Constipation in Children: Causes, Remedies and When to Worry

Constipation is one of the most common reasons children visit the pediatrician. It can cause belly pain, crankiness, poor appetite and even accidents in children who are already toilet trained. The good news is that most constipation in children is not caused by a serious medical problem, and simple changes in diet and daily routine often help a great deal.

What Counts as Constipation?

Every child's bowel habits are different, and the number of bowel movements alone doesn't tell the whole story. A child may be constipated if they:

• Have fewer bowel movements than usual, often fewer than two or three a week
• Pass hard, dry, lumpy or very large stools
• Strain, cry or have pain when pooping
• Have streaks of bright red blood on the stool or toilet paper from a small tear (fissure)
• Avoid using the toilet or show "holding" behaviors such as crossing legs, standing on tiptoes, clenching the buttocks or hiding in a corner
• Have stomach aches that improve after a bowel movement
• Have soiling or smears in the underwear, which can happen when hard stool backs up and looser stool leaks around it

What About Babies?

Bowel patterns in infants vary widely. Breastfed babies may poop after every feeding or go several days without a bowel movement and still be perfectly healthy, as long as the stool is soft when it comes. Many babies also grunt, strain and turn red while pooping; this is usually normal as they learn to coordinate the muscles involved. Hard, pebble-like stools, or stools that are painful to pass, are more likely to mean true constipation. Constipation sometimes starts when babies begin solid foods or switch from breast milk to formula or cow's milk.

Always talk with your pediatrician before giving an infant water, juice, or any laxative, suppository or home remedy.

Common Causes of Constipation in Children

• Withholding: the most common cause in toddlers and young children. After one painful bowel movement, a child may hold stool in to avoid pain, which makes the next stool even larger and harder.
• Toilet training: pressure to use the potty, or starting before a child is ready, can lead to holding.
• Diet: too little fiber from fruits, vegetables and whole grains, or too much milk, cheese and processed foods.
• Not enough fluids, especially in hot weather or during illness.
• Changes in routine: travel, starting school, or not wanting to use school or public bathrooms.
• Low physical activity.
• Some medicines, such as certain iron supplements.

Less commonly, constipation is related to a medical condition such as thyroid problems, celiac disease or a problem with the nerves or muscles of the bowel. Your pediatrician will look for signs of these conditions during an exam.

How to Help at Home

Add fiber gradually

Offer fruits and vegetables at every meal and snack. Fruits such as pears, prunes, plums, peaches and apricots, along with berries, beans, peas, and whole-grain breads and cereals, are good choices. Increase fiber slowly to avoid gas and bloating.

Encourage fluids

Water helps fiber do its job. Offer water throughout the day, especially with meals.

Watch the milk

For toddlers and young children, too much cow's milk can contribute to constipation and fill them up so they eat fewer high-fiber foods. Ask us how much milk is right for your child's age.

Create a relaxed toilet routine

Have your child sit on the toilet for about 5 to 10 minutes after meals, once or twice a day, when the body's natural reflexes make a bowel movement more likely. Use a footstool so their knees are higher than their hips and their feet are supported; this position makes pooping easier. Keep the mood calm and positive, and offer praise or a small reward chart for sitting, not just for results.

Take a break from toilet training if needed

If constipation started during potty training, it's okay to go back to diapers or pull-ups for a little while. Avoid punishment or shaming for accidents; soiling is not something a constipated child can control.

Get moving

Daily active play helps keep the bowels moving.

Medical Treatment

If changes at home aren't enough, your pediatrician may recommend a stool softener or laxative that is safe for children. Many children with long-standing constipation need medicine for several months to retrain the bowel, so don't stop too soon even if things improve. If there is a large amount of stool backed up, the doctor may first recommend a "clean-out." Only use laxatives, enemas or suppositories under your pediatrician's guidance.

When to Call the Pediatrician

Contact our office if your child:

• Is an infant and is constipated, especially if younger than 4 months
• Has constipation lasting more than 2 weeks despite home care
• Has blood in the stool, or soiling accidents
• Has belly pain that keeps coming back, poor appetite or poor weight gain
• Has pain or bleeding from a tear around the anus

Preventing Constipation

• Serve a variety of high-fiber foods every day, and limit sugary, low-fiber snacks.
• Keep a water bottle handy at home and school.
• Build regular toilet time into your child's daily schedule.
• Encourage your child not to "hold it." Talk with teachers if your child avoids school bathrooms.
• Make physical activity part of every day. See making exercise a way of life.

The Bottom Line

Constipation is common and usually very treatable. A combination of fiber, fluids, physical activity and a positive, regular toilet routine works for most children. If the problem keeps coming back or causes pain, accidents or worry, talk with us. Early treatment prevents the cycle of pain and withholding from becoming a long-term habit. For more on healthy eating, read our article on proper nutrition habits.