lying down for 2-3 hours after meals.

Eat dinner at least 3 hours or more before bedtime.

Limit/avoid irritants like caffeine, alcohol, tobacco, pepper, and spicy foods.

Limit chocolate and mint (e.g., spearmint, peppermint) that relax the lower esophageal sphincter.

Avoid foods that slow down stomach emptying – large meals, high-fat meals, excessive amounts of protein, and large amounts of fiber in one meal.

Do not arbitrarily remove foods from your diet (to avoid possible nutrient deficiencies from over-restriction). Instead, keep a food diary to monitor which foods cause issues.

Sipping water may help to periodically rinse the esophagus.

Rinse mouth and/or brush teeth if reflux reaches the oral cavity to prevent tooth decay.

Raise the head of the bed for sleeping or when lying down (stack pillows; use a cushion wedge).

Wear loose-fitting clothing.

Lose weight if needed.

Discuss medications and supplements that may contribute to or may reduce reflux with your healthcare provider (e.g., theophylline, pain medications, and hormones may increase reflux; acid suppressants, prokinetic agents, and proton pump inhibitors may reduce it).

Avoid overfeeding babies, and do not force them to finish a feed.

Interrupt infant feeding more frequently to burp.

For infants, trial smaller, more frequent feedings.

Ensure infant formula is properly mixed.

Hold infants upright 20-30 minutes after feeds. Then, positioning the infant with the head elevated or on their left side while awake may be helpful. (Infants should be placed on their backs while sleeping).

Some may also find it beneficial to place infants on their right side while awake for the first hour post-feed to promote stomach emptying followed by left side placement while awake to decrease reflux. (Infants should be supine while sleeping).

With excessive or prolonged reflux in infants, discuss the possibility of food allergies (e.g., milk protein allergy, egg allery) with your healthcare provider.

Caution: changes or additions to infant formula or breast milk, such as anti-reflux formulas or thickeners, should to be discussed with your healthcare provider before use as they may not meet nutritional needs, may create excessive calorie intake, and/or may not be safe for use in certain infants.

Stay hydrated.

Cold beverages and ice chips (in children older than 3) may be more easily tolerated.

Use oral rehydration solutions when necessary. (See recipe below & under diarrhea).

Slowly reintroduce solid foods as tolerated.

Trial bland, dry, starchy, or salty foods.

Eat smaller, more frequent meals to maintain nutrient intake.

Eat slowly and chew well.

Avoid strong odors and greasy or high-fiber foods.

Focus on energy-dense foods, such as avocados, nut butters, and lean proteins, and fruits and vegetables since they have potassium and magnesium.

Mints, chocolate, coffee, teas, and carbonated beverages may exacerbate these symptoms (although carbonated drinks might help soothe a nauseated stomach in some situations).

Trial eating foods at room temperature.

Move slowly from laying down to sitting or standing.

Sit upright 2-3 hours post meals.

Wear loose-fitting clothing.

Eat a snack before getting out of bed in the morning (e.g., during pregnancy).

Interrupt infant feedings to burp more frequently.

Hold infants upright 20-30 minutes after feeds.

Avoid jostling infants after feeds.

Ensure proper mixing of infant formula and avoid overfeeding.

Rinse mouth with water, baking soda dissolved in water, or brush teeth after vomiting to protect teeth.

Use gum or hard candy to help offset metallic taste in mouth.

A vitamin B6 supplement may or may not help.

Ginger and acupressure may be helpful.

Consider zinc intake.

Consult your healthcare provider about zinc supplementation. (Caution, high dose zinc supplements for extended periods may cause a copper deficiency).

Smaller, more frequent meals may be more tolerated.

If foods are too sweet, add lemon, salt, or sour sauces.

Marinating foods in or adding fruit juice may help disguise bitter tastes.

Choose more neutral-flavored foods (e.g., tofu, eggs, white fish, or chicken vs. pork, steak, or salmon).

Use plastic utensils or chopsticks instead of silverware to reduce metallic tastes.