Constipation at preschool age was associated with food selectivity and feeding via cow’s milk-based bottles in the first 6 months of life, according to a study published in Journal of Pediatric Gastroenterology and Nutrition.

In this cross-sectional study of children aged between 2 and 6 years, functional constipation and eating behaviors were assessed using Rome IV criteria and the Children’s Eating Behavior Questionnaire, respectively. Parents and guardians were interviewed to obtain infant feeding history. Actual water intake or a child’s interest in water were studied as potential confounders. A sample calculation estimating a 25% prevalence of constipation determined the sample size of 1051 children.

The mean age of participants was 4.4 years and functional constipation was reported in 242 (23.0%) children. There were no significant differences between children with and without constipation in terms of age, sex, and socioeconomic or anthropometric status.


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Compared against children without, those with constipation showed lower interest in drinking water and were fed with cow’s milk-based feeding bottles at 0 to 6 months of age. Children with constipation had higher scores of food avoidance behavior while children without had higher scores of behavioral dimensions related to interest in food.

After adjustment, functional constipation was associated with an absence of enjoyment

of drinking water (odds ratio [OR], 2.65; 95% CI, 1.55–4.55), food fussiness behavior (OR, 6.65; 95% CI, 5.19–8.52) and the consumption of cow’s milk-based feeding

bottles at 0 to 6 months of age (mixed breastfeeding OR, 10.83; 95% CI, 4.57-26.69; infant formula OR, 6.35; 95% CI, 3.42– 11.79; whole cow’s milk OR, 17.02; 95% CI, 7.33-39.51).

The study is limited by the inability to determine a cause-and-effect relationship between eating behavior and constipation. While it may be possible to infer a causal relationship between infant feeding behavior and constipation, data was collected retrospectively and is subject to recall bias.

Investigators noted that, “[B]reast feeding in the first 6 months of life may be a tool in the prevention of functional constipation later in life (41) and eating behaviors are a relevant area for future research in [functional constipation] management.” “Future prospective studies should investigate the causal association between eating behavior and functional constipation in children from resource-constrained settings,” they concluded.

Referencede Oliveira MBB, Jardim-Botelho A, de Morais MB, da Cruz Melo IR, Maciel JF, Gurgel RQ. Impact of infant milk-type and childhood eating behaviors on functional constipation in preschool children. J Pediatr Gastroenterol Nutr. 2021;73(3):e50-e56. doi: 10.1097/MPG.0000000000003163. PMID: 33938529