Constipation in children

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.

Key points

  • 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.

Cause Description
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
Diet
  • 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
  • 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
Medicines
  • 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.

Read more about laxatives for children.

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. 

Learn more

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

References

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

Credits: Health Navigator Editorial Team. Reviewed By: Nir Fireman, Auckland DHB (5 May 2017)