Constipation

Disclaimer: This fact sheet is for education purposes only. Please consult with your doctor or other health professional to make sure this information is right for your child.

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Constipation is a common problem in childhood. It is rarely due to an underlying medical cause. Your doctor will be able to determine if any extra tests are necessary for your child. This fact sheet is for toddlers and children experiencing constipation and does not apply for babies (under 1 year of age)

What is constipation?

There is a wide variation in how often healthy children and adults will pass stools (poo). Some children pass a stool (go to the toilet) three or four times a day, while others may go twice a week without any problems. There is even greater variation in babies. “Constipation” is when stools are hard, painful or difficult to pass.

How do I know if it’s a problem?

Your child may be constipated if he or she:

Says it hurts to pass a stool

Naturally, children (and adults) avoid things that cause pain.  If it is painful to pass a stool, children may avoid going to the toilet and “hold on”. This makes the stool dry, and it is harder and more difficult to pass. It is normal to have slight discomfort before needing to pass a stool but it is not normal if your child is in a lot of pain.  Discuss this with your doctor.

Passes stool in their pants without meaning to (soiling)

Children who are constipated can have runny stools that they can’t control. This is due to “overflow” of liquid stool around the hard, older stool that is stuck there. If your child soils their underwear regularly, discuss this with your doctor who may prescribe medication. Treatment of soiling usually requires a combination of medication and behaviour changes, often for a long time.

What causes constipation?

It is not always clear why children become constipated. Causes may include:

1.   Holding onto stools 

  • Children may put off going to the toilet if it is painful or if they are too busy and distracted e.g. if they are playing.
  • Other children might avoid using toilets at preschool/school if they are unfamiliar, smelly, or if they don’t want to be teased.
  • Holding on can cause the stool to build up in the bowel and it can become hard.

2.   Illnesses where your child eats and drinks less

  • If your child has a viral illness, they may eat and drink less than normal.  This can contribute to constipation because less food/drink is being consumed. Children can also get constipated after having gastroenteritis due to poor fluid intake.  

3.   Not enough fibre from food 

  • Fibre helps our bowels to work regularly.  See “Ways to Include Fibre” for some suggestions on how to make fibre part of your child’s diet.
  • It is also important to not to give your child above the recommended amount of fibre as it can worsen the symptoms especially in a child not drinking enough fluid.

4.   Not enough fluid

  • Your bowels need fibre and fluid to work together, to keep them moving regularly. 

Some underlying medical conditions can contribute to constipation. However, these are uncommon in children. Discuss this with your doctor if any further tests are required.  

What to do

It is important for your child to pass any hard stool that is stuck in the lower bowel. The lower bowel can often be overstretched and not working properly. Any hard stool that may be stuck needs to be passed to clear the bowel and let it recover.  The stools then need to be kept soft, often for a long time, to allow the overstretched bowel to return to its normal size again.  This will also help the stools to bepassed without pain. While having enough fibre is important, the best way to treat constipation is with medication and behavioural techniques.

There are different ways to treat constipation:

Healthy eating and drinking habits:

Drinking enough fluid: School age children need to be drinking 4-6 cups per day, and possibly more in hot weather.  Water is the best drink for your child.  Small amounts of diluted juice or sugar free cordial can be used.  Pear juice and prune juice contain natural stool softeners.

Including fibre in the diet: This can be done by eating fruit and vegetables, beans and legumes (e.g. lentils) as well as choosing wholegrain breads, cereals & crackers.

Getting plenty of exercise.

Correcting toilet behaviour

Encourage your child to go to the toilet regularly.  A good time is after meals, because your body has a natural reflex to stimulate the bowels.

Teach your child to go to the toilet when they feel the urge/need to go, and not to hold on.

Have a high enough foot stool under your child’s feet (aim to have their knees higher than their hips) when they are sitting on the toilet. This can help to ease stools.

It is important to encourage your child, and not to criticise or punish them.

Medications

If you child needs medication to help them pass stools, your doctor will advise you about: which medication to use, how much to use, and how long to use it for.  Some medications that can be used in adults are not generally used in children It is important to follow their instructions carefully. Your child needs to drink plenty of water when using these medications.

How to prevent further problems

To prevent constipation, encourage your child to go to the toilet regularly - at least once a day – after meal times is a good time.  Teach them to go to the toilet when they feel the urge/need to go (and not to hold on!).  It is very important that a child is encouraged in correct toileting behaviour and not criticised or punished. Having enough fibre is a good lifelong habit for everybody. Increasing the fibre and having extra drinks will not usually treat constipation – but these can be important to prevent it coming back after things have improved with the above treatments. 

You could include fibre in your child’s diet by:

  • Eating plenty of fruit and vegetables

  • Using wholegrain breads and cereals

  • Including nuts: NOTE: we recommend using ground nuts, rather than whole nuts, in children under 5 years due to choking risk.

 

Remember

  • Treatment of constipation takes time and patience. Constipation can, and often does, come back again
  • Fibre, fluid and regular exercise can all help to keep the bowel working regularly.
  • Remind your child to avoid holding on to their stools. Encourage them to sit on the toilet after at least one meal a day
  • Always use any medications for constipation as directed by your doctor.

Useful Resources

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The Children's Hospital at Westmead
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Sydney Children's Hospital, Randwick
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Hunter New England Kids Health
www.hnekidshealth.nsw.gov.au

For publications recommended by our hospitals' experts, please visit the Kids Health book shop.