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Constipation is the most common cause of abdominal pain in kids. Signs include less frequent bowel movements or hard, dry stools. Talk to your child's doctor before using any over-the-counter remedies. A change in diet, plenty of water, and exercise can help. Also, address any anxiety she might have about using the toilet.
How can I tell if my child is constipated?
Signs of constipation in kids include:
- Less frequent bowel movements than usual: This is true especially if your child hasn't had a bowel movement in four or more days and is uncomfortable when she tries to poop.
- Hard, dry stools or large stools: Hard, dry stools can be very uncomfortable to pass, and large log-like stools might even clog the toilet. A child with abnormal stools may poop regularly and still be constipated.
- Belly pain and bloating: Constipation is the most common cause of stomach ache in kids.
- Soiled underwear: You may see very watery stool in your child's underwear or diaper. Don't assume this is diarrhea – it may be evidence of constipation. Liquid stool can slip past a blockage in the lower intestine and wind up in your child's underwear or diaper.
How often should kids poop?
How frequently kids have bowel movements varies from child to child. Young children tend to have bowel movements several times a week. Your child may poop after every meal, or may wait a day or two in between bowel movements. The frequency depends on factors such as:
- What and how much he eats and drinks
- How active he is
- How quickly he digests food
Can what my child eats and drinks cause constipation?
Yes. Reasons kids get constipated include:
- Drinking too much milk. Filling up on milk, which can be binding, at the expense of eating food high in fiber is often the main cause of constipation in children.
- Eating too many low-fiber foods. Your child could wind up constipated if she eats a lot of cheese, yogurt, or peanut butter, for instance, and not enough fruits, vegetables, and whole grains.
- Dehydration.If your child becomes dehydrated, her system will respond by absorbing more fluid from whatever she eats or drinks – and also from the waste in her bowels. The result is hard, dry stools that are difficult to pass.
What else besides diet causes constipation in children?
- Toilet anxiety: If your child feels pressured about toilet training or is anxious about having had a painful bowel movement, he might deliberately withhold his stool. If he shows all the signs of straining to have a bowel movement – stiffening his body and getting red in the face – he may actually be trying to hold it in. If constipation becomes chronic, the intestinal muscles can weaken, making it even more difficult to have a bowel movement.
- Not enough time on the toilet: Sometimes children don't completely empty their bowels. That can cause a buildup of feces that makes the colon cramp and stretch. An enlarged colon can lead to hard stools that are larger than normal and difficult to pass – which only makes your child even more reluctant to use the potty.
- Lack of activity: Movement helps blood flow to your child's digestive system, so he may experience trouble pooping if he's not active.
- Underlying medical issues: Constipation is sometimes a symptom of other conditions, including irritable bowel syndrome (IBS), lactose intolerance, hypothyroidism, and diabetes.
- Supplements and medications: Some supplements, such as iron, and some medicines, such as antidepressants, can lead to constipation.
- Stress: A child who is anxious or upset might become constipated or have diarrhea.
What diet changes will help treat and prevent constipation in the child?
- Limit foods that have a binding effect. These include bananas, cooked carrots or squash, and large quantities of dairy products such as milk, cheese, yogurt, and ice cream. Two cups of dairy a day are adequate for a toddler or preschooler. For a grade-schooler, 2 1/2 cups of dairy a day are adequate. (For example, 1 cup is a cup of milk or yogurt, or 1 1/2 ounces of hard cheese.) For more information, see our guides to feeding your toddler, preschooler, or grade-schooler.
- Boost your child's fiber intake. Serve plenty of whole grains, fruits, and vegetables. Offer apricots, plums, peas, beans, broccoli, and prunes. If she doesn't like the taste of prunes, try adding prune juice to her milk: Just 1 ounce of prune juice in half a cup of milk can be very effective. Popcorn is also a great source of fiber for older children, but it's a choking hazard for younger kids.
- Increase fluids. To help keep your child's stools soft, encourage her to drink at least 32 ounces of something other than milk each day. Water is your best choice, but she can have a little prune, pear, or apple juice, which you can dilute with water. Limit juice consumption to 4 ounces (1/2 cup) a day for toddlers 1 through 3 years, 4 to 6 ounces (1/2 to 3/4 cup) a day for children 4 through 6 years, and 8 ounces (1 cup) for children 7 years and older.
What else besides diet changes can I do to help treat or prevent constipation in my child?
- Encourage daily exercise. Being active gets the blood flowing to the intestines, helping to stimulate gut contractions and increase the transit time of food through the intestines.
- Wait or back off on toilet training. Pressuring your child to use the potty before he's ready can make him afraid or resentful, and he could wind up withholding bowel movements. If you notice your child doing this, increase the amount of fiber he eats (see above) and back off on training. Wait to try again until you spot the signs that he's really ready.
- Discourage delaying bowel movements. Encourage your child to use the toilet as soon as he feels the urge to poop and to tell you if he needs to go when you're out and about.
- Hang out in the bathroom. Children who have been constipated for a long time may have trouble perceiving that their rectum is full. If your child says he never feels like he needs to poop, try having him spend five to 10 minutes on the toilet after breakfast and dinner. Make it a pleasant experience by reading a book or talking to him. But don't force him to stay there if he doesn't want to, or he'll start to think using the toilet is a punishment.
Can I give my child a laxative or other over-the-counter treatment for constipation?
Always talk to the doctor first. If your child is very constipated, the doctor may suggest using an over-the-counter:
- Stool softener
- Lubricant (such as mineral oil)
- Enema (for severe or chronic constipation)
- Glycerin suppository: A glycerin suppository will stimulate your child's rectum and help her pass a stool. Using a suppository occasionally is fine, but don't do it on a regular basis because your child could wind up relying on them to have a bowel movement.
- Psyllium, if your child is at least 6 years old: If your grade-schooler is a picky eater and it's hard to get her to eat high-fiber foods, psyllium may help. This dietary fiber absorbs liquid in the intestine to form stools that are easier to pass.
What should I do if my child is deliberately withholding bowel movements?
Talk to the doctor. Withholding stool makes constipation worse.
Some children aren't comfortable using the toilet away from home, so they try to wait if they're somewhere else. Others start resisting bowel movements after having one that was hard and difficult to pass.
Also, if your child is deliberately holding back his stools, treating his constipation with suppositories or an enema could be extremely upsetting to him. Always check with your doctor before resorting to this type of treatment.
When should I call the doctor?
Call the doctor if your child is constipated and:
- Isn't eating
- Loses weight
- Has blood in her stool
- Has anal fissures – slight tears in the delicate skin near the opening of her anus (see "What should I do if my child has anal fissures?" below)
- Isn't responding to basic treatments for constipation, such as drinking more water and eating more fiber
- Is deliberately withholding bowel movements (see "What should I do if my child is deliberately withholding bowel movements?" above).
What should I do if my child has anal fissures?
If your child is passing hard, dry stools, they can cause slight tears, called anal fissures, in the delicate skin near the opening of his anus. If this happens:
- Talk to your child's doctor, who may prescribe or recommend a hydrocortisone cream or ointment. Applying it after a warm bath will help relieve the pain and promote healing.
- Don't use hemorrhoid cream; it's not safe for children.