Challenging the view that lack of fibre causes childhood constipation

David Tappin*, Mariusz Grzeda, Carol J Joinson, Jon E Heron

*Corresponding author for this work

Research output: Contribution to journalArticle (Academic Journal)peer-review

8 Citations (Scopus)
92 Downloads (Pure)


To assess evidence supporting the view that ‘low fibre causes childhood constipation’.

Triangulation integrated three approaches: a systematic review NICE Guideline CG99 examining effectiveness of increasing fibre; a cohort study, ALSPAC, to assess if constipation (or hard stools) can precede fibre intake at weaning; and a literature search for twin studies to calculate heredity.

CG99 examined the literature regarding the effectiveness of increasing fibre. ALSPAC asked parents about: hard stools at 4 weeks, 6 months and 2.5 years and constipation age 4-10 years, as well as fibre intake at 2 years. Twin studies and data from ALSPAC were pooled to calculate concordance of constipation comparing monozygous and dizygous twin pairs.

CG99 reported six Randomised Controlled Trials (RCTs). ALSPAC hard stool data from 6,796 children at 4 weeks, 9,828 at 6 months and 9,452 at 2.5 years plus constipation data on 8,401 at 4-10 years was compared with fibre intake at 2 years. Twin studies had 338 and 93 twin pairs and ALSPAC added a further 45.

Increasing fibre did not effectively treat constipation. Hard stools at 4 weeks predated fibre and at 6 months predicted lower fibre intake at 2 years (p=0.003). Heredity explained 59% of constipation.

RCTs indicate that increasing fibre is not an effective treatment for constipation in children. Hard stools can precede and predict later fibre intake. Genetic inheritance explains most childhood constipation. Extended treatment with stool softeners may improve fibre intake and limit long term damaging sequelae of constipation.
Original languageEnglish
Number of pages5
JournalArchives of Disease in Childhood
Publication statusPublished - 10 Mar 2020


  • cohort
  • observational study
  • constipation
  • childhood
  • twins
  • heredity
  • diet


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