Constipation is a common problem in children. It is defined as dry and hard stools that occur infrequently, usually less than three times per week. It occurs when stool sits in the colon too long causing too much water to be absorbed from the stool. It can cause stools that are painful or difficult to pass. Fortunately, constipation is usually temporary.

Constipation can be caused by many factors. Withholding occurs when a child has a hard, painful bowel movement. It hurt so they decide not to do that again. When they feel the urge to defecate, they withhold the stool. As they withhold, the stool dries out in the colon, becoming harder and more painful to pass. You can see how this becomes a cycle. Some kids are just too busy to stop to use the restroom. They do not want to miss any of the fun, so they skip potty time or forget to go.

Routine changes such as travel can cause constipation. A new daycare or school may be the culprit, as some children refuse to use a public toilet. Dietary changes can play a role in constipation. You may notice this if your child’s diet includes foods that are binding such as cheese, bananas, and rice. If you child is not getting enough fiber-containing fruits and vegetables, constipation may present.

Constipation can also occur if your child is not drinking enough fluids, especially water. (Water must not be given to infants less than six months of age.) Certain medications such as iron can cause constipation. Use medications as directed by your child’s pediatric healthcare provider and follow up if constipation occurs. Family history may well play a role in constipation. Rarely medical conditions can include constipation as a symptom.

Prevention is easier than cure. Be sure to offer healthy high-fiber foods to your child, including fresh fruits and vegetables (strive for five fruits and vegetables daily), whole grain breads, and whole grain cereals. A young child should have about 20 grams of fiber each day. Be sure that your child has plenty of fluids daily, including water. Eat meals on a regular schedule. Physical exercise is helpful to prevent constipation. Having a good bathroom routine with time for toilet sitting after each meal is healthy and encourages normal evacuation of the bowels. Use a footstool for your child while on the toilet to allow them to feel secure. Reward efforts to go and do not punish any accidents.

Contact your pediatric healthcare provider if you notice that your child has hard, dry stools, less than three bowel movements per week, difficult bowel movements, pain with pooping, vomiting, blood in a stool, or if you notice soiling in your child’s underwear. Your healthcare provider will take a complete medical history of the problem and do a thorough examination of your child. They will explain the diagnosis and recommend a treatment plan.

If your child is diagnosed with constipation, the treatment plan may include dietary changes, such as increasing fiber by adding fresh fruits and vegetables, as well as whole grains. Juices such as apple, prune, and pear may be helpful. Decreasing constipating foods such as cheese, bananas, and rice may be discussed. Exercise may be recommended. They may recommend an enema or a glycerin suppository to soften hard stool. They may recommend a stool softener or laxative such as polyethylene glycol (MiraLAX) to increase the amount of water in the colon. Never give a laxative, stool softener, or enema without a recommendation from your pediatric healthcare provider.

If your child is impacted, you may be referred to the local emergency department to remove the blockage. If the constipation is persistent (chronic), your child may be referred to a digestive specialist known as a gastroenterologist.