Dr. Tamara (Cullen) Evans, ND

As a pediatric naturopathic practitioner, one of the top complaints I see in this population is constipation. This condition may start as early as 6 months with solid food introduction, but often presents itself during the toddler years. While there are many causes of constipation that must be considered for diagnosis, it is not uncommon to conventionally treat a case of constipation with Miralax laxative. In fact, pediatricians prescribe Miralax so often, that there is an inside joke amongst them that they refer to this medication as Vitamin M. Funny or not, Miralax does do its job and helps relieve a child of painful stomachaches and impacted stool. It is a great tool to use for difficult cases and especially when we need to “clean out” a child. But, are there other natural treatment options for constipation? You bet! Here are some options for you to consider for your child. Please consult your child’s physician if he/she is already on a laxative treatment regimen.

  1. Avoidance of cow’s milk dairy – An association between cow’s milk consumption and constipation is suggested by observations of improvement after elimination of cow’s milk from the diet in some infants and children1. As an example, one study focused on 65 children (ages 11 to 72 months) with chronic constipation who had been referred to a pediatric gastroenterology clinic2. Patients were given cow or soy milk for two weeks. Improvement in constipation was observed in 68 percent of children when fed with soy milk compared with none of the children with cow’s milk. In addition to cow’s milk, unripe bananas (due to high starch content) and applesauce (due to high pectin) may be constipating.
  1. Increase high fiber foods, such as prunes, peas, beans, pears, and whole grains. For infants and children younger than two years, a reasonable goal for fiber intake is about 5 grams per day. 3 One-half cup of vegetables or one piece of fruit provides approximately 3 g of fiber. Infant rice cereal is negligible in fiber.
  1. Acacia fiber – if you have a picky eater at home and need to get more fiber into their diet, consider this palatable, easy to use type of fiber supplement. For children over 12 months, mix 1/2 tsp. (or 1 gram of fiber) into 4-6 oz of half water/half prune juice, twice daily.  After 5 days, increase to 1 tsp. (or 2 grams) twice daily, if needed for effect. Always be sure to have your child drink plenty of fluids to balance the fiber intake.
  1.  Epsom Salt baths – a warm bath saturated with Epsom Salt can deliver Magnesium through the skin, which can help relax muscles. Since the colon is an organ with muscle around it, this can improve peristalsis and therefore bowel movements. If you do this bath at bedtime, it has the added benefit of relaxing your child for sleep.
  1.  Tummy massage – to improve the movement of the stool in the colon, start with a warm pack on the belly for 5 minutes and then massage the belly gently in a clockwise direction. If you use a drop of lavender and peppermint essential oil in a carrier oil, such as jojoba or olive oil, these will help to further relax the musculature of the abdomen and intestines.

Recognizing and reversing constipation early in children can save a lot of distress down the line. Once a child has started solid foods, they should be having a bowel movement at least once daily; one that is not hard, compacted, or difficult to pass. If you notice additional signs, such as fever, vomiting, blood, mucous, or abdominal distension, please consult your doctor right away.

IMG_3135Tamara (Cullen) Evans, ND is a 1999 graduate of Bastyr University and currently practicing primary care medicine, with a focus on pediatrics, in Seattle, Washington. She currently serves as the Advanced Pediatrics professor at Bastyr University and she sits on the American Board of Naturopathic Pediatrics, an organization dedicated to the creation of a Naturopathic Pediatrics Board Certification Exam. Additionally, she was a founding Board member of the PedANP and has lectured both nationally and internationally. To date, her greatest accomplishment is raising her teenage son, Max.



  1. Irastorza, Inaki, Berta Ibañez, Lissette Delgado-Sanzonetti, Natalia Maruri, and Juan Carlos Vitoria. “Cowʼs-Milk–free Diet as a Therapeutic Option in Childhood Chronic Constipation.” Journal of Pediatric Gastroenterology and Nutrition 51.2 (2010): 171-76. Up to Date. Web. 13 May 2015.
  2. Iacono, Giuseppe, Francesca Cavataio, Giuseppe Montalto, Ada Florena, Mario Tumminello, Maurizio Soresi, Alberto Notarbartolo, and Antonio Carroccio. “Intolerance of Cow’s Milk and Chronic Constipation in Children.”New England Journal of Medicine N Engl J Med 339.16 (1998): 1100-104. Up to Date. Web. 13 May 2015.
  3. Agostoni, C., E. Riva, and M. Giovannini. “Dietary Fiber in Weaning Foods of Young Children.” Pediatrics 96 (1995): 1002. Up to Date. Web. 13 May 2015.


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