Constipation in Children

When you have a baby, everyone jokes about the perils of diaper changes. What they don’t tell you is that you will spend years concerning yourself with the details of your child’s bodily functions. So, when your kid is constipated, it’s natural to be concerned. To help ease your worries, Amina Ahmed, MD, a Stanford Medicine Children’s Health pediatrician at South Bascom Pediatrics, offers her advice for managing your child’s constipation.

What is constipation?

If your child is having trouble going to the bathroom or does not have regular bowel movements, they could be constipated. For some kids, this could mean they go a few days without a bowel movement. For others, it could mean they have to strain and/or pass hard, dry stools.

“Constipation is a very common thing, and it’s sometimes hard to define,” Dr. Ahmed explained, “so, if they’re going two times or less than that per week, and if it’s painful for them to pass their stools, or if they’re passing a very large caliber stool and it’s hard, all those would be ways to define constipation.”

Causes of constipation

Dr. Ahmed outlined some of the common causes of constipation in children:

• Low-fiber diet: Lack of fiber leads to stools that are difficult to pass.
• Dehydration: Can cause hard, dry stools.
• Toilet training: Kids learning to use the toilet can often hold their poop too long.
• Behavioral issues: Starting school or emotional stress can trigger constipation.

Encouraging your child to eat more fiber, drink water, and maintain a regular toileting schedule can make it easier for them to go, according to Dr. Ahmed.

“Eat vegetables, lots of them, and fruits, high-fiber foods. Include them in the diet in various ways,” she said. “Maintain adequate hydration, at least 24 to 32 ounces of water or fluid a day. And then, limit cow milk, and be mindful that they’re not taking too much whole milk in their diet. And I think just good toileting habits.”

How to treat your child’s constipation

While it may be tempting to give your kid an over-the-counter laxative, Dr. Ahmed urges parents to check with their pediatrician first—especially when dealing with infants and young children.

“Constipation in the beginning can, like I said, mean different things for different parents, so it’s really important that the first time, they should be talking to their physician if they think their child is constipated,” she advised. “I caution against just use of over-the-counter laxatives because there are so many different types. You can abuse laxatives if you’re just constantly taking them without really getting to the core of why the child is having constipation. It’s not a healthy thing for the child.”

Instead, Dr. Ahmed recommends focusing on dietary and lifestyle changes, such as choosing whole-grain breads and pastas, finding fun ways to incorporate fibrous fruits and vegetables, making sure that kids drink enough water, and developing toilet routines.

“If your child does not just generally take a lot of fibrous foods, you need to include those in the diet. There are some fruits that have a sugar in them that helps stimulate the gut, and it acts like a mild laxative: any stone fruit—prunes, apricots, peaches—they all help. But especially prunes and figs. Apple is also a great choice because apple has insoluble fiber, soluble fiber, and has got sugars that help you go,” she said.

“Finding that right combination for your child, and then adding that to their diet—that will usually cure the constipation.”

Chronic constipation in kids and when to see the doctor

While occasional constipation is common, some kids are constipated all the time, which can be a bigger issue. If a kid can’t or won’t poop, over time the stool can build up in the rectum and be very difficult and painful to pass. Severe constipation can be serious, and Dr. Ahmed recommends checking in with your pediatrician.

“Think of the colon to be like a sock. It distends. You know how you can stuff a sock? You can stuff your colon with poop, and it gets stretched out, and that’s when the poop calibers are very big,” she said. “There’s a muscle in the colon that helps contract the colon to push out the poop. Now, if the muscle is all extended, it’s not contracting effectively, which means you’re not able to get the poop out, and it further worsens the constipation.”

Dr. Ahmed shared that you should always reach out to your child’s pediatrician if you are concerned about their constipation, but especially if you notice signs that it is getting worse.

“If your child is passing pebble-like stools, that’s not right. If there’s any blood with the stools, that’s always not right,” she explained. “If the child is complaining of persistent abdominal pain, meaning like every day they complain of abdominal pain, that’s not right. And if they’re having to strain a lot, they’re sitting for 10 minutes, 15 minutes on the pot, and they’re just straining, not being able to pass anything, that’s not right. Talk to your pediatrician.”

To learn more about constipation, check out the “Constipation in Children” episode of HealthTalks.