At Bladder & Bowel UK we are frequently asked questions about the role of water for children with bladder and/or bowel conditions, as well as how to encourage reluctant children to drink the right amount of water for their age, size and activity levels.  We have written and are publishing this blog to help professionals, children, young people and families as part of Nutrition and Hydration Week 2021.

Encouraging children to drink more water

Adequate fluid intake is important for maintaining health and wellbeing. There is guidance for how much water children of different ages and genders should be drinking.

Suggested intake of water-based drinks per 24 hours by age and gender
(Adapted from CG 111 Nocturnal Enuresis NICE 2010 and American dietary requirements, cited in CG 99 Constipation in Children and Young People, NICE 2010).

Children will need more than this if they are physically active, if the weather or classroom is hot, or if they are overweight.

However, many parents complain that their children are reluctant to drink and say they do not feel thirsty, or they refuse to drink water.  Not drinking enough can cause or exacerbate constipation and bladder problems including urinary tract infections, day and night time wetting, as well as being the reason for headaches, feeling tired and struggling to concentrate.

What type of fluids should my child be drinking?

Water is the best drink, as it does not contain any sugar or other additives. However, some children refuse to drink water.  If this is the case for your child, you could try the following:

• Offer them water from the fridge or add ice cubes to it
• Use very dilute sugar-free fruit squashes as an alternative

There are also some things that are not advised. These include:

• Not offering your child fizzy drinks as an alternative to water, except as a rare treat. Fizzy drinks can irritate the bladder lining. This may make your child need to rush to get to the toilet or they may need to go to the toilet more often than is usual.
• Avoid giving your child drinks with caffeine in them. Caffeine can also irritate the bladder causing the same issues as fizzy drinks – having to get to the toilet in a hurry and needing to go more frequently than is usual.
• Not letting your child have more than 500mls (one pint) of milk per day. While milk is healthy, the body uses it more as a food than as a drink.  Additionally, too much milk can exacerbate or cause constipation and may contribute to excessive weight gain.

How can I encourage my child to drink more water-based drinks?

Encouraging children to drink may be difficult, especially if they do not feel thirsty. However, thirst is quite a late sign of needing fluids, so children should be drinking regularly. They should have about six to eight drinks spread evenly throughout the day.  They should be having about half of their drinks during the school day.

Things that may encourage them to drink more include:

• Build drink times into your family’s routine.
• Make drink times fun: sitting together with a book or game and only read the next page or have your turn at the game when your child has had a few more sips. If your child refuses to  drink then put away the book or game until the next drink time.
• Let your child chose their glass, cup or straw. Novelty straws work well for some children.
• You could offer them ice cubes or add slices of fruit to water.
• Start by expecting your child to drink only slightly more than they currently are and then gradually increase the amount you expect them to have until they are having about 1.5litres per day.
• Some children manage better if given half a glass and told to drink it all; others do better if given a full glass and are asked to drink half of it.
• Measure out your child’s water into a clean jug or plastic bottle each day, so they can see what they should be drinking. Pour all their drinks from that so they can see how well they are doing and offer them a small reward if they manage to drink it all.
• Ice lollies and jellies have high water content, but try to chose ones that are sugar-free.
• Do not have battles over drinks.

How can I encourage my child to drink more when at school?

There is information about bladder and bowel issues in nurseries, schools and colleges on the Bladder & Bowel UK website at https://www.bbuk.org.uk/wp-content/uploads/2021/01/Managing-Continence-Problems-in-Schools-2019-.pdf. This includes information for schools on why it is important for children to be drinking well during the school day.

Other things that may help include:

• Ensure your child always has a sports bottle of water for school each day. Make sure they bring the bottle home at the end of the day and offer them a small reward for drinking most or all of it.
• If your child enjoys cold drinks, almost fill the water bottle and put it in the freezer overnight. The water will stay cold as it melts at school the next day.
• Ask the teacher to build drink times into the day, or to allow the children to have their water bottles on their desks.
• Ask the teacher to allow the children to have their water bottles on their desks whenever possible and to use the toilet when they need to. If your child thinks they will not be allowed to go to the toilet, they might not drink at school.
• Encourage secondary age children to drink when moving between classrooms, unless this is not allowed in their school.

Other things to consider

Do not encourage your child to drink in the hour before they go to bed as this may cause bedwetting or make it worse.  If your child has a bladder or bowel problem, making sure they drink the right amount during the day can help (see the chart above).   A good fluid intake can also help when toilet training.

Where can I get further advice or support?

If you are worried that your child may have constipation, or if they have day or night time wetting, if they are struggling with toilet training, or you have any other concerns about their health speak to their GP, school nurse or health visitor for more advice.

There is also lots of information about bladder and bowel conditions in children on the Bladder & Bowel UK website on the Children Resources page.

Bladder & Bowel UK also offer a free confidential helpline for anyone affected by bladder and bowel issues. Contact us via our enquiries web form and a member of the team will be in touch.

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What we eat can affect our health. Diet is particularly important in the early years of life because childhood is the time of rapid growth and development and lots of activity.  It is also a time when behaviours and habits are learnt that may continue to have an influence into adulthood.

Constipation and diagnosis

What we eat affects our bowels as well as the rest of our body. Constipation is known to affect about 10% of children and if not treated quickly can last for weeks, months or even longer. Although it is most likely to start when children are toddlers, it is known that it can occur in babies, particularly around the time of weaning and in older children as well.  Constipation is not always easy to diagnose in children as there are different symptoms which are not always recognised. Not all children who are constipated pass hard or infrequent poos, which are the things that most families associate with this problem.

Constipation can cause abdominal pain, soiling (where poo leaks into the child’s clothing), poor appetite, poor behaviour, low mood. It can affect school attendance and how well children do with their education. It impacts on the whole family, particularly if there is soiling.

Constipation and poor diet

The belief that constipation is associated with poor diet, particularly a lack of fibre and of not drinking enough water-based drinks is still common. However, research evidence suggests that this may not be the case for most children. While it remains true that healthcare professionals are often unable to find the underlying cause of constipation for many children who have the condition, some studies suggest that constipation may have a genetic element or other causes rather than low fibre intake.

The National Institute for Health and Care Excellence (NICE) produced guidance on constipation in children in 2010. This advice and the research evidence underpinning it has been reviewed several times since, but remains: ‘Do not use dietary interventions alone as first-line treatment’ for constipation in children. This is because NICE found that there was no evidence to suggest that giving children more fibre to eat would, on its own, improve the constipation.

So, what should the advice be for children with constipation and for their families?  Treating constipation in children according to NICE guidance involves use of laxatives as the initial intervention. Usually macrogols are tried first: Cosmocol, Laxido and Movicol are all macrogols that may be prescribed for children. Once the child’s constipation is improving lifestyle advice should also be given. This involves providing information about food, drinks and regular toilet visits to try and poo, usually at least once a day after meals.

Constipation and fluids

Children with constipation should be encouraged to drink the right amount of water-based drinks each day, for their age, size and activity levels. Water is needed by the body and if insufficient is drunk each day, the body will try to retain water where it can. That includes reabsorbing more from the poo, creating drier, harder poos that may contribute to constipation. However, there is no evidence that increasing fluid intake alone will treat constipation in children.

The correct amount of water for children is about 600mls for children aged 7–12 months, 900mls for 1–3 year olds, 1200mls for 4–8 year olds, 1600mls for girls aged 9– 3 years old, 1800mls for boys aged 9–13 years old, 1800mls for girls aged 14–18 years old and 2600mls for boys aged 14–18 years old. If children are very active, overweight or in hot environments they will need more than this.

It is suggested that children with constipation have the same fibre intake as is recommended for their peers. For children aged 2 to 5 year-old this is about 15g of fibre a day; for 5 to 11 year-olds it is about 20g and for 11 to 16 year-olds it is about 25g. Children should get much of their fibre from fruit and vegetables high-fibre bread, baked beans and wholegrain breakfast cereals. Children should not be given unprocessed bran, as this can cause bloating and wind and reduce the absorption of some nutrients in their food.

Rarely constipation in children may be associated with a food intolerance or allergy. The most common of these include an intolerance to dairy products or to gluten. Gluten is a protein found in wheat, barley and rye. However, children should not have dairy products or gluten-containing foods removed from their diet without the advice of a healthcare professional.

More information on constipation in children

If you are concerned that your child may be constipated or have a problem such as an allergy or intolerance to a particular food, do speak to their healthcare professional (GP, school nurse or health visitor) for advice, as constipation can happen in children who already have healthy eating and drinking habits and adjusting diet and fluids alone is unlikely to make the problem better.

There is more information about constipation and its management for children, and on other bladder and bowel conditions experienced in childhood, on the Bladder & Bowel UK website at https://www.bbuk.org.uk/children-young-people/children-resources/.

There is a table with more information about how much fibre is in different foods in the leaflet Understanding Childhood Constipation at https://www.bbuk.org.uk/wp-content/uploads/2020/12/Understanding-Childhood-Constipation-1.pdf

Bladder & Bowel UK publish a quarterly e-newsletter, which is full of interesting articles, suggestions and information for people affected by bladder and bowel conditions. To receive the newsletter please send an email to bbuk@disabledliving.co.uk, You can find out more on our newsletters page.

To contact our confidential helpline, fill in our confidential helpline enquiries form.

For more information about bladder conditions in children visit: https://www.bbuk.org.uk/bladder-resources/.

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