DEAR DR. BLONZ: I have a child who has periodic constipation, but he is otherwise in good health. Our pediatrician could find nothing wrong and he suggested an over-the-counter stool softener. It works but only as a temporary measure. What is an appropriate amount of fiber for a child? He drinks a lot of milk. Could this be playing a role? -- S.S., Monterey, Calif.
DEAR S.S.: Constipation for anyone is not normal, especially if it persists. As for recommended amounts of fiber, the basic formula is 11.5 grams of dietary fiber for every 1,000 calories. This means that a typical adult taking in 2,500 calories per day should have about 29 grams of dietary fiber per day. Scaling that down for children: a 5-year-old with an average intake of 1,800 calories should have about 21 grams of fiber. Those between the ages of 7 and 10, with an average daily intake of 2,000 calories, should have about 23 grams of dietary fiber every day.
Studies tend to report that children's diets are low in fiber. My solution for fiber-poor diets starts with what I consider to be the most important meal: breakfast. Does your son have breakfast? A morning bowl of high-fiber cereal might do the trick. If he longs for a sugary cereal, have him use it to sweeten the high-fiber cereal. During the day, you should consider giving him dried fruits. Dried blueberries, for example, contain 10 grams of fiber per half-cup serving; figs and dates contain 9 grams; dried apricots, 8 grams; prunes, 7 grams; and raisins, 5 grams of fiber per serving. Not only do these fruits offer unique, sweet flavors, they're all loaded with important nutrients and phytochemicals.
Avoid imposters like "fruit snacks" and other types of pseudo-fruit treats aimed at the young shopper. The apparent aim is to cajole parents into choosing these products as a convenient way of adding fruit to their child's diets. Although these products boast that they are "made with real fruit," many are gummy sugar concoctions that pale in comparison to the genuine article. Read the label.
Milk doesn't contribute to constipation as a rule, but chronic constipation may be a symptom of a milk allergy. It is estimated that food allergies are present in up to 5 percent of children, and about 90 percent of food allergies involve peanuts, milk, eggs, soy, tree nuts, wheat and shellfish. With the exception of peanuts and/or tree nuts, most children outgrow these allergies.
Another side to the milk issue is that it contains no fiber, so if consumed by itself, it does little to move the bulk of food through the system. Parents with children who eat a low-fiber diet may mistakenly think that the milk is responsible for their child's constipation, when the problem is more likely due to the absence of fiber-rich foods in the daily regimen.
Finally, you mention that your son is otherwise in good health. Be alert to the possibility that socialization issues and other stressors can also play a role in constipation. If your son or your family has been subject to an unusual amount of stress, including issues at school or competitive sports, discuss with your health professional whether these factors should be considered.
Send questions to: "On Nutrition," Ed Blonz, c/o Universal Uclick, 1130 Walnut St., Kansas City, MO, 64106. Send email inquiries to firstname.lastname@example.org. Due to the volume of mail, personal replies cannot be provided.