Chronic constipation is fairly common amongst children but it’s important to point out, it’s not normal. While our first assumption is its usually caused by reduced fibre and water intake, there are a few other factors which may causing these gastrointestinal symptoms (1).
Vitamin B12
Recent evidence suggests that low levels of Vitamin B12 in children occurs more often than originally assumed (2). While constipation alone may does not automatically indicate B12 deficiency, it can occur due to the autonomic nervous system dysfunction associated with vitamin B12 inadequacy (3). Gastric emptying of solids and liquids depends on complex neurohormonal interactions which rely on vitamin B12 (3).
Other Symptoms of Vitamin B12 inadequacy
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Weakness
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Fatigue
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Lack of appetite
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Delay in growth
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Irritability
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Tingling or burning sensation (in extremities)
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Hypotonia (low muscle tone)
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Reduced tactile sensation
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Seizures
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Ataxia (lack of muscle control)
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Symptoms of paralysis
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Involuntary movements
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Concentration problems
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Memory disorders
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Personality changes
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Hyperpigmentation of the skin
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Vomiting
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Diarrhea and/or intestinal symptoms
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Jaundice
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Headache (2)
Reasons for Vitamin B12 Inadequacy
Natural food sources of B12 are limited to foods of animal origin, meaning that it is often a micronutrient in short supply particularly in vegetarian and vegan populations (4). Malabsorption can also lead to low vitamin B12 absorption.
Cow’s milk allergy or cow’s protein hypersensitivity
Cow’s milk allergy has many symptoms including diarrhoea and eczema. Constipation, while less frequent can also be a consequence of cow’s milk allergy (1). Evidence suggests that removing cow’s milk products from children with chronic constipation is associated with improvements in 80% of children. This is also be due to the connection between cow’s milk protein hypersensitivity and constipation (1). Whether the chronic constipation is caused by hypersensitivity to the cow’s milk protein or an allergy, an elimination diet (removing all cow’s milk products) may be helpful in either identifying or ruling out cows milk as a cause (1).
You may have already had your child tested for a cow’s milk allergy via a skin prick test. While his test is extremely useful it only rules out an IgE-mediated food allergy (1). Therefore, even if your child’s skin prick test was negative this does not rule out cow’s milk allergy.
Conclusion
Dealing with chronic constipation may not be as simple as upping fibre and hydration. Food allergies and sensitivities, such as cows milk and inadequate intake of vitamin B12 are the less obvious contributors of constipation in children that certainly warrant further investigation. Constipation in children can be multifactorial and it’s important to work with your healthcare practitioner to properly assess and identify the individually factors that may be at play.
References
1. Dehghani S, Ahmadpour B, Haghighat M, Kashef S, Imanieh M, Soleimani M. The Role of Cow’s Milk Allergy in Pediatric Chronic Constipation: A Randomized Clinical Trial. Iran J Pediatr. 2012;22(4):468-474.
2.Visser P. Vitamin B12 Deficiency in Children | Stichting B12 Tekort [Internet]. Stichting B12 Tekort. 2020 [cited 29 September 2020]. Available from: https://stichtingb12tekort.nl/english/vitamin-b12-deficiency-in-children/
3. Yağcı M, Yamaç K, Acar K, Cingi E, Kitapçı M, Haznedar R. Gastric emptying in patients with vitamin B12 deficiency. European Journal of Nuclear Medicine and Molecular Imaging. 2002;29(9):1125-1127.
4. Green R. Vitamin B12 deficiency from the perspective of a practicing hematologist. Blood. 2017;129(19):2603-2611.
Written By Brittany Darling
NUTRITIONIST (BHSC), WESTERN HERBAL MEDICINE (ADV DIP),
CERT. PAEDIATRIC NUTRITION
