Constipation in Children: Causes and Relief

Constipation is one of the most common reasons children have tummy trouble. It can make a toddler cranky, keep a preschooler from wanting to use the potty, and send a school-age child to the nurse's office with stomach aches. The good news is that most childhood constipation is not caused by a disease, and small daily changes usually fix it. This guide focuses on toddlers and older children.

What counts as constipation

Every child has their own pattern. Some go every day, others every couple of days, and both can be normal. Constipation is less about the number and more about how the poop looks and how it feels to pass. Your child may be constipated if:

• Stools are hard, dry, lumpy or very large
• Pooping is painful, or your child strains a lot
• Your child goes much less often than usual, such as fewer than three times a week
• You see streaks of bright red blood on the stool or toilet paper, often from a small tear around the anus
• Your child has belly pain or a full feeling that improves after a bowel movement

Some signs are easy to miss. A child who is badly backed up can leak soft or liquid stool into their underwear. Parents often mistake this for diarrhea or for a behavior problem, when it is really a sign of a large, hard stool stuck higher up. Constipation can also lead to daytime wetting, bedwetting and bladder infections, because a full bowel presses on the bladder.

Common causes by age

Toddlers (about 1 to 3 years)

• Diet changes. Moving from breast milk or formula to cow's milk and table food changes stool. Some toddlers drink so much milk that they have little room for fiber-rich foods.
• Picky eating. A diet heavy in crackers, white bread, pasta and cheese, with few fruits and vegetables, can slow things down.
• Toilet training. Pressure to use the potty, or fear of it, can lead a child to hold stool in.

Preschool and school-age children

• Avoiding school or public bathrooms. Many kids hold it all day because the bathroom is dirty, lacks privacy, or they do not want to miss recess.
• Busy routines. Rushed mornings, long car rides, sports and screens leave little time to sit and relax on the toilet.
• Less activity. Moving the body helps move the bowels.
• Changes such as travel, a new school, illness or stress.

Less often, constipation is a side effect of a medicine or a sign of a medical condition such as thyroid problems or celiac disease. Your pediatrician will think about these if the usual steps do not help.

The holding cycle

Holding stool in is the single biggest driver of ongoing constipation in children. It usually starts with one painful bowel movement. Your child remembers the pain and tries not to go again. The longer stool stays in the colon, the more water the body pulls out of it, so the next one is even harder and bigger. That one hurts too, and the cycle repeats.

You may see your child crossing their legs, standing on tiptoe, stiffening, hiding in a corner or rocking. It can look like they are trying to poop, but they are actually trying not to. Breaking this cycle means making bowel movements soft and painless again, so your child can trust that going will not hurt.

Everyday ways to help

Fiber

Fiber holds water in the stool and keeps it soft. Add it slowly over a week or two to avoid gas and bloating. Good choices include:

• Fruits such as pears, prunes, plums, apples with the skin, berries and kiwi
• Vegetables such as peas, broccoli, sweet potatoes and carrots
• Beans, lentils and hummus
• Whole grains such as oatmeal, whole wheat bread, brown rice and popcorn for children old enough to eat it safely

Fluids

Fiber works best with enough water. Offer water through the day, and more in hot weather or after active play. In a San Antonio summer, kids can lose a lot of fluid without noticing. If your child drinks a lot of cow's milk, ask your pediatrician how much is right for their age. Cutting back can leave room for other foods and drinks.

Activity

Running, biking, swimming, dancing and active play all help the gut move. Aim for active time every day.

Building a toilet routine

• Schedule sitting time. Have your child sit on the toilet for a few minutes after meals, when the body naturally wants to move the bowels. Breakfast is a good time if mornings allow it.
• Get the position right. Feet should rest flat on the floor or a step stool, with knees slightly higher than hips. Dangling feet make it harder to push.
• Keep it relaxed. Offer a book or a calm song. Never punish accidents or force sitting. Praise the effort of sitting, not just the results.
• Pause toilet training if needed. If a toddler is holding stool out of fear, it is fine to take a short break and go back to diapers or pull-ups while things get softer.
• Talk to the school if your child avoids school bathrooms. A note allowing bathroom breaks or use of the nurse's bathroom can help.

A word about medicines

Sometimes diet and routine are not enough, and your pediatrician may suggest a stool softener or another medicine for a while. Do not give laxatives, enemas or suppositories without talking to your pediatrician first, and ask for the right dose by your child's weight. When a medicine is used, it often needs to continue for weeks or months while the bowel returns to normal, so do not stop the moment things improve unless your pediatrician says to. MedlinePlus explains constipation in children, and HealthyChildren.org has more on toilet habits and nutrition.

When to call us

Call your A thru Z Pediatrics office if:

• Constipation lasts more than two weeks or keeps coming back
• Your child is soiling their underwear or has new daytime or nighttime wetting
• There is more than a small streak of blood in the stool
• Your child has a poor appetite, is losing weight or is not growing as expected
• Pooping is so painful that your child is very afraid to go
• Home changes have not helped after a week or two

Call 911 or go to the nearest ER if your child has severe belly pain that does not let up, a hard or swollen belly with vomiting, green or bloody vomit, or seems very ill.

For a checkup about ongoing tummy trouble, you can request a visit online.