Children’s Gut Health Quiz: From Poop to Probiotics

Concerned about your child’s gut health? This parent-friendly quiz addresses children's poop habits, constipation, probiotics, diet, and what’s genuinely worth worrying about.

Let’s talk about something that doesn’t get nearly enough attention… your child’s poo.

Yes, we’re really doing this.

It might feel a bit gross, a bit awkward, maybe even a bit silly — but your child’s poo is one of the most underrated clues to what’s going on inside and their gut health.

Poo is shaped by your child’s nutrition, hydration, nervous system, toilet habits, and even their sensory experience of the world. It also affects their appetite and general well-being. And yet, many parents are left quietly wondering:

• Is this normal?

• Should I be worried?

• Is it just a phase, or something we should look into?

• Could it be constipation… even if they’re going every day?

• Do I need to cut out gluten? Try probiotics? Get a gut test?

Disclaimer:

The information in this blog is for general educational purposes only and is not intended to replace personalised medical or nutrition advice. Every child is unique. If you have concerns about your child’s growth, digestion, or dietary needs, please speak with a qualified health professional.

This quick quiz is here to help you check in with what you do know, and gently fill in the gaps. We’ll walk through the basics of gut health, signs of constipation, the truth about probiotics, gluten, and microbiome tests… all with no shame, no panic, and no overwhelm.

Just honest, useful info — so you can feel more confident about what’s happening in the bathroom.

Ready to test your gut instinct?

Let’s go…

Q1. How often should a child poo?

A) Once or twice a week

B) Once a day or every other day

C) At least 3 times a day

D) It doesn't matter; everyone is different.

Answer: B.

While there is a wide range of what’s considered normal, by around age 3, ideally, most children should have a soft bowel movement once a day or once every other day.

Going less than four times a week, even without obvious discomfort, is often a sign of constipation. This means the journey from the mouth to the bum is taking too long. Interestingly, pooing more than 3 times a day can also signal constipation. It might point to their bowel being very full, and poo is being passed a bit at a time.

But it’s not just about numbers.

A noticeable change in your child’s usual pattern, whether they’re going more or less often than normal, can be an important clue that something’s up. That is why keeping an eye on a child's bowel habits is an important caregiving responsibility, even after infancy.

In some households, poo is talked about openly — and that’s great! And I don’t just mean cracking jokes (though humour can help), but actually checking in about what’s going on.

If your household is a little more private, it might not be something that comes up often, and I get that. As kids get older and more independent, it becomes harder to keep track.

That’s why it’s worth creating a gentle, shame-free space for these conversations from time to time, so your child knows it’s safe to speak up when something feels different.

What helps?

Try to take the awkwardness out of it: make it casual, matter-of-fact, and free of shame (use humour to make it comfortable to talk about, not to tease your child). Books, educational resources, or even the “Know Your Poo” exhibit at the Science Centre Singapore, can be great ways to start the conversation, especially for kids who are more private or sensitive.

One of my favourite tools is the child-friendly Bristol Stool Chart from ERIC. It is a quick, non-invasive, inexpensive and evidence-based way to help assess and monitor bowel movements. I love that it gives parents and children a simple, less awkward way to talk about their poo. For older kids who are toileting independently, I often say:

“You don't need to tell me all the details - check the chart and let me know the range you are in over the next day or two.

Alternatively, you can say, if your poo looks like number 1 to 3, or 6 to 7 — let a grown-up know. And if you're ever unsure, it's always better to say something.

Click to download this Poo Checker from ERIC.

This helps them feel more in control, provides a framework, and reduces shame or secrecy. One of my clients even has a copy stuck up on the back of the bathroom door!

Q2. What are common signs of constipation in children?

A) Hard, pellet-like poos

B) Skid marks in underwear

C) Reflux, heartburn, or bloating

D) Decreased appetite and belly pain

E) Pee leakage

F) Bouts of diarrhoea

G) Having large poos that block the toilet.

H) All of the above

Answer: H. All of the above.

Constipation isn’t just about how often a child poos. Even if they go daily, they could still be constipated, especially if the poo is hard, painful, or feels incomplete.

Often, constipation in children hides in plain sight.

Many children experience occult constipation, which means stool is being retained in the bowel, but there are no apparent signs. In fact, what looks like diarrhoea may actually be overflow: liquid poo leaking around a blockage of hard stool. It is estimated that 1 in 3 children is constipated.

That’s why current guidelines recommend ruling out constipation first — especially if a child has:

• Recurrent tummy pain

• Soiling or “skid marks”

• Diarrhoea

• Pee accidents or bladder issues

  
  

These symptoms may all trace back to incomplete bowel emptying. Let me explain what happens when stool builds up in the rectum:

• It stretches the bowel, reducing sensation (so kids don’t feel the urge to go).

• Liquid poo can leak out around the blockage (often mistaken for diarrhoea).

• It can cause tummy aches, appetite loss, bloating, or reflux.

• A full rectum may press on the bladder, leading to urine leakage.

• Some children avoid the toilet altogether because it hurts to go.

The Poo in You is an excellent video that explains how typical digestion works, how constipation develops, and how this is related to soiling accidents.

If you are concerned that your child has been constipated for a while or might have faecal impaction, it is crucial to go to your doctor as soon as possible and get a diagnosis and the correct treatment to ensure proper disimpaction. Preventative dietary interventions, like increasing fibre intake, are not advised when there is a faecal impaction. This blockage needs to be cleared first through the appropriate macrogol laxative protocol prescribed by your doctor. And then you can start working on preventative treatments.

Red flag to know:

Blood in the stool is not a typical symptom of tummy troubles. If your child is passing blood in the toilet, on the paper, or mixed in — it’s essential to get this checked out by your child’s doctor as soon as possible, especially if it’s happening more than once.

Bonus Info: Small Shifts, Big Wins: The Power of Toilet Posture

Sometimes, it’s the simple things that make the most significant difference. One of the most overlooked tools in managing constipation? How your child sits on the toilet.

Children often slump, dangle their legs, or even clench without realising it. This posture can make it harder to poop, especially if their feet don’t touch the floor.

That’s where a potty stool (formally called a defecation posture modification device - fancy, right!) comes in. It helps your child sit in a more natural, supported position, relaxing the muscles needed for smoother bowel movements.

Studies have shown that using a potty stool can be a safe and practical support for children with functional constipation — especially when combined with medical treatment or dietary strategies.

It’s a minor tweak, but one that can make a surprisingly significant impact.

Q3. What can affect my child’s bowel movements?

A) Diet (e.g. fibre, fluids, variety of foods)

B) Movement and daily routines

C) Stress and emotional well-being

D) Muscle coordination, body awareness, strength, and pelvic floor function

E) Hypermobility and neurodivergence

F) All of the above

Answer: F. All of the above.

Gut health isn’t only about what your child eats, although nutrition certainly plays a role. Bowel movements are influenced by a whole range of factors, from daily routines and physical movement to emotional well-being, body awareness, and even how your child sits on the toilet.

In fact, it is estimated that up to 59% of constipation in children is not caused by food or fluid intake at all. But when a child is constipated, it almost always affects how they eat, what they eat, and even their appetite cues. That’s why we take a whole-child view of digestion, and often work alongside an interdisciplinary team to support not just the gut, but the child’s overall well-being.

Here are some areas that might be affecting your child’s poo habits:

• Stress & Emotional Well-being: anxiety, fear of public or school toilets, or even past painful poo experiences can lead to holding behaviour.

• Sensory processing differences can make toileting challenging due to sensitivity to smells, sounds, textures, or the feeling of needing to go.

• Toileting Routine & Posture: things like potty posture, effective pushing, and sitting long enough to empty the bowel fully.

• Body Awareness & Coordination: Some children (especially those with motor planning challenges or neurodivergence) may need support with interoception, core strength, or pelvic floor coordination.

• Hypermobility and Ehlers-Danlos syndromes: Connective tissue differences in hEDS can affect the movement and sensitivity of the digestive tract, contributing to a range of gut symptoms.

• Medication: certain medications, e.g. ADHD-stimulant medication, can cause gastrointestinal side-effects like abdominal pain, diarrhoea, and constipation.

  
  

And of course: Nutrition & Fluid

Fluids, fibre, and food variety matter, but it is not always easy to make significant changes overnight. It is imperative to meet families where they’re at and make practical and sustainable dietary changes that take the whole child into account.

For example, a child aged 4-8 should ideally be drinking ~1200ml a day. But if your child struggles with drinking enough, we might try:

• Fun drink bottles (especially ones with straws).

• Broths, soups, or juicy fruits.

• Homemade ice lollies.

• Naturally flavoured water drops or electrolyte drinks.

Small, doable steps are much more effective than big, dramatic overhauls that can't be sustained or negatively affect your child's growth or relationship with food and body.

Q4. True or False:

The only way to "heal" my child's gut is to cut out gluten.

Answer: False.

It’s easy to jump to food elimination when a child has tummy troubles, mainly when social media likes to blame gluten for inflammation. But for most children, gluten is not the root cause.

For example, a large study looked at over 1,100 children with ongoing gut symptoms like pain, bloating, and diarrhoea. Researchers wanted to test whether gluten was actually the problem. Here’s what they found:

• 96% of the children had no link between their symptoms and gluten.

• A small group of 36 went through further testing.

• In a careful, placebo-controlled trial, even among those 36 children, most didn’t react differently when given gluten compared to a placebo.

So, does food matter?

Absolutely. But cutting foods out shouldn’t be the first or only step.

While eliminating certain trigger foods can sometimes be important, doing so without proper guidance can create unnecessary stress and delay getting to the real issue. A qualified health professional can help figure out whether food is truly contributing — and how to make any changes safely.

Important: If you suspect Coeliac Disease, your child must be eating gluten for at least 6 weeks before doing the screening test. Removing it too soon can make results unreliable and delay a proper diagnosis.

What works better?

A structured, supportive approach that looks at the whole picture:

✔️ Is your child eating enough overall? (calories, nutrients, energy)

✔️ What’s their fibre intake — and fibre variety?

✔️ Are they staying well hydrated?

✔️ Are there any potential triggers? (explored with guidance)

✔️ How well is their gut moving? Any underlying conditions?

✔️ Are there emotional or sensory factors at play?

Why be cautious with elimination diets?

Elimination diets are a bit like medication - they need to be considered carefully, weighing up the potential risks and benefits with a medical provider. In many cases — especially for the families I support, including neurodivergent children or selective eaters with limited safe foods — elimination or strict diets are not possible.

Here’s why:

• Nutrient gaps: Cutting out major food groups without planning can lead to deficiencies (calcium, fibre, zinc, etc.), especially during key growth years.

• Meal overwhelm: Special diets often require more time, effort, and money when many families are already struggling with capacity.

• Sensory overload: New or unfamiliar foods can increase anxiety and food refusal.

• Food fears: Children are still developing their relationship with food and their bodies. Overly restrictive or controlling eating can spiral into long-term issues if there’s no clear “exit plan.”

• Gut health: Cutting back on food variety may reduce fibre and food diversity — key to microbiome health.

• Social stress: Travel, birthdays, and school lunches can become harder with highly restricted diets (when they can already be challenging!)

  
  

But what about kids who do feel better off gluten or dairy?

In children with Coeliac Disease or Cow's Milk Protein Allergy, strict avoidance is essential.

But when kids feel better on a gluten-free diet, it doesn’t always mean gluten is the problem. Research suggests it’s often not the gluten protein itself, but rather FODMAPs — fermentable carbohydrates like fructans (found in wheat) or lactose (found in dairy) — that may be triggering symptoms. In many cases, children may feel better with minor, targeted adjustments, such as reducing certain foods rather than eliminating entire food groups. As always, these changes should be guided by a qualified medical professional.

The bottom line?

Food can support gut health, but restriction isn’t the only (or always the best) way to find relief — especially in children, who are both psychologically and physiologically different from adults.

There’s a lot we can do before removing whole food groups. In my practice, families often see real improvements with a gentle, step-by-step approach that supports both nutrition and emotional well-being.

And if an elimination diet is truly needed? Please do it with the support of a registered dietitian — not TikTok. I will always listen to your concerns and ideas, and if we go down that path, we'll do it together.

Q5. Probiotics: Which statement is true?

A) All children need a daily probiotic supplement.

B) Specific probiotic strains can be effective for specific conditions and symptoms.

C) The best probiotic for kids is from natural sources like fermented foods.

D) Probiotic supplements are well-controlled, and you can assume all contain the active ingredients.

Answer: B

Probiotics can be helpful — but they’re not one-size-fits-all. Different strains do different things, and the research is clear that the type, strain, and dose matter.

While fermented foods like yoghurt, kefir, or kimchi can support gut health (and I do love them!), we often don’t know which specific probiotic strains they contain — or in what amounts. And they may contain other ingredients that could aggravate symptoms in those with sensitive tummies. So while they’re great as part of a varied diet, they’re not a substitute for targeted supplementation when it’s clinically indicated.

It is also important to note that, as with all supplements, there are significant gaps in regulation, and many probiotic supplements have been found not to have any active strains. A 2021 study found that of 104 probiotic products, nearly half contained different bacteria from those listed on the label. So using reputable brands is essential.

Not every child needs a probiotic supplement. But there’s growing evidence that the microbiome plays a role in gut issues like Irritable Bowel Syndrome in Children, especially when symptoms begin after a stomach bug. But the exact mechanism isn’t fully understood yet, and dysbiosis (an imbalance in gut bacteria) is just one piece of the puzzle.

However, in certain situations, such as after gastroenteritis, during antibiotic use, or when managing symptoms like constipation or bloating, a well-matched probiotic strain may offer relief and is worth trying if you have the financial means.

Bottom line:

Probiotics can help in some situations — but it’s best to look at the evidence or get personalised advice first. The right strain at the right time is far more effective than guessing or grabbing the nearest bottle.

Q6. True or False:

A microbiome test is the best starting point for kids with digestive symptoms.

Answer: False.

Microbiome testing is an exciting area of research — and we’re learning more every year. For some families with disposable income, it's understandable to feel curious. The procedures are relatively non-invasive and pose no risk to the child.

But when it comes to helping children with tummy troubles, they're not considered a reliable or effective first step for diagnosis or treatment — especially when the suggested “treatment” often involves buying expensive, unregulated supplements or powders from the same company.

Important note: Microbiome testing is different from medical stool tests (like a PCR stool panel), which may be clinically indicated as part of a proper medical workup.

Why not?

• No clear definition of a “healthy” microbiome. There’s currently no agreed-upon gold standard — especially not for growing children. Every lab uses its own educated guess, and kids’ microbiomes shift naturally with age, hormones, development, and food exposure.

• It’s just a snapshot. The microbiome changes all the time — even within the same person — based on sampling technique, diet, time of day, and natural fluctuations. One stool sample offers only a partial picture, and it doesn't reflect what’s going on further up the digestive tract.

• Unclear next steps. Should we retest after dietary changes? How long is one test valid? What do we do with the results — especially when they confirm what we already know (e.g. “your child needs more fibre”)?

• Doesn’t account for real-world context. I recently worked with a family who had done a microbiome test on their child with significant sensory processing differences, other disabilities, poor growth, and a very limited diet. The report pointed out things a diet history could easily do: that he was eating a small variety of food, low in vegetables and whole grains, and higher in refined carbohydrates. But the suggestions completely missed the most important issue — that he wasn’t getting enough fuel (or calories), and if he could make a dietary change, he would have. Instead of offering meaningful support, the report felt more like a judgment and left the family no closer to the help they actually needed.

At this stage, clinical experience matters more.

At this stage, clinical experience and a good medical and diet history matter far more. In my practice, I get more valuable insights from understanding your child’s symptoms, eating patterns, sensory preferences, toilet habits, and nervous system regulation than from any microbiome test.

Bottom line?

Microbiome tests may play a role in research or specialist care, but they’re not the place to start.

We begin with simple, supportive, evidence-informed changes — not expensive tests or overwhelming protocols.

That said, I continue to stay updated on the latest research in this space, and if the science shifts, I’m open to shifting my approach too. But for now, clinical experience and real-world context give us far more useful information than a lab report ever has.

Results/Wrap-Up:

• Got most of these right? You’re a Poo Pro! 🎉

• Learned something new? You’re not alone — poo isn’t often talked about, but it matters.

  
  

Quick Recap: What This Quiz Taught Us

1. Constipation isn’t just about frequency. A child can poo every day and still be constipated if they’re not fully emptying.

2. Tummy troubles have many causes — not just food. Think: fibre, fluids, stress, posture, routine, and even sensory processing.

3. Cutting out gluten and dairy without guidance can do more harm than good — especially if Coeliac Disease hasn’t been ruled out.

4. Probiotics aren’t magic pills. The strain matters, and not every child needs one.

5. Microbiome tests sound exciting, but they’re not a first-line solution. A good nutritional assessment and medical history are the best place to start.

6. Talking about poo matters. Whether you’re an open-book family or a little more private, helping your child feel safe talking about their body is a gift for life.

   
   

   

Gut health doesn’t have to be guesswork. If you’re feeling unsure or need tailored support, I’m here to help.

If you’re still unsure about what’s going on in your child’s gut — or want someone to walk through it with you — book a Discovery Call to discuss the best way forward. We’ll gently figure it out together.

References

• Di Nardo G, et al. Italian guidelines for the management of irritable bowel syndrome in children and adolescents: Joint Consensus from the Italian Societies of Gastroenterology, Hepatology and Pediatric Nutrition (SIGENP), Paediatrics (SIP), Gastroenterology and Endoscopy (SIGE) and Neurogastroenterology and Motility (SINGEM). Ital J Pediatr. 2024 Mar 14;50(1):51. doi: 10.1186/s13052-024-01607-y. PMID: 38486305; PMCID: PMC10938778.

• Francavilla R, Cristofori F, Verzillo L, Gentile A, Castellaneta S, Polloni C,

  et al. Randomised double-blind placebo-controlled crossover trial for

  the diagnosis of non-celiac gluten sensitivity in children. Am J Gastro-

  enterol. 2018;113(3):421–30.

• NHS National clinical constipation pathway for primary care for children. March 2023 https://www.england.nhs.uk/long-read/national-clinical-constipation-pathway-for-primary-care-for-children/?ref=canihaveanothersnack.com

• Eric The Children’s Bowel and Bladder Charity https://eric.org.uk/childrens-bowels/