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Constipation

Introduction

Here you’ll find answers to some of the questions that parents often have about this condition. Additional resources are listed at the bottom of the page. Diagnosis and management information can be found in the Constipation module, which is written for primary care clinicians but also may be of help to parents and family members.

What is constipation and what causes it?

Constipation is a pattern of delayed, painful, or hard bowel movements. Most people have an occasional hard poop, but if this happens frequently, it can cause problems. Hard stools and pain/discomfort associated with passing them may cause children to “retain” stools. These retained stools get even harder and fresh stool may start leaking around these hard stools, causing “accidents” or encopresis.

What are the symptoms of constipation?

Constipation can cause pain, a swollen belly, loss of appetite, gastro-esophageal reflux (heartburn), and even loss of ability to control the bowel movements. Pain from constipation in kids is usually crampy, sharp, or achy pain around the belly button or the sides of the belly. Usually this pain occurs while your child is awake and is worse after eating or with exercise. Although the cramps or aches may keep children from falling asleep, the pain does not usually wake them from sleep. Sometimes a child can accumulate so much poop in their rectum that it keeps the anus open, resulting in leaking, which can appear to be diarrhea or soiling. Bulky hard poop can make small rips in the anus that leave spots of blood when the child wipes.

How is it diagnosed?

The primary care clinician may use specific criteria to diagnose constipation. Constipation generally includes more than one symptom including two or fewer bowel movements in a week, leaking stool once a week, holding back bowel movements, hard or painful bowel movements, or large stools that block the toilet.

What is the prognosis?

Most children with functional constipation require prolonged treatment. In one study, after intensive initial medical and behavioral treatment, 60% of children were treated successfully after 1 year with follow-up care and 80% of children were treated successfully by 8 years of follow-up care. One-third of the children needing follow-up beyond puberty continued to have severe complaints of constipation. [van: 2003]

What is the risk for other family members or future babies?

There are some conditions that lead to an increased risk of having constipation, such as diabetes, hypothyroidism, celiac disease, and specific protein allergies, although most children have constipation, not associated with other medical conditions. Families can ask their primary care clinician about the cause of their child's constipation and the risk of constipation in future children.

What treatments/therapies/medications are recommended or available?

Parents can help prevent constipation by making sure that the child gets adequate fluids and fiber in the diet, exercise, appropriate positioning, and regular, unrushed toileting time after meals. These strategies are also good first steps to treat mild constipation as well.
In addition to fluids, diet, and lifestyle changes, the daily use of medications over a prolonged period may be necessary to keep some children regular; this is called “maintenance therapy.” In children, these medications are various kinds of laxatives. The child’s primary care clinician in the medical home can work with the family to develop a tailored plan for the child’s constipation if needed.

How will my child and our family be impacted?

Changes in dietary, eating, and exercise habits are part of the routine needed to reduce constipation and can be supported by the whole family adopting the changes.

When should I seek urgent medical attention for my child?

  • Vomiting or dehydration related to the constipation or bowel problem
  • Swollen, firm abdomen that is painful to the touch or associated with fever (seek immediate medical attention)
  • Pain doesn’t go away or is getting worse
  • Blood is in or around the stool (can be non-urgent, but check with your primary care clinician if this is new)
  • Stool is not able to be passed despite appropriate medications
  • An enema has not come back out

Are there medications that can help my child's constipation?

A typical bowel program will first clean out the large intestine and then continue to keep the stool mushy and easy to push out. This is the main mode of constipation treatment. The goal of the bowel management program is to produce 1-2 mushy, easy-to-pass, painless poops every day. It is important for the treatment to continue for several months, if not longer. If your child has any problems with their prescribed bowel program, or is not getting better with this program, you should contact your primary care clinician to tailor a program for your child’s specific needs. For more detailed information on medication, contact your primary care clinician. No medication, or clean out, should be initiated without consulting the child's physician first.

Are there diet choices that can help my child's constipation?

  • Liquid – Inadequate liquid intake may contribute to constipation. Increasing water may be helpful, but can be difficult to do, particularly with a young child. Avoid using sweetened beverages, especially sodas, to increase fluid intake. 1- 4 oz. per day of prune or apple juice can help with constipation in some children and infants.
  • Fiber – Increasing fiber in the diet may reduce constipation. The best sources of fiber include whole grains, fruits, and vegetables. Avoid highly processed and carbohydrate-rich foods that lack fiber as these may decrease appetite. If using formula, consider switching to one with fiber.
  • Stimulating foods – Some foods may stimulate the intestines to move more quickly. Prunes are the most common of these, but children may vary in which foods work best for them.
  • Constipating foods – Many foods seem to contribute to constipation, at least in some children. Bananas and cheese are the most common. Again, this can vary among children.
  • Refer to a nutritionist as needed (see all Nutrition Assessment Services services providers (105) in our database).

Are ther other habits than can help my child's constipation?

  • Meals – Regular meals are helpful in keeping the bowels moving. Sitting on the toilet following meals can enhance the ease of passing bowel movements.
  • Fewer snacks – Snacking, particularly “grazing” (eating small amounts of food, usually low in fiber, through the day), can limit the amount of food eaten at meal times and result in a poor gastro-colic reflex, resulting in poor gut motility and constipation.
  • Exercise – Kids who get plenty of exercise seem less likely to get constipated. Daily exercise also has benefits in terms of fitness and weight control. Time in a stander or walker may help with evacuation for kids who spend most of their time in a wheelchair or lying down.
  • Behavioral issues – For children who are toilet trained, ensure adequate time and privacy for defecation (e.g., it isn't going to happen in a public school bathroom stall). During potty training, positively reinforce all passage of stool, and treat accidents with a neutral approach.
  • Toileting routine – It is helpful if your child goes to the toilet and tries to poop after meals. This is particularly important after breakfast on school days, when he or she may not have another opportunity to poop until evening. (See Toilet Training for CYSHCN.)
  • Positioning – Ensure the child is adequately supported in an upright position to allow optimal defecation. Placing the feet on stool can help for kids whose feet don’t reach the ground. If indicated, obtain an adapted toilet seat with adequate support. (Example: Squatty Potty).

Is there help with diaper costs?

Diapers are a huge health care expense. Generally Medicaid will cover the cost of diapers for the incontinent child after age 3 through a home care company with a clinician’s prescription and letter of medical necessity. Less frequently, private payers can be convinced to do this.

Resources

Information & Support

Where can I go for further information?

For Parents and Patients

About Kids and Teens GI Health (IFFGD)
Reliable digestive health knowledge, support, and assistance about functional gastrointestinal and motility disorders; International Foundation for Functional Gastrointestinal Disorders.

Baby's First Days: Bowel Movements & Urination (AAP)
Important points about first bowel movements; American Academy of Pediatrics.

How do I know if my child is constipated? (AAP)
Information about bowel patterns, and signs, treatment, and prevention of constipation; American Academy of Pediatrics.

Dietary Fiber (IFFGD)
Information about different kinds of fiber, how to incorporate fiber into the diet gradually, and serving sizes to help prevent constipation; International Foundation for Functional Gastrointestinal Disorders.

Hungry Kids: High-Fiber Foods (National Fiber Council) (PDF Document 66 KB)
Explains how to increase fiber in kids’ diets and provides information about fiber requirements and reading food labels.

Pediatric Constipation (Medscape)
Overview of approaches to managing constipation, with links to dosing guides for each medication.

Pediatric Constipation Medication (Medscape)
Information about various medications used to treat constipation in children from medical experts.

Constipation (NASPGHAN) (PDF Document 178 KB)
Fact Sheet about constipation with information about the diagnosis and management from the American Society for Pediatric Gastroenterology, Hepatology and Nutrition (NASPGHAN).

Constipation (NASPGHAN) Spanish (PDF Document 177 KB)
Fact Sheet in Spanish about constipation with information about the diagnosis and management from the American Society for Pediatric Gastroenterology, Hepatology and Nutrition (NASPGHAN).

You Can Poop Too Program (BeHealth Solutions)
Online program that provides education and ongoing tools to solve the physical, emotional and behavioral issues of encopresis; only available for purchase.

Patient Education

Infant Constipation (Nationwide Children's Hospital)
Information about signs of constipation in infants under 1 year of age and indications for when to call your doctor.

Let's Talk About Constipation (Spanish) (Intermountain Healthcare) (PDF Document)
One-page handout, in Spanish, explaining childhood constipation.

Let's Talk About Constipation in a Child: Bowel Clean Out (Intermountain Healthcare) (PDF Document)
Guide for caregivers on bowel clean-out and daily care for constipation at home.

Let's Talk About Constipation in a Child: Bowel Clean Out (Spanish) (Intermountain Healthcare) (PDF Document)
One-page guide, in Spanish, for caregivers on bowel clean-out and daily care for constipation at home.

Let's Talk About Enemas Fleet (Spanish) (Intermountain Healthcare) (PDF Document 59 KB)
One-page handout, in Spanish, for caregivers on how to give enemas to children.

Let's Talk About Fleet Enemas (Intermountain Healthcare) (PDF Document 59 KB)
Handout for caregivers on how to give enemas to children.

Let's Talk About Rectal Suppository (Intermountain Healthcare) (PDF Document)
One-page guide for caregivers about rectal suppositories for children.

Let's Talk About Rectal Suppository (Spanish) (Intermountain Healthcare) (PDF Document)
One-page guide, in Spanish, for caregivers about rectal suppositories for children.

Let’s Talk About Constipation (Intermountain Healthcare)
One-page handout explaining childhood constipation.

The Poo in You - Constipation and Encopresis Video (Children's Hospital Colorado)
Excellent 5-minute video about why soiling accidents occur and what can be done to make them stop happening. Includes simple information about the digestive process, role of colon, and medicines that may help with constipation and resulting encopresis.

Understanding and Treating Constipation in Children Video (PCH)
An 8-minute video that helps parents and other caregivers understand constipation and what can be done to remedy it; Primary Children's Hospital.

Tools

Food Record (University of Rochester) (PDF Document 151 KB)
A 3-day food record with instructions for parents.

Stool Diary Using Bristol Stool Form Scale (NIH) (PDF Document 147 KB)
Printable record of stool habits for 1 week; originally from Lewis SJ, Heaton KW, Scandinavian Journal of Gastroenterology - reproduced by the National Institutes of Health.

Services

Clinical Social Worker (LCSW, MSW)

See all Clinical Social Worker (LCSW, MSW) services providers (1) in our database.

General Pediatric Surgery

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Nutrition Assessment Services

See all Nutrition Assessment Services services providers (105) in our database.

Pediatric Gastroenterology

See all Pediatric Gastroenterology services providers (2) in our database.

Pediatric Neurosurgery

See all Pediatric Neurosurgery services providers (1) in our database.

Prescription/Pharmacy

See all Prescription/Pharmacy services providers (29) in our database.

Psychologist, Child-18 (PhD, PsyD)

See all Psychologist, Child-18 (PhD, PsyD) services providers (8) in our database.

For other services related to this condition, browse our Services categories or search our database.

Authors

Content Last Updated: 12/2016

Page Bibliography

van Ginkel R, Reitsma JB, Büller HA, van Wijk MP, Taminiau JA, Benninga MA.
Childhood constipation: longitudinal follow-up beyond puberty.
Gastroenterology. 2003;125(2):357-63. PubMed abstract / Full Text