Constipation (Child)

Bowel movement patterns vary in children. A child around age 2 will have about two bowel movements per day. After 4 years of age, a child may have one bowel movement per day.

Image showing a cross-section of the colon blocked by stool.

A normal stool is soft and easy to pass. But sometimes stools become firm or hard. They are difficult to pass. They may pass less often. This is called constipation. It is common in children. Each child's bowel habits are a little different. What seems like constipation in one child may be normal in another. Symptoms of constipation can include:

  • Abdominal pain

  • Refusal to eat

  • Bloating

  • Vomiting

  • Problems holding in urine or stool

  • Stool in your child's underwear

  • Painful bowel movements

  • Itching, swelling, or pain around the anus

  • Any behavior that looks like the child is trying to hold stool in, such as standing on toes, holding in abdominal muscles, or "dance like" behaviors

Sometimes streaks of blood can occur in the stool, usually due to an anal fissure. This is a tearing of the anal lining caused by straining with constipation. However, any blood in the stool needs to be evaluated by your child's healthcare provider.

Constipation can have many causes, such as:

  • Eating a diet low in fiber

  • Not drinking enough liquids

  • Lack of exercise or physical activity

  • Stress or changes in routine

  • Frequent use or misuse of laxatives

  • Ignoring the urge to have a bowel movement or delaying bowel movements

  • Medicines such as prescription pain medicine, iron, antacids, certain antidepressants, and calcium supplements

  • Less commonly, bowel blockage and bowel inflammation

  • Spinal disorders

  • Thyroid problems

  • Celiac disease

Simple constipation is easy to stop once the cause is known. Healthcare providers may not do any tests to diagnose constipation.

Home care

Your child’s healthcare provider may prescribe a bowel stimulant, lubricant, or suppository. Your child may also need an enema or a laxative. Follow all instructions on how and when to use these products.

Food, drink, and habit changes

You can help treat and prevent your child’s constipation with some simple changes in diet and habits.

Make changes in your child’s diet, such as:

  • Talk with your child's healthcare provider about their milk intake. In children who don't respond to other conservative measures, your healthcare provider may advise stopping cow's milk for 2 weeks to see if symptoms improve. If symptoms improve during this trial, you may switch to a nondairy form of milk. This is likely a form of milk allergy rather than true constipation.

  • Increase fiber in your child’s diet. You can do this by adding fruits, vegetables, cereals, and grains.

  • Encourage an increase in your child's activity or exercise level. Exercise with your child to increase their enjoyment.

  • Make sure your child eats less meat and processed foods.

  • Make sure your child drinks plenty of water. Certain fruit juices such as pear, prune, and apple can be helpful. However, fruit juices are full of sugar. The Academy of Pediatrics recommends no juice for children under 1 year of age. Children age 1 to 3 should have no more than 4 ounces of juice per day. Children 4 to 6 should have no more than 4 to 6 ounces of juice per day. Children 7 to 18 should have no more than 8 ounces (1 cup) of juice per day.

  • Be patient and make diet changes over time. Most children can be fussy about food. Don't shame or punish your child. Frame the situation as a challenge you will manage as a team, not as a problem that is the child's "fault."

Help your child have good toilet habits. Make sure to:

  • Teach your child not to wait to have a bowel movement.

  • Have your child sit on the toilet for 10 minutes at the same time each day. It is helpful to have your child sit after each meal. This helps to create a routine.

  • Give your child a comfortable child’s toilet seat and a footstool.

  • You can read or keep your child company to make it a positive experience.

Follow-up care

Follow up with your child’s healthcare provider as advised.

Special note to parents

Learn to be familiar with your child’s normal bowel pattern. Note the color, form, and frequency of stools. Laxatives can be dangerous to children. Never give your child laxatives or enemas unless your child's healthcare provider says it's OK to do so.

When to seek medical advice

Call your child’s healthcare provider right away if any of these occur:

  • Abdominal pain that gets worse

  • Fussiness or crying that can’t be soothed

  • Refusal to drink or eat

  • Blood in stool

  • Black, tarry stool

  • Constipation that does not get better

  • Weight loss

  • Symptoms get worse or your child has new symptoms

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