Constipation in Children

Overview

Constipation is a common condition in children where bowel movements become infrequent or difficult to pass. In simple terms, it means that a child is having trouble with regular pooping. For many children, constipation can be uncomfortable, leading to abdominal pain, bloating, and even changes in mood. While occasional constipation is normal, ongoing problems can affect a child’s overall health and well-being.

According to experts at the North American Society of Gastroenterology, Hepatology, and Nutrition (NASPGHAN), constipation is when a child has trouble pooping or delays it for two weeks or more, causing the child to feel uncomfortable or upset.

At Gertrude’s Children’s Hospital, we understand how worrisome constipation can be for both children and their families. Our goal is to provide accurate information, empathetic care, and effective solutions to help children feel better and maintain regular bowel habits.

Symptoms

Understanding the signs of constipation can help parents act quickly to ease discomfort. Common symptoms include:

  • Fewer than two bowel movements a week.
  • Hard, dry, or lumpy stools.
  • Pain or straining during bowel movements.
  • Abdominal pain or bloating.
  • Stools that clog the toilet.
  • Traces of liquid stool in underwear, indicating stool leakage around a blockage.
  • Decreased appetite or feeling full quickly.
  • Irritability or crankiness, which may improve after a bowel movement.

Most cases of long-term constipation in children start because they had a painful bowel movement, and then they begin to hold in their poop to avoid the pain. In very young children, holding in poop is more of a natural reflex to avoid pain, while older children may do it more intentionally, but still to avoid discomfort.

Common signs of withholding stool include: 

  • Crossing ankles
  • Squatting
  • Becoming stiff
  • Holding onto furniture or the caregiver/parent
  • Crying, sweating and flushing
  • Hiding during pooping 

In young babies, constipation often starts when there is a change in their diet, like switching from breast milk to formula, starting solid foods, or moving from formula to whole milk.

In toddlers, constipation can happen around the time they start potty training. It can also develop after an illness, especially if the child had a bad diaper rash or became dehydrated.

For older children, constipation often begins when they start school because they may avoid going to the bathroom while at school.

Causes

Constipation can result from a variety of factors. Often, it’s due to a combination of dietary habits, lifestyle factors, and sometimes underlying medical conditions. The main causes include:

    • Dietary Factors: 
      • A lack of fiber in the diet is one of the most common causes. 
      • Fiber helps add bulk to stools and promotes regular bowel movements. 
      • Children who consume low-fiber foods like processed snacks, fast food, and sugary treats may experience constipation.
    • Dehydration: 
      • Inadequate fluid intake can make stools harder and more difficult to pass. 
      • Water and other fluids help soften stool and promote better bowel function.
    • Holding in Stools: 
      • Some children may resist the urge to poop due to fear of painful bowel movements, embarrassment, or simply being too busy playing. 
      • This can lead to harder stools, making the problem worse.
    • Changes in Routine: 
      • Changes like starting school, moving houses, or traveling can disrupt a child’s usual bathroom routine, leading to constipation.
  • Stress, a desire for control, or experiences of trauma (such as abuse)
  • Medical Conditions: 
    • Occasionally, constipation can be a symptom of a more serious medical issue, such as hypothyroidism, celiac disease, or Hirschsprung’s disease (a condition affecting the intestines).
  • In older children, a diet low in fiber and high in dairy can also lead to hard stools, which can cause small tears in the skin around the anus (called anal fissures). These fissures make pooping even more painful, worsening the constipation cycle.

Diagnosis

At Gertrude’s Children’s Hospital, diagnosing constipation typically starts with a thorough medical history and physical exam. Doctors will ask about the child’s bowel habits, diet, and any other symptoms they may be experiencing.

Key steps in diagnosing constipation may include:

  • Physical Exam: Checking the abdomen for bloating or pain.
  • Discussion of Symptoms: Reviewing bowel movement frequency, stool consistency, and any related discomfort.
  • Additional Tests: In some cases, X-rays or blood tests may be done to rule out underlying conditions.

Our pediatric team is highly experienced in making the diagnosis process as comfortable and stress-free as possible for both children and parents.

Treatment Options

At Gertrude’s Children’s Hospital, we believe in providing personalized care that considers the unique needs of each child. Treatments for constipation range from simple lifestyle changes to medical interventions depending on the severity of the condition.

  • Clearing the Colon (Colon Evacuation)

If your child has a hard mass of stool stuck in their colon (called a fecal impaction), the first step is to clear it out. Doctors can find this by feeling the abdomen or seeing it on an X-ray. To remove the stool, your doctor might suggest using medications that help empty the colon, such as:

  • Oral solutions like polyethylene glycol (a stool softener)
  • Laxatives like magnesium citrate or sodium phosphate
  • Enemas (a liquid medicine inserted into the rectum)

Sometimes, young children might refuse to take oral medications because they don’t like the taste or amount. In that case, enemas or suppositories may be used to help clear the stool.

  • Making Pooping Less Painful

Once the colon has been emptied, it’s important to make sure future bowel movements aren’t painful. To do this, doctors often recommend using laxatives regularly to keep the stool soft and prevent any discomfort. The goal is to have 1-2 soft poops a day.

Many parents worry about long-term laxative use, but it’s important to know that they are safe when used correctly. Using laxatives for several months is common. This won’t lead to dependency or cause any harm.

If your child has small tears in the skin around their anus (called anal fissures), a doctor might suggest using ointments or suppositories to help heal the area and reduce pain.

  • Building Good Bathroom Habits

To prevent constipation from coming back, it’s important to encourage regular bathroom habits. Children should try to sit on the toilet twice a day for 5-10 minutes, especially after meals. This takes advantage of the body’s natural reflex to go after eating.

For school-aged children, it’s best not to expect them to use the bathroom during school hours, as many kids may feel uncomfortable doing so.

  • Dietary Changes

Diet plays a key role in preventing and treating constipation. Encouraging a balanced diet with plenty of fluids, fruits, vegetables, and whole grains can help. Some fruit juices, like prune, pear, and apple, contain natural sugars that help keep stools soft.

Although research is limited, a healthy diet that includes these types of foods is often recommended. For younger children, it may also help to temporarily remove cow’s milk from their diet, as some kids develop constipation due to cow milk proteins.

  • When to See a Specialist

If your child’s constipation is caused by an underlying medical condition, such as Hirschsprung disease, or if they don’t respond to standard treatment, it may be time to consult a pediatric gastroenterologist or surgeon. These specialists can help manage more complex cases of constipation.

  • Monitoring and Long-Term Management

Once your child starts having regular bowel movements without pain or discomfort, you can begin reducing laxative use under the guidance of your doctor. It’s important to keep monitoring your child’s bowel habits, especially during changes in routine, to avoid any relapses.

Constipation can be frustrating, but with the right treatment and support, it can be managed successfully, ensuring your child stays happy and healthy. If you have concerns, don’t hesitate to reach out to a healthcare provider for guidance.

Patient Success Stories

At Gertrude’s Children’s Hospital, we are committed to providing the best possible care for children with Constipation. Here’s why families trust us:

“When our son was diagnosed with Constipation, we were terrified. The doctors at Gertrude’s Children’s Hospital acted quickly, and thanks to their expertise, he made a full recovery. We are so grateful for their care and support during such a difficult time.”

Jamesparent of a child with Constipation

Constipation in Children

Every child is different, but generally, children should have a bowel movement at least once every 2-3 days. Anything less frequent may be a sign of constipation.

High-fiber foods such as fruits (like apples and pears), vegetables (like broccoli and carrots), whole grains, and legumes (like beans and lentils) are excellent for promoting regular bowel movements.

If your child has fewer than two bowel movements a week, is experiencing pain during bowel movements, has blood in their stool, or if the condition lasts more than two weeks, it's time to seek medical advice.

Yes, emotional factors such as stress or anxiety can contribute to constipation. Changes in routine or fears about using the bathroom can make children hold in their stool, which leads to constipation.

Laxatives can be safe for short-term use in children when recommended by a doctor. Our pediatricians will provide the appropriate dosage and type based on your child’s age and condition.

Contact Us

At Gertrude’s Children’s Hospital, we’re here to support your child’s digestive health every step of the way. If your child is struggling with constipation, don’t hesitate to reach out. Our expert team is ready to provide compassionate care tailored to your child’s needs.

Contact us today to learn more about our Constipation in Children treatment options.

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