Constipation is when your child has hard and/or infrequent bowel motions (poos, stool). Constipation often starts after one hard poo has caused pain, and so your child tries to avoid pain the next time by holding on and not going to the toilet.
- Constipation in children is very common affecting up to 30% of children.
- It is most common in 2 to 4-year-olds who are potty training.
- In most children constipation lasts a short time and is not serious.
- If your child has constipation that doesn’t go away, see your doctor.
- If left untreated, constipation may cause your child to ignore the urge to poo due to pain and/or distress associated with this.
- If your child has been given laxatives or stool softeners and is still not getting better, see your doctor.
Common symptoms of constipation in children
A child with constipation may:
- move in a way that suggests they are holding in their poo, such as standing on tiptoes and then rocking back on the heels of the feet, clenching their bottom, and other unusual, dance-like behaviours
- cry, strain or show other signs of pain when going to the toilet
- have hard, dry or small poo (like pebbles)
- complain of stomach pain or cramps
- experience urinary tract infections and bedwetting
- have poo in their pants or 'skid marks'.
What causes constipation in children?
Constipation is caused when poo moves too slowly through the gut, where water is absorbed from the poo, making it hard and dry. Hard, dry poo is more difficult for the muscles in the bottom to push out of the body.
|Ignoring the urge
- Children most commonly develop constipation as a result of holding in poo
- The may do this because they are feeling stressed about potty training, are embarrassed to use a public bathroom, do not want to interrupt playtime, or are fearful of having a painful or an unpleasant poo
- Constipation in children is often caused by a poor diet that is high in fat and refined sugar (sweets, cakes, biscuits) and has too little fibre
- Fibre helps the poo stay soft so it moves smoothly through the gut
- Fruit (fresh and dried), vegetables, whole grain cereals and bread, nuts and lentils are good sources of fibre
- Dehydration can make constipation worse
- It is often as a result of drinking too little fluid, or losing too much fluid such as by vomiting or excessive sweating
|Changes in routine
- Changes in the usual time of meals, as well as changes in their daily toileting routine (for example when on holiday) can cause your child to become constipated
- A number of medicines can cause constipation as a side effect, for example antacids, iron supplements, some anti-cough medicines and some pain medicines
Constipation in babies
It can be difficult to know if a baby has constipation because there is such variation in the firmness and frequency of poo in babies.
- Breastfed babies may have a poo following each feed but some breastfed babies only poo every 7 to 10 days.
- Babies fed formula tend to poo at least every 2 to 3 days.
It is common for babies to strain a lot when they poo. As long as their poos are soft, they aren’t constipated.
How to prevent constipation in babies
Constipation is often caused by changes such as weaning from breastmilk or other types of milk. To ease constipation in babies:
- try increasing the amount of water your baby drinks, by offering small amounts of water between feeds
- for bottle fed infants, consider trying out different infant formulas to find one that makes poo softer and easier to pass.
How to prevent and ease constipation in children
- Increase the fibre content of your child's diet by giving your child more fruit (either fresh or dried) and vegetables.
- Limit foods that have little or no fibre, such as ice cream, cheese, meat and processed foods.
- Increase the amount of water your child drinks by giving them water at each meal time and extra water when it is hot.
- Encourage a regular toileting routine such as sitting on the toilet for 5 minutes, once or twice a day.
- Encourage daily exercise and physical activity. This helps stimulate normal bowel function.
- For children over 12 months of age, try giving them one glass of undiluted apple juice or kiwifruit juice.
If these methods don't work, medications such as laxatives may be needed. Laxatives usually work by softening the poo. Some help the bowel push out the poo by stimulating the nerves in the bowel.
Your doctor or pharmacist will advise you on a suitable laxative for your child. Children should take medication until their bowel habits are normal for an extended period of time and they have overcome their holding behaviour. If treatment is stopped too soon, a child will likely become constipated again.
When to see your doctor
You should take your child to the doctor if any of the following apply:
- your child has been constipated for a long time and the methods described above have not worked
- your child has tummy pain
- your child is pooing in their pants (soiling).
If left untreated, constipation in children can lead to faecal impaction, where hard poo blocks the gut and normal bowel action cannot push the poo out. Over time, this can cause faecal incontinence, where children over the age of 4 years regularly poo their pants because the bowel has stretched and is unable to register that there is a poo.
If your child has ongoing problems with toileting your doctor may refer them to a paediatrician or continence nurse.
The following links provide further information on constipation in children:
Constipation Kidshealth NZ
Constipation Ministry of Health, NZ
Faecal incontinence Continence NZ
Constipation in children Patient Info UK
Constipation in children and young people; NICE Clinical Guideline (May 2010)
Childhood constipation Auth MK, Vora R, et al; BMJ. 2012 Nov 13;345:e7309
Fibre makes poo softer and easier to pass
It is important to get your child into the habit of eating a healthy, balanced diet that includes food with fibre and plenty to drink (mainly water). This will help to prevent constipation.
Giving your child (aged over 15 months) more fibre in their diet can help prevent constipation and also treat short term or very mild constipation. Fibre is also important long term for regular bowel functioning. If your child has had constipation a long time, just increasing fibre without other treatment is unlikely to resolve the problem.
How to increase fibre in your child's diet
- give at least 3 servings of vegetables each day; this includes potato, pumpkin, kumara
- fruits with the peel left on, such as plums, prunes, raisins, apricots, and peaches have a lot of fibre as does kiwifruit
- give cereals high in fibre, such as bran cereals, Weet-Bix, whole grain cereals, porridge; avoid refined cereals, such as cornflakes, rice bubbles or those with added sugar
- for children older than 12 months, give wholemeal breads (instead of white bread)
- try adding bran to muffins and other baking, or add it to your child's regular cereal
- try adding 1 to 2 tablespoons of ground flax seed/linseed meal to cereals, soup or mixed into a smoothie
- give legumes (beans and peas), such a baked beans, hummus, lentils.
It is also important to give your child plenty of water with the increase in fibre.
Clinical pathways & guidelines
Constipation Starship Clinical Guidelines, February 2012
Constipation BPAC, October 2007
Idiopathic constipation and nocturnal enuresis in childhood: a guide to management: putting NICE guidelines into practice BMJ Learning
Bristol Stool Chart
Access for the following regional pathways is localised for each region and access is limited to health providers. If you do not know the login details, contact your DHB or PHO for more information:
Laxatives for the management of childhood constipation (Plain language summary)
"Constipation within childhood is an extremely common problem. Despite the widespread use of laxatives by health professionals to manage constipation in children, there has been a long standing lack of evidence to support this practice.
- This review included eighteen studies with a total of 1643 patients that compared nine different agents to either placebo (inactive medications) or each other.
- The results of this review suggest that polyethylene glycol preparations may increase the frequency of bowel motions in constipated children. Polyethylene glycol was generally safe, with lower rates of minor side effects compared to other agents. Common side effects included flatulence, abdominal pain, nausea, diarrhoea and headache.
- There was also some evidence that liquid paraffin (mineral oil) increased the frequency of bowel motions in constipated children and was also safe. Common side effects with liquid paraffin included abdominal pain, distention and watery stools.
- There was no evidence to suggest that lactulose is superior to the other agents studied, although there were no trials comparing it to placebo.
- The results of the review should be interpreted with caution due to methodological quality and statistical issues in the included studies. In addition, these studies were relatively short in duration and so it is difficult to assess the long term effectiveness of these agents for the treatment of childhood constipation. Long term effectiveness is important, given the often chronic nature of this problem in children." (Gordon M et al, Cochrane Review 2012)
Gordon M, Naidoo K, Akobeng AK, Thomas AG. Osmotic and stimulant laxatives for the management of childhood constipation. Cochrane Database of Systematic Reviews 2012, Issue 7. Art. No.: CD009118. DOI: 10.1002/14651858.CD009118.pub2.