Overview
Constipation means that stools have become hard and are difficult to pass. Some parents are overly concerned about how often their child has bowel movements. That's because they've been taught that a healthy child has a bowel movement every day. But this isn't true. How often a child has bowel movements isn't as important as whether the child can pass stools easily. Your child isn't constipated if their stools are soft and pass easily. This is true even if it has been a few days since the last bowel movement.
Newborns younger than 2 weeks should have at least 1 or 2 bowel movements a day. Babies older than 2 weeks can go 2 days and sometimes longer between bowel movements. It's usually okay if it takes longer than 2 days, especially if your baby is feeding well and seems comfortable. Breastfed babies are more likely to have frequent stools. They may have a stool as often as every feeding. Constipation is likely to occur when a baby switches from breast milk to formula. This is even more likely if the change happens during the first 2 to 3 weeks of life.
As babies grow older, the number of bowel movements they have each day gets smaller and the size of their stools gets bigger. A child age 3 or 4 years may have as many as 3 bowel movements a day or as few as 3 a week.
It's important for parents to recognize that there are many "normal" patterns for bowel movements in children. Some babies may seem to have trouble passing a stool. The child's face may turn red, and they may strain to pass stool. If the stool is soft and the child doesn't seem to have other problems, this isn't a concern.
Most children will be constipated now and then. The problem usually doesn't last long or cause long-term problems. Home treatment is usually all that's needed to relieve constipation that occurs now and then.
If your child is constipated often over 3 months or longer, this is chronic (long-term) constipation, and your child should see their doctor.
Causes of constipation include:
- Changes in diet, such as when a child starts to eat more adult foods.
- Not drinking enough fluids. Sometimes the normal amount of fluid a child drinks isn't enough. This can happen when the weather gets hot or the child gets more active.
- Not taking the time to have a bowel movement. A child may be so interested in play that they ignore the need to have a bowel movement.
- Reluctance to use the toilet. A child might become constipated when they are in a new environment, such as when travelling.
- Changes in daily routine, such as when travelling or after starting school.
- Medicines. Many medicines can cause constipation.
Constipation may occur with cramping and pain if the child is straining to pass hard, dry stools. The child may have some bloating and nausea. There may also be small amounts of bright red blood on the stool caused by slight tearing (anal fissure) as the stool is pushed through the anus. All of these symptoms should stop when the constipation is relieved.
Chronic constipation
For reasons that aren't always known, some children often have constipation that doesn't get better or go away with short-term home treatment (chronic constipation). This may be because of the painful passing of a hard, dry stool. After a while, the child may not be able to resist the urge to have a bowel movement and will pass a large mass of stool. The child may have to "push hard" during the bowel movement, which may be painful. Passing the stool relieves the pressure and pain until another mass of stool collects. Then the cycle is repeated. Fear of pain may cause the child to try to hold the bowel movement.
Other causes of chronic constipation may include:
- A crack (fissure) around the anus. It can make bowel movements painful and cause the child to resist passing stools. Fissures are a common problem that may get worse every time the child passes a large stool.
- A brief illness with poor food intake, fever, and little or no physical activity. This can upset normal bowel habits.
- Emotional problems or toilet training problems. They can lead to withholding stools on purpose. A child may have fought the toilet training process or been pushed too fast. Struggling with parents for control may cause a child to hold stools back as long as possible.
- A change in environment. At school, children may withhold stools for several reasons. Maybe they are afraid or embarrassed to use school washrooms. Or maybe their schedules are too busy for them to take time for a bowel movement. Or maybe their school activities interrupt their normal bowel movement time.
The child may not be able or willing to pass the stool regardless of its size. Liquid or loose stool may leak out, soiling the child's underwear. When this occurs in a child who is past the age of normal toilet training, it's called encopresis.
Working with your child’s doctor
If your child’s constipation doesn’t get better with home treatment, talk to your child’s doctor.
Your child’s doctor may recommend the following to treat and manage constipation:
- Education: Learning about constipation—including why your child is constipated and how to help your child to have soft stools they can pass easily without pain—is the first step to managing it. See the resources below for more.
- Cleanout of stool from your child’s body: Your child may need this if they have been constipated for some time. A cleanout may be done with medicine that brings water into the bowel to soften stool (osmotic laxatives). Or your child may need an enema to flush out stool. Follow the instructions from your child’s doctor.
- Long-term treatment with osmotic laxatives: Your child will likely need to use medicine for a longer time, usually months or years, as the many reasons for constipation are addressed. Your child’s doctor will monitor your child while they are using the medicine. Be sure your child takes their medicine as directed.
- Support for your child: This includes helping your child not to be afraid to pass stool, making it easier for your child to pass stool, and encouraging your child to use the toilet any time they feel the urge. It is important not to punish your child if accidents happen.
- Diet: Your child’s doctor may recommend adding more fibre to your child's diet after constipation has been treated successfully. This is important to keep their bowels healthy and prevent constipation. Follow the instructions from your child’s doctor on how to increase fibre gradually with vegetables, fruits, and whole grains. Increasing fibre too quickly can make your child uncomfortable and cause bloating and gas. Make sure your child is drinking enough fluids.
Treating chronic constipation in children takes time. It takes at least several months to:
- Allow all these steps to work.
- Set up new and healthy habits.
- Prevent constipation from coming back.
Always follow the instructions from your child’s doctor. Never stop medicines suddenly, because your child needs to wean off medicines gradually. If you have any questions about the medicines your child is taking, ask your child’s doctor or pharmacist.
Chronic constipation usually requires several months of treatment and co-operation between the parents, the child, and the doctor to overcome the problem. Don't be discouraged if the problem comes back during these months. The rectum is made of muscle tissue. When a child has had chronic constipation, the muscle gets stretched. It may take several months to get the muscle back into shape.
Other health conditions
In rare cases, constipation in children may be caused by other health problems, such as:
