A common scenario: Your child is complaining of intermittent stomach cramps or pain. Maybe their appetite has decreased recently. Or suddenly they start having bathroom accidents, even though they’ve been toilet trained for some time.
Constipation in kids occurs with big changes such as switching to solid foods, toilet training, and starting school.
Evaluate your child’s stool softness using a stool chart.
Go to the pediatrician if your child’s constipation has led to appetite changes, pain with pooping, or an abnormal bowel pattern for 2 weeks.
A common treatment for constipation centers around diet, hydration, and behavior changes such as regular toilet sits.
Medications such as laxatives and stimulants can help treat constipation, but the key to success is in helping your child develop consistent toilet habits.
You go to the doctor and, after some questions, an exam, and maybe an abdominal x-ray, the pediatrician tells you that your child is constipated. How could that be? How could your child’s symptoms be related to something so seemingly simple? Constipation is common in kids. Roughly 1 in 20 pediatrician visits are due to constipation.
What is “normal” poop?
Every child is different, and stool patterns change as they grow. Rather than focusing on quantity, paying attention to how your child’s stool looks can be good information about their bowel health. Evaluate the softness of your child’s stool using the Bristol Stool Chart, which ranges from type 1 to type 5. The goal is to have a type 3 or 4 stool, but it is normal for stool to vary each time.
Type 1 is small, round balls.
Type 2 is formed but lumpy.
Type 3 is smooth and soft.
Type 4 is fluffy and mushy.
Type 5 is watery with no solid pieces.
What is constipation?
Constipation is a condition of infrequent and hard stools, stools that are painful to pass, or less than two bowel movements per week.
Constipation can occur for many reasons, but it is especially common in childhood during an infant’s transition to solid foods, during toilet training, and when kids enter school.
A change in diet can cause constipation in infants transitioning from formula or breast milk to solid foods
Children who are toilet trained may avoid stooling if they are not interested in using the toilet or who don’t want to interrupt their play to use the bathroom. Kids may also withhold to feel a sense of control or to avoid a painful bowel movement, which worsens constipation. It can also take time for a child who is toilet training to adjust to sitting while pooping, rather than standing in a diaper.
Starting school is a big adjustment for kids. They may not want to have a bowel movement at school because they are in an unfamiliar environment or feel that school bathrooms are too public. They may not even realize they need to have a bowel movement while at school as they pay attention to a new environment and activities.
Constipation symptoms in kids
- Straining to poop.
- Stomach pain.
- Pooping less often than usual.
- Underwear stains.
- Feeling full.
- Some blood on the toilet paper.
- Decreased appetite.
When to see the pediatrician
If your child’s constipation has lasted longer than two weeks or has led to appetite changes or pain with pooping, it’s time to see the doctor. If left untreated, constipation can become encopresis. This occurs when there is a large amount of stool in the colon, which causes diarrhea to leak around the hard stool. In rare cases, there could be a medical reason for your child’s constipation.
Increasing fiber in the diet can help move stools along because it isn’t digested, so it helps clean out the intestines. High-fiber foods include fruits, cooked vegetables, whole-grain bread, and beans. There are also over-the-counter fiber gummies as an alternative source of fiber.
Drinking water helps soften stool by keeping water in the gut, making it easier for stool to move through the colon.
For some kids, withholding stool gives them a feeling of being in control. They may be more interested in playing rather than visiting the bathroom, so they hold it in. But ignoring the sensation makes it harder to go later. Encourage your child to sit on the toilet after meals, as eating helps stimulate the GI tract. Toilet sits should include no distractions, such as phones or tablets, and should last for at least 5 minutes. Help them to relax by taking deep breaths or having them blow bubbles. Consider a reward system to encourage the development of a toilet-sitting habit.
Your doctor may prescribe stool softeners, laxatives, or a combination. Stool softeners and some osmotic laxatives help draw water into the colon, which can soften hard stool. Stimulant laxatives help squeeze and push poop out by moving the muscles of the colon. If your child has recurring constipation, their doctor may prescribe a “cleanout” dose, or a large dose, of these medications to help empty the bowels, followed by a “maintenance” dose, or a small daily dose, to manage recurring constipation.
Less common, but effective, are suppositories and enemas. Your child’s pediatrician should determine if this is the right treatment for your child.
Referral to GI specialist
For kids with chronic constipation, pediatricians may refer them to a pediatric gastroenterologist, who specializes in GI problems. Chronic constipation can lead to loss of nerve sensation and a stretched-out colon, which can cause leaking or accidents. This is treatable with a combination of diet changes, medication, and behavior changes.
Constipation requires consistency
Treating constipation requires some trial and error. Your child’s doctor can help determine the right treatment depending on your child’s age and the onset of constipation, which may be starting with diet and hydration. For toddlers and school-age children, treating constipation requires their willingness to develop habits of using the bathroom regularly, and learning to relax while sitting on the toilet. Constipation management is a change of habits, and that can be a challenge. Practice patience and be assured that small, consistent changes are good progress.