[0:00 – 1:47]
Meg Faure: Welcome to a brand new episode of Sense by Meg Faure. Today, we’re going to be handing the mic over to paediatric dietician, Kath Megaw, for our very first Feeding Sense segment. Kath is gonna be doing a takeover. She’s gonna take over as our host and she’s gonna unpack baby and toddler digestion from every angle, every month. So this is a first of a regular series. Kath’s very first episode today, she is joined by Nicole Comninellis. She’s a brilliant paediatric physiotherapist with a special interest in neurodevelopment, infant digestion, and pelvic floor health. And importantly, she is a mom herself. But today, they are going to be tackling one of the most common and misunderstood challenges in babies and toddlers, and that is constipation. So if you have been battling with a little one who’s constipated, this is an episode you must not miss. From babies arching and straining, to toddlers avoiding the potty, to special needs little ones who battle with constipation, Kath and Nicole help us to make sense of what’s really going on in your little one’s body and what you can do about it. There are gonna be three key things that you’re gonna take away today. The first is why movement and posture are as important as food when it comes to helping your baby poo comfortably. So we’re gonna talk about that. They also talk about how constipation can really trigger stress patterns in the brain and how to interrupt that cycle early because the minute your little one gets stressed about pooing, they then hold onto their poo and then constipation gets worse. So we’re gonna talk about how to break that pattern. And then they’re gonna talk about simple and practical strategies from positioning to language to routine, all of which can help prevent constipation from spiralling into a chronic issue. Whether your baby is struggling to pass a stool or if your toddler is terrified of the potty, this episode is packed with real strategies, clinical wisdom and compassion. So don’t go anywhere. This is an amazing episode. Over to Kath and Nicole.
[1:48 – 2:30]
Bailey (Announcer): Welcome to Sense by Meg Faure, the podcast that’s brought to you by Parent Sense, the app that takes guesswork out of parenting. If you’re a new parent, then you are in good company. Your host Meg Faure is a well-known OT, infant specialist and the author of eight parenting books. Each week, we’re going to spend time with new mums and dads just like you to chat about the week’s wins, the challenges and the questions of the moment. Subscribe to the podcast, download the Parent Sense app and catch Meg every week to make the most of that first year of your little one’s life. And now, meet your host.
[2:33 – 2:57]
Kath Megaw: Hi, everyone. It’s so awesome to be on this Feeding Sense podcast journey with you. I’m Kath Megaw and a paediatric dietician. And I’m very excited today about today’s topic and excited about the guests joining us. Nicole, it’s so wonderful to have you join us. I would love you to just tell everyone a little bit about you and who you are.
[2:57 – 3:43]
Nicole Comninellis: Sure, I’m a physiotherapist with a special interest in paediatrics. I studied at Wits for my undergrad and I did my Master of Science in Medicine and Child Health at Wits as well. I have done courses since graduating specifically in paediatrics and that’s the field that I’ve worked in since then in neurodevelopment, in neurology, in paediatric pelvic floor. Yeah, very many interesting nooks and crannies. Also, I’m a certified neonatal therapist. I have two kids of my own and I feel like we’re on a never-ending journey of learning. Yeah, thank you for having me today.
[3:44 – 5:48]
Kath Megaw: Oh, it’s wonderful. And I think guys, just to sum up, Nicole’s all her amazing qualifications and experience. She really is amazing working with little people and just helping them navigate their bodies. And our bodies are attached to so many different challenges and different areas from our development to our eating behaviour to, and one of the topic that we’re gonna talk about today, constipation, and love what you say. You’re a mom of two and a boy and a girl, if I’m correct, Nicole. And I always say that, you know, my kids probably helped me and forced me to put my theory into practise and then make huge adjustments. So I’m very excited and I’ve worked with Nicole. So I have the benefits of working with her and I’ve worked with her over the years and will continue to do so, which is really exciting. And so I’m really excited about this interview and this chat and that we can really just bring some insight. So let’s just jump right into constipation. I mean, constipation is something I know I come across in my practise on a regular basis. It’s something I see regularly, whether it’s babies struggling with constipation to toddlers, to young children, to even teenagers. But for the topic of today, we’re gonna look mostly at our babies and toddlers and just their journey around constipation. So obviously with my hat on as a dietician, I go straight for what is the child eating? Are they getting enough water to drink, et cetera, et cetera, all things that are really important and necessary to look at. But just as I suppose the parents watching will be very aware that we know that that doesn’t always solve all the problems. So I would love just to hear from your perspective as a physio, what does constipation look like in a baby or toddler? And what are some of the signs that you would come across that may not seem as obvious?
[5:49 – 11:19]
Nicole Comninellis: I think it depends on the age of the child or the baby. Also, if they’ve had a long-term issue with constipation or if it’s a new thing, you know, if it’s a baby and it’s also a parent who’s navigating a journey of constipation for the first time, whether the baby’s breastfeeding or formula feeding or whether they’ve started solids or not yet, there’s different things that we think about versus a toddler who’s already maybe mobile or a toddler who’s maybe not mobile for whatever specific reason. And looking at all the domains around what could be affecting all of these areas. For babies, yes, for sure. You know, we all understand that certain things, certain foods, whether coming, you know, through from breast milk or from formula can lead to digestive difficulties, you know, on either end of the spectrum. But also part of this is that, you know, in babies, there are certain postures and certain movements that babies are supposed to sort of, if they have had the ability to make it through full term, let’s say the preterm population have very different postures, but they have, you know, a certain expectation, I wanna say almost like genetically to move and all of these things sort of keep the body, I wanna say like in sync with itself and everything has a knock on effect on something else. And so when all the systems can work symbiotically, it can create just a really easy, comfortable time in all domains. When we have like, for example, the preterm population where, you know, they are born early, not only is that like a threat to the nervous system, but now they are having to, and even with as much as possible, like minimised stress, you know, they are having to undergo developments in a different sort of order, and not just physically, but also, you know, in terms of digestive processes as well. For example, babies who may have had difficulty breathing might have also had difficulty with how their diaphragm can move and the diaphragm and the pelvic floor are supposed to be sort of besties, you know, they need to be in a certain kind of sync as well as other muscles just in terms of development. If you’re born early, just sort of biomechanically or from like a strength perspective, you may not have the ability to firstly keep yourself in a posture desirable for releasing gas, releasing stools comfortably, or you may not be able to generate the strength needed to actually like, you know, get a good clear out of what’s sitting there waiting to come out. And so then with the little people, it’s quite easy to then, you know, if you don’t get everything out, sort of back up, back up, back up. And at some point that can just look like they’re just really straining a lot. And so we see like different signs. So we might hear about the baby that’s just always straining and arching and pushing back and refluxing a lot. And always irritable, always on this high alert. And some babies might have constipation but not have any other signs. They might just be constipated, but maybe that’s because their internal understanding of the system doesn’t like allow them to feel that stress at the same level as say another baby, whether they’re full term or preterm. And so just your innate understanding of what’s high alert for you or for somebody else can mean that something is frightening versus not frightening. And so the way then the body responds might be driven to like increase cortisol. And then there’s like a whole cascade of events that come with that. And sort of when we look at that early sort of infant period as well, when they are repeating the same sort of postures, the same sort of behaviours, we do also have to consider from like a neurological perspective of just brain development, that repetition is laying down quite a strong network for like a go-to highway. And so even if there’s like a period of resolve, it might be quite easy to fall back into that at a later point. And these are things that I really, there’s a good groundwork for that.
[11:20 – 12:20]
Kath Megaw: Before you carry on, just so that I just, so that my moms can obviously just understand, I just wanna bring back to what you said, which was so lovely in the beginning, that that synchronisation between kind of all parts of the body is so important, especially when it comes to passing stool and going to the loo and just generally doing life. So some of them, and we see that in the newborns, they look like they’re breathing and they’re pooping and they’re doing everything all in the same.
Nicole Comninellis: That’s what we want, yeah.
Kath Megaw: Yeah, and they’re doing it all together and sometimes they’re a bit discoordinated in that. But this last point you mentioned really like piqued my interest was just around that cortisol and then that kind of neurotransmitter pathway in the brain that kind of lays down a different pathway. And so if you are constipated and you’re struggling with that, you kind of stay in that mode. Is that what I’m understanding that you’re saying?
[12:21 – 14:51]
Nicole Comninellis: So any sort of threatening experience, whatever it may be, can then lead to elements of stress, right? Stress postures and driving that, then autonomic nervous system into like a sympathetic overdrive. So that’s like your fight and flight. And we can’t, our digestive systems can’t work so well under those conditions. It’s like genetically like long determined that, that is not the moment to go when we are under stress because it’s really like, okay, am I in danger? I need to survive. This would not be a good time to poop. And so if we can consider like seeing that perspective with babies as well, like how do we help them not feel like that even as a small infant so that when they go they are creating good positive understanding of like the interoception of their body, like making sense of the insides, if you will. And like you say, like just being able to breathe and poop and not have it be the end of the world. Not only then does that make it easier for the baby, but also for the family. Nobody wants a baby that’s having a tough time, passing stool that’s such a basic human need. Nobody wants to suffer through that. We all want to help our babies. And so that’s why it’s important to look at how can we help them. And sort of just taking like a little step towards like toddlers as well, right? In there there’s a lot of other things that are coming in. For example, the need for autonomy and other sensory processing things. Also whether they were preterm or full term. And as well as the family’s cultural dynamics, what have they learned about their bodies over time based on what they’ve observed, based on what is spoken about, books that are read, like the normalisation of body function essentially.
[14:52 – 15:34]
Kath Megaw: I like that. So just for the infant moms, before we move further into the toddler, ’cause I’m really excited to speak about some of those practical things there. And I know you’ve got amazing experience in that. For those infant moms, we’ve heard now that we don’t want to create it as an anxiety space for a baby. And we don’t want it to be an area that creates a stress or the way they make these pathways that making a poo is sore and difficult and that. So what kind of just one or two practical tips for those early months of pooping, what would you suggest could be helpful for a new mom or a mom with a newborn to really understand?
[15:35 – 16:13]
Bailey (Announcer): This episode is brought to us by Parent Sense, the all-in-one baby and parenting app that help you make the most of your baby’s first year. Don’t you wish someone would just tell you everything you need to know about caring for your baby? When to feed them, how to wean them and why they won’t sleep? Parent Sense app is like having a baby expert on your phone guiding you to parent with confidence. Get a flexible routine, daily tips and advice personalised for you and your little one. Download Parent Sense app now from your app store and take the guesswork out of parenting.
[16:15 – 16:24]
Kath Megaw: What would you suggest could be helpful for a new mom or a mom with a newborn to really understand?
[16:25 – 17:29]
Nicole Comninellis: I think the first thing is to just understand the variation that can come with, you know, what is considered normal with poos. Firstly, like, you know, in terms of what they look like, how often, you know, when to know something doesn’t seem right, because sometimes not knowing can mean that you can’t prevent something if it’s sneaking up on you. And then past that, I really do think that we need to consider how babies are held in their day-to-day, the positions they are experiencing, their routine, not in terms of just like, I wake up, I eat, I sleep, I poop, you know, whatever. But actually, what is the day-to-day variation? How many different positions is this baby held in a day?
[17:30 – 17:35]
Kath Megaw: So it’s good to hold in variety of positions and to change position in.
[17:35 – 18:22]
Nicole Comninellis: We need variety. We know that babies have a, and this is really well researched, we know that they have movements that continue after birth into the first few weeks, and then slowly change into other kinds of movements. And these are very well-researched movements. And we can look at them and know like, well, is this movement typical? Or is there some difficulty in the coordination here? And if there’s a baby that has difficulty in coordination, that doesn’t mean that there’s something terribly wrong, but it can point towards dysfunction and coordination. And like, well, how can we improve that coordination? Obviously, in a baby who’s had a turbulent history…
[18:22 – 18:59]
Nicole Comninellis: …then we would look more closely, you know, at the whole picture. But those babies aside, because I feel like that’s a whole different group, we need parents to know that actually sometimes the most basic of human functions, and that’s bonding and contact, can help so much, because our general way you hold a baby is going to favour easy stooling, as opposed to a baby that’s laying on their own, trying to do everything on their back or, you know.
[19:00 – 19:43]
Kath Megaw: But that’s so helpful. So for our mums there with babies that are developing neurotypically, we really just want to keep encouraging, picking up connection, changing positions, holding, allowing them to have some free time on their tummies. I always hear the physios talk about that so much. But that’s all part of the pooping journey, actually, is these different positionings that I’m hearing. So that’s really, yeah, that’s really helpful and something that’s so manageable for parents to do. And probably, you know, just to not be scared to hold and access your baby in the different positions, which is so lovely. Yeah.
[19:44 – 20:21]
Nicole Comninellis: They are very capable of doing very many of the same positions we can do. It’s just that they are subject to us, how do we hold them? And to sort of just branch off of that as well, it’s like, how do we listen to them? Because they’re all telling us, you know, how they feel, they’re communicating all the time. And many parents will know, well, that’s the face he makes when he makes a poop, you know, like, are we just going to let him lay there and struggle or are we going to maybe pick him up and…
[20:21 – 21:25]
Kath Megaw: Let gravity help a bit. Yeah, I love that. OK, wonderful. So now we move on to our toddlers, this little age group of human beings that are trying to find their space in the world. And in my world, it’s all about the food and what they suddenly realise they have a voice there, which often does impact what happens in their gut. But then also, like you say, there comes another element here, that they are learning that they have some autonomy. And I can imagine that if it’s in the food space, they also experience in that autonomy, even in the pooping space or whether they are… And I know often parents have kind of expressed that that first constipation incident happened around the time of trying to potty train. So clearly, there’s a bigger thing at play than just what food has gone into them during the course of that day. So, yeah, just give me your insights into toddlers and their pooping habits.
[21:26 – 26:57]
Nicole Comninellis: Yeah, so toddlers are an interesting bunch. I think firstly, there’s lots of different types of personalities. They are going to be those that really understand their bodies very well. They know what this feeling means and they can very quickly learn what to make of that. There are those that maybe don’t understand their bodies so well. Maybe they are, you know, tuned into other things. We do need to consider those that might down the line have ADHD or hypermobility where their body is telling them other things or their focus is all over the place. And also, the messages that they receive from their body are sometimes not necessarily as… What’s the right word? Like bright. Sometimes that’s diminished. It’s a bit dull. So those that have your connective tissue disorders or hypermobility, sometimes there’s a certain laxity that can make certain signals harder to make sense of or feel. And that’s definitely what is observed in a lot of those populations. Toddlers, yes, it’s an interesting time. Firstly, one presumes that they are mobile and happily mobile, you know, exploring different apparatus, you know, having learned to walk, climbing up, enjoying things like jungle gyms and slides and swinging and roly polies and all sorts of things. And all of these activities actually really help the digestive system. But through that as well is that drive to also sort of maybe possibly pick what they are eating. And sometimes this is like a little bit of a chicken and an egg thing, right, as well. Because if you are constipated, you might also not be feeling your best in terms of eating habits. And so it is kind of like, you know, which sets which one off. And then you’re throwing in other new experiences, like often maybe new siblings, starting school, different environments that maybe feel a bit more threatening, or maybe a different structure to the structure that’s at home. And it’s often like if you think of learning to use the toilet as well, you need it to be a really safe space. Because that’s where you are essentially your most vulnerable. And that’s where you need to be at your most peace, to really be able to, you know, let it go. And so if you are then having all of these different factors coming up, and even just simple things like having somebody take your toy away at school and now you’re upset might mean something like, well, you’re going to withhold because now doesn’t feel like the right time to go, even though you might have had the message. And so with interesting toys and everything else happening, sometimes they just don’t want to go because they just want to keep playing. And, you know, their bodies are little, it’s easy to back up as well. Aside from, you know, any other major life events. So then it just becomes a pattern, it again becomes, well, this is what I’m used to. And slowly with time, the body changes. So the storage facility or the rectum, it can actually expand. And when that happens, the brain needs it to be stretched in order to feel that there’s something there. And well, if it’s pretty wide, it’s going to need more and more to send that message. And then at the same time, you’re going to need quite a lot of abdominal pressure to be able to get that to move out. And the longer things stay in the gut, the more water comes out as well. So it does start then very quickly becoming a little bit of a nightmare. And then you get the, it’s sore. It doesn’t, my tummy’s sore. When the poo is finally coming out, it is so hard or so wide that it is painful. And that is that fear starts. And it just takes one of those to set off the like, I don’t want to do that again. Much like tasting a food that, you know, it wasn’t a favourite the first time, but we know that we have to sometimes continue trying before we accept something. But with that, it becomes very fear-driven and anxiety-producing and that’s in a state of stress. And then you’re going to see overflow into other areas as well, like avoidance behaviours or only being able to poo under very specific conditions, which can then be very hard for families.
[26:58 – 28:05]
Kath Megaw: So, yeah, I think you’ve really unpacked how it kind of progresses from an innocent bit of constipation into something that can become quite difficult and challenging to deal with and needing quite a lot of intervention. So definitely like most things in life with kids and early intervention is always important. So if you’ve noticed your child’s stool habits are starting to change or you notice that they’re struggling, don’t struggle on your own, you know, get some help, just get some guidance. But just to kind of, as we come to a conclusion and a wrap up here, I always just love to leave parents with something that’s tangible that they can take away. So if a mom is listening or a dad is listening and struggling with a toddler who is, you know, having some constipation issues, what would be some first line? Obviously, you know, there’s interventions and there’s, you know, to get assistance and help is so important. But what would be some first line things that a mom can do or some even some preventative things that we can do as parents to actually prevent it getting to the point where it’s such a big problem?
[28:06 – 29:46]
Nicole Comninellis: I think, you know, firstly, like looking at the diet and hydration side of things, making sure that they’re actually getting enough water as well, and not just overloaded with, like you say, fibre, like trying to get as much of a balance as possible. And looking at behaviours and how you can use your day to day body sort of reflexes to drive behaviours. Those that are listening might know for themselves that, you know, after a certain amount of time, after a meal, they actually got to go, they need to go. And, and so this is one of the body’s mechanisms to say, well, you know, we’ve just had a meal, we’ve been chewing something. And, you know, chewing is a really important thing that stimulates the gut. And one of those reflexes then gets going and moves things along. So having kids actually eat foods that where possible where they can actually chew, and those that can’t chew, because maybe they have a special need, or disability or neurodevelopmental condition, how can when they are receiving whichever kinds of food that they are receiving, how can chewing be brought in where possible to help with that. And then looking at things like movement, exercise, simple things, just having a good run around, doing a few bunny hops on the floor, whatever it may be just getting some activity.
[29:47 – 29:50]
Kath Megaw: Squatting position, I suppose, is quite helpful.
[29:50 – 32:25]
Nicole Comninellis: And it sort of unpacks a little bit that like, I remember as a kid, we were told, like after eating, no, you need to like sit and be still for a bit. But that’s obviously all very false. And, and then the benefit of tummy massage can really go a huge long way as well. You know, not only does it tune you in with a child, you know, you bringing a sense of calm, you bring understanding to the body, but also then assisting with that motility of moving things along. And it really, really, really helps from small babies, you know, right up. It has huge, huge value. And so a lot of parents will come in saying, you know, they have been doing tummy massage, but when we see how they’re doing it, it’s not quite effective enough in that it’s very just superficial on the skin. And so then being able to show, okay, well, let’s, let’s do it a little bit differently. And, you know, let’s observe your baby as well. You’re not going to massage a child that is screaming as well. Screaming and tummy pain, you’re not going to say, well, like lay down, let me massage you. Like, I don’t know about anybody else, but I’m not going to be able to massage through hard, hard abs that are not letting anybody come close. And so then also just like some education about, you know, the right time for things. And then also just what the toddlers as well, they have such a big drive for autonomy. And sometimes just the language that you use for encouragement in such a careful way to not make it seem like a demand, especially for those like demand avoidant as well. But, you know, how do they know that it’s their idea and how do they feel the success from doing the thing that their body asked them to do that they listened to without having negative input around that? Because again, it could take one negative comment for a toddler to stick to that makes them realise there’s something bad about this.
[32:26 – 32:58]
Kath Megaw: So it’s like saying to them, you know, you can choose this toy or this toy when you go and sit on the toilet now, then they still think they’re in charge of the whole thing. You know, it’s actually going to the toilet. Yeah, exactly. So just like structuring things differently, I would say also not telling a toddler to hurry up or taking time there and making it like what you said, a safe space in the bathroom, that that is a safe space, not a scary space.
[32:59 – 33:23]
Nicole Comninellis: Yeah, it definitely needs to be. It needs to be a very safe space. It also needs to be a supportive space just physically. If they’re using a little potty, it needs to be well fitting, needs to properly be the right size so that when they sit on, they’re not falling through. They need to have their feet supported, knees above the hips.
[33:23 – 33:45]
Kath Megaw: Oh, very important. So it’s amazing when that’s when those knees above the hips opens everything up and how important that is and how simple that actually is. It’s simple, it’s free and it makes a huge difference, like you say, to the brain when you just open that space in the pelvic floor.
[33:45 – 34:05]
Nicole Comninellis: We see that, you know, kids will take up that position, but then they don’t actually know how to relax their muscles as well. So to also, you know, educate parents that it’s not always about like pushing, but sometimes it’s actually just about learning how to relax as well.
[34:06 – 35:51]
Kath Megaw: That’s good. Phew. There’s such a lot of amazing, helpful tips that you’ve given to the mums and dads out there today. So we really just hope that for those of you struggling with your children, with the issue of constipation, that you’ve able to take away something from our chat today with Nicole. Thanks, Nicole, for for joining us on this journey. And it’s always so holistic. You know, food plays a role, absolutely. But there’s so many other factors as well that we don’t want to forget. And that’s why I love to bring in the different elements around that so that we know. And also just, you know, when we are loading our kids with lots and lots of fibre, and often we get given fibre sachets by our medical doctors because we need fibre for our stools and that, but then we don’t drink enough water, it does create another whole big problem on its own. So that’s another tip to just remember is make sure that you’re meeting the fibre intake that your kids are getting with enough water, that you’re creating a safe space in the bathroom, that you’re creating routine, that you are just creating movement from your newborn, your baby, your toddler, move, play, dance around with them. And I just love how things go across different spaces, you know, from movement helps with constipation, but it also helps with core development, which then helps in the school space. And so it’s just all so integrated, overall health. So thanks so much, Nicole. And how would parents get hold of you if they would want to seek out some more help from you?
[35:52 – 36:09]
Nicole Comninellis: I think the easiest would be to go to the website, which is www.thelaunchpad-kids.com. Because on there, there’s information and there’s an online booking. So that’s the easiest.
[36:10 – 36:26]
Kath Megaw: Okay, wonderful. Well, we’ll definitely put that in the notes. And thank you so much for your time. We really appreciate it. And to you mums and dads out there, have the best time with your little ones. And remember, you are amazing parents. Thank you.
[36:27 – 36:28]
Nicole Comninellis: Thank you so much for listening.
[36:29 – 36:39]
Bailey (Announcer): Thanks to everyone who joined us. We will see you the same time next week. Until then, download Parent Sense app and take the guesswork out of parenting.
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