Preschoolers with chronic constipation tend to be picky eaters

In the first study of its kind in the U.S., researchers found that normally developing preschool children with chronic constipation have underlying sensory issues that contribute to their difficulties with toileting behaviors. These children are often picky eaters who might be overly sensitive to food textures, tastes, or odors. They also might have an exaggerated response to noises, bright lights, or other sensory stimuli. Findings were published in the Journal of Pediatrics.

“Our study is revolutionary, revealing that chronic constipation in young children accompanies heightened sensory sensitivity,” says senior author Mark Fishbein, MD, pediatric gastroenterologist at Ann & Robert H. Lurie Children’s Hospital of Chicago and Associate Professor of Pediatrics at Northwestern University Feinberg School of Medicine. “In many cases, chronic constipation might be the first hint that the child also has some sensory issues and could benefit from occupational therapy. Feeding problems due to sensory sensitivities are especially common in these children and they are best addressed when kids are under 5, before maladaptive behaviors become more entrenched.”

In the study, Dr. Fishbein and colleagues assessed the differences in sensory processing patterns between 66 children, 3-5 years of age, with chronic constipation and a matched group of 66 controls. They also examined how the children’s sensory profiles correlate to atypical toileting behaviors. They determined that children with chronic constipation showed increased responses to sensory stimuli and increased avoidance behaviors. Heightened oral sensory processing (sensitivity to food textures, tastes or odors) emerged as the most significant factor in predicting the child’s tendency to behaviors such as withholding stool or overall bathroom avoidance.

“On the surface, the association between oral processing and constipation may not seem intuitive,” says Dr. Fishbein. “However, increased sensory sensitivity can create discomfort and lead to avoidance, and we see that response in both food refusal and in the toileting behaviors of children with chronic constipation. Both feeding problems and constipation may develop as a result of sensory processing difficulties.”

Recognition of the association between chronic constipation and sensory sensitivity could transform clinical practice.

“Our study offers an expanded tool kit to clinicians who care for children with chronic constipation,” says Dr. Fishbein. “Comprehensive care of these children should include consideration of sensory issues and possible referral to occupational therapy.”

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