Constipation and children

Constipation is when a person has difficulty passing a hard bowel motion (poo), which can cause pain and discomfort.

A healthy diet, drinking enough fluid, exercise, gentle toilet training and regular toilet habits all help to prevent and treat constipation in children. Constipation in babies is different, and treatment for an infant should always be guided by a doctor.

It is not just how often a child goes#

Constipation is not only about how often a child opens their bowels. It also refers to how hard the stool is when it is passed.

When a child is constipated, going to the toilet hurts. They may also have regular tummy pain and bloating. Babies are constipated if their poo is dry and crumbly or like pellets.

Some children open their bowels only once or twice a week, while others go every day. If this is a child’s normal pattern, they have no pain when they go, and the poo is not hard, there is no reason to be concerned.

Constipation that goes on for a long time can cause other problems, such as soiling, where softer poo leaks out around a solid lump and dirties the underpants.

Constipation is a common problem#

The cause is not always clear, but it may include:

• Drinking too much milk and not getting enough solid food
• Ignoring the urge to go because the child is busy playing
• Holding back during toilet training
• Avoiding school or preschool toilets, for reasons such as lack of privacy or an unpleasant toilet
• Not getting enough exercise

A hard poo can also cause a small tear or crack in the skin next to the anus (an anal fissure). Because it hurts, the child holds on, the poo becomes harder still, and passing it becomes even more painful.

Signs of constipation in children#

• Showing signs of holding on, such as crossing the legs or running around
• Crying or refusing to sit on the toilet
• Saying it hurts when doing a poo
• Complaining of tummy pain
• Soiling their pants (with ongoing constipation)

Treating constipation in children#

• Encourage your child to exercise more.
• Establish a regular toilet routine. “Bowel training” needs motivation and encouragement, and a star chart of rewards can help your child sit on the toilet at a similar time each day.
• Talk to the teachers if the school toilets are a problem.
• Try to deal with the problem quickly. The longer a child stays constipated, the worse it may become and the longer it can take to treat.
• See a doctor if constipation is a long-term problem.

Limit the use of laxatives#

Laxatives should not be used more than once or twice. They do not solve the underlying problem and may change the way your child’s bowels work. If you do use one, choose a laxative that increases bulk and fibre in the gut.

Add fibre to your child’s diet#

A healthy diet is very important. Suggestions include:

• Offer more wholegrain or wholemeal breads, rice, cereals and high-fibre biscuits.
• Offer more fruit, dried fruit and vegetables.
• Increase fibre intake slowly.
• Encourage your child to drink plenty of water.

Constipation in babies#

Breastfed babies are hardly ever constipated, although they may not pass a motion for several days or up to a week. Even then, the poo is usually soft. Many babies strain and go red in the face when passing a normal poo. This is not a sign of constipation unless the poo is hard and causes pain. True constipation in babies is rare and should always be checked by a doctor.

Causes of constipation in babies#

• Formula that is too strong. If your baby is bottle-fed, make sure the formula is made up correctly.
• Not enough fluid. Bottle-fed infants may need extra fluid, such as cooled, boiled water, between feeds, and breastfed infants may need more frequent feeds.
• Solids that are not right for the baby. Use foods suited to your baby’s age. Large amounts of legumes (peas, lentils and so on) and high-fibre cereals are not appropriate for young infants.
• A hard poo causing a small tear in the skin around the anus, which makes the baby hold on so that the poo becomes harder and more painful to pass.

Increasing fibre from wholegrain cereals and large quantities of fruit, vegetables and water may not be suitable for an infant with constipation. Follow the usual advice from your child health nurse or doctor about introducing solids for infants under one year.

Treating constipation in babies#

• If your baby is bottle-fed, check the tin to make sure the formula is made correctly. Always measure the water first and then add the formula powder.
• Offer extra drinks of water.
• Try gentle tummy massage.
• A warm bath may help relax the baby’s muscles (be prepared for them to poo in the bath).
• Give only medication prescribed by your doctor.

Things you should NOT do when a baby is constipated#

• Do not give prune juice to infants under six months. It contains a natural bowel irritant, even when diluted.
• Do not add sugar, malt extract or rice cereal to formula. It will not help.
• Do not introduce solids before four to six months of age as a way to treat constipation. This is not recommended.

Complications of long-term constipation#

Occasional bouts of constipation cause no health problems. However, if constipation lasts a long time and a large mass of poo is held in the gut, soiling may begin. This can lead to serious social and emotional problems, so it is best to treat ongoing constipation early.

Key points#

• Constipation can cause pain and discomfort.
• Treatment for infant constipation requires expert medical advice.
• Constipation is a common problem.
• A tear in the skin next to the anus (an anal fissure) may be caused by passing a hard poo.
• This can make a child hold on for longer because it hurts to go to the toilet.

Where to get help#