Pears and Constipation - Cure or Cause?
Constipation is very common in babies and toddlers. It is actually one of the primary concerns that parents will go to see a general practitioner or pediatrician about. It is most common in babies around the time of starting solids and for toddlers going through toilet training.
For babies, the change in dietary intake can result in changes in bowel motions, which is why I do have a section on this in The Nourished Baby. The process of the gut maturing (which takes two years) can mean that children experience potentially a bit of constipation (and also loose bowel motions) from time to time - our Smushie would go through stages of functional-constipation - and might need a bit of extra help with this and/or potentially they may be having some foods which are causing a little bit of a blockage to occur.
In toddlers it is a little bit more complex as dietary changes are a harder (cue toddler-brain) and it can often coincide with toilet training. By toddler-stage children can overrule the urge to go if they are not feeling ready or comfortable for what ever reason, which can also lead to a bit of a blockage happening as well.
Keep in mind that there is also some genetic predisposition and potentially other underlying factors with constipation, so do always consult with your medial practitioner first to rule these out.
The Importance of Fibre
There have been a number of new research reports on the management of constipation for children (see below). There is a clear association between a lack of fibre in the diet and constipation in little ones. With constipation the aim is to clear the gut in the least invasive way as possible and also to help prevent constipation occurring again. This is where fibre really comes in - as it helps to add bulk to the stool (insoluble fibre, such as fruit and vegetables skins) AND helps to move it through the lower intestine (soluble fibre).
So Are Pears the Answer?
Many of the parents that I work with are commonly recommended to try pear to help relieve constipation. However, like a lot of areas with starting solids and infant nutrition there is some conflicting advice around this.
It is not completely left of field for pears to be suggested to help with constipation. They are naturally high in sorbital - a natural sugar alcohol which can have a laxative effect. Sorbital is also manufactured as an artificial sweetener which is also where you may have heard this name before. Other foods that also contain sorbital are prunes (also often recommended for constipation), plums, necterines, peaches and apples.
However, the flip side to pears is that as a fruit they contain more fructose (natural sugar) than vegetables and still have less fibre as well. For example the difference in both soluable and insoluable fibre between pear and broccoli is:
|Insoluble Fibre||Soluble Fibre|
Potentially large amounts of pear (especially without the skin) may increase the risk of constipation due to the higher amounts of fructose, as well as replacing the opportunity for other fibrous foods. While pear is what I call 'middle of the road' in terms of fructose amounts i.e not high like bananas but also not low like berries (it has 9.5g/100 so 2 teaspoons) it is still high compared to that of most vegetables. If your child is already having high amounts of fruit and then pear is added, this could be potentially be further counter productive - and given the current current state of what is provided by the baby food industry in which a large percentage of baby food contains fruit and very little vegetables (less than 10%) this is a real probability.
In addition, the transit time of a stool through the gut is affected by the bacteria in the gut which large amounts of fructose can alter. I do discuss more about the importance of bacteria in a babies gut in The Nourished Baby.
It is fibre which is the primary concern when it comes to the management of constipation.
Do use pears to help with constipation but if possible also use the skin - remember this can be pureed and blended up. In the recipe below I do this with kiwi-fruit. It is also why prunes can help as they still have the skin on. You still want to add a lot more fibrous foods, including your green leafy vegetables and I would also highly recommend having your child's overall diet checked as well to help minimse any other foods that could be causing a bit of discomfort, such as baby rice (my blog on this here).
Toddler Friendly Prune Smoothie (aka the constipation smoothie!)
This is my go-to smoothie to help with constipation. It is packed full of ingredients to help the gut to clear itself and very high in fibre - I created this recipe to help our youngest who has had some functional constipation and has worked every time! Just click here for the recipe!
A Special Note - A Team Approach
In reading a number of recent research papers on the management of constipation in infants and children there was a very clear message in which they all stressed the the importance of a multi-team approach for managing constipation, especially for those with toddlers - I work with a number of families struggling with constipation alongside other health care providers and those specialising in toliet training (for example). You can book a 1-1 consultation through my online system here.
Remember that you do not need to struggle with this on your own and sometimes the smallest little tweaks, especially diet-wise can make a really big difference and getting support will help you to feel less alone as well.
xxx Dr Julie Bhosale
References and Further Reading:
The Nourished Baby, 2017 (by me!!)
Ekvall, S (2016). Constipation and Fibre (3rd Ed). Pediatric and Adult Nutrition in Chronic Diseases, Developmental Disabilities, and Hereditary Metabolic Disorders: Prevention, Assessment, and Treatment. Oxford University Press.
Howarth, L & Sullivan, P. (2016). Management of chronic constipation in children. Paediatrics and Child Health, 26, (10), 415-422 doi.org/10.1016/j.paed.2016.06.007
Ferrara, L & Saccomano, S. (2017). Constipation in children: Diagnosis, treatment, and prevention
The Nurse Practitioner. 42(7):30–34, DOI: 10.1097/01.NPR.0000520418.32331.6e