Fussy Eating Linked To Constipation in Preschoolers

MedicalResearch.com Interview with:
Anne Tharner, PhD
and
Jessica C. Kiefte-de Jong, PhD
Department of Epidemiology
Erasmus Medical Center, Rotterdam
The Netherlands

Medical Research: What is the background for this study? What are the main findings?

Response: Constipation is one of the most common health problems in children, and occurs in most cases without organic reason. In our study, we examined if fussy eating behavior might be related to constipation in children. “Fussy eaters” are children who reject specific foods – often (green and bitter) vegetables – and often compensate this with the intake of less healthy but highly palatable foods (such as fast food or sweets). This kind of diet might be one of the reasons for constipation in children, but at the same time, children might develop difficult eating patterns due to digestive problems such as constipation. Therefore, we examined whether fussy eating and functional constipation mutually affect each other, which might point to the development of a vicious cycle.

We examined this in a large study including almost 5000 children aged 2-6 years who participated in a longitudinal study in Rotterdam, the Netherlands. Families were regularly followed up starting in pregnancy.

Our main finding was that fussy eating co-exists with functional constipation and also predicts subsequent development of functional constipation. In addition, we also found evidence for the reverse, as functional constipation predicted subsequent fussy eating behavior. Together with previous studies, our findings suggest that indeed a vicious cycle may develop throughout childhood in which children’s constipation problems and problematic eating behavior mutually affect each other. On the one hand, fussy eating might affect the development of functional constipation via poor dietary quality which is a characteristic for the diet of fussy eaters. On the other hand, our findings show that functional constipation in also predicts future fussy eating. This pathway is less well studied, but it is conceivable that children with constipation and the accompanying abdominal pain and painful defecation may develop problematic eating behavior.

Medical Research: What should clinicians and patients take away from your report?

Response: Awareness of the interconnectedness of fussy eating and functional constipation might be beneficial for affected families to better understand both conditions and relieve anxiety and guilt about them. Protocols for the long-term management of constipation already emphasize the importance of behavioral interventions to promote awareness of the condition and its causes, to improve toilet training and dietary habits, and to address anxiety and guilt in parents and children. This aspect of treatment should be further stressed, as longterm use of laxatives might not be an ideal treatment for constipation, particularly in children. Behavioral interventions targeting fussy eating behavior in children might be a useful strategy in the treatment of functional constipation, as fussy eating behavior might be one of the reasons for unhealthy dietary intake involved in constipation. Likewise, awareness of digestive problems in fussy eaters might help to reduce some of the stress related to food fussiness in children. Also, the treatment of fussy eating might be facilitated by the use of laxatives in children with constipation, if fussy eating is in part a learned behavior in response to painful bowel movements.

Medical Research: What recommendations do you have for future research as a result of this study?

Response: More research is needed to examine both eating behavior as a factor in the development of constipation and vice versa the role of digestive health problems for the development of fussy eating behavior in order to establish whether these two conditions are actually causally related. If this is the case, the effectiveness of behavioral interventions on top of the use of laxatives in the treatment of constipation should be examined. More information regarding how a vicious cycle between problematic eating behavior and digestive problems might develop starting at an even younger age are needed to implement early interventions. Also, related factors such as parenting behavior in general and in regard to feeding might also be examined to be able to develop effective behavioral interventions.

Citation:

Bidirectional Associations between Fussy Eating and Functional Constipation in Preschool Children. 
Tharner, Anne et al. The Journal of Pediatrics

Published Online: October 28, 2014
DOI: http://dx.doi.org/10.1016/j.jpeds.2014.09.028