Constipation in children

Your child may be constipated if, for more than 2 weeks, they:

• have hard stool (poo)
• don't go to the toilet regularly
• don't completely empty their bowel during a bowel movement

Constipation occurs in around 1 in every 10 children. It's more common for children to become constipated when they:

• start eating solid foods
• are toilet training
• have a change in routine, such as when they start school

What is normal for children?

Normal bowel habits for children vary:

• Babies who are breastfed may have a bowel movement as often as after each feed, or as little as once a week.
• Babies who are bottle-fed and older children will usually have a bowel movement at least once every 1 to 3 days.

Symptoms of constipation in children include:

• looking uncomfortable during a bowel movement
• being irritable or upset
• having abdominal (tummy) pain that comes and goes
• having less of an appetite than normal
• passing stool in their underwear
• being bloated

They might do things to stop a bowel movement, such as:

• crossing their legs tightly
• squatting
• refusing to sit on the toilet
• hiding when they need to do a bowel movement

Some children who are constipated may have an anal fissure. This is a small split in their anus (bottom) that causes pain and bleeding. This occurs because they have been straining (pushing hard) to pass a bowel movement.

It's common for babies under 6 months of age to strain when passing stool. This is part of learning how to co-ordinate a bowel movement and does not always mean they are constipated.

Children can become constipated if they:

• don't eat enough fibre
• don't drink enough water
• take certain medicines
• have a diet high in processed foods
• have a diet high in dairy products

Children may hold back bowel movements instead of going when they need to go. This can happen if it's been painful for them to poo before. 'Holding on' can make constipation worse.

A change in environment can cause constipation in children. This may affect:

• toddlers during toilet training
• older children when they are starting school

Some children become constipated because of a medical condition, such as:

• a thyroid deficiency
• coeliac disease
• cows milk allergy

A doctor can diagnose constipation. They will ask about your child's symptoms and behaviour such as:

• when the symptoms started
• what their stool looks like
• if bowel movements are painful
• if your child has had any recent changes in diet, such as starting solid food

Your doctor may feel your child's abdomen (tummy) and look at their bottom.

Tests

Most children won't need further tests to diagnose constipation.

If your child has severe constipation, or your doctor wants to better understand what is causing the constipation, they might recommend:

• an abdominal x-ray — this can check for a large build-up of stool
• a blood test — this can check for a medical condition that may be causing constipation

You should see a doctor if your child:

• hasn't had a bowel movement in one week
• has faecal incontinence (passes stool when they don't mean to)
• has symptoms that are not improving with simple diet changes
• is in pain

See your doctor or child health nurse if your child is less than 12 months old and you think they are constipated.

When to seek urgent care

You should seek emergency care if your child has constipation as well as:

• fever
• vomiting
• blood in their stool

Treatment of constipation in children will depend on the cause.

Self-care at home

Constipation in children can often be managed at home with lifestyle changes.

For toddlers and older children, adding high-fibre foods to their diet can help manage constipation:

• Offer your child prune juice — try mixing it with another juice or freezing it into icy poles to make it taste better.
• Add psyllium husk fibre to your child's food as a natural fibre supplement.
• Encourage your child to eat 3 servings of vegetables and 2 servings of fruit per day.
• Choose wholemeal bread instead of white bread.

Changing formula may help formula-fed babies with constipation.

Medicines for constipation

Laxatives are a type of medicine that can be used to help treat constipation. Laxatives are not recommended for children without medical advice.

Ask your doctor or pharmacist if laxatives are right for your child.

Other treatment options

Other treatment options include:

• suppositories — these are small tablets that are placed into your child's rectum (bottom) to help a bowel movement occur. Your doctor may recommend this if your child has severe constipation.
• bowel irrigation — if your child is severely constipated they may need to be admitted to hospital to have their bowel emptied.

Long-term constipation can cause faecal incontinence. This is because constipation makes the nerves in the bowel less sensitive, so your child may not feel the urge to go to the toilet.

Speak to your doctor if your child has symptoms of faecal incontinence.

Encourage your child to have healthy bowel habits to help prevent constipation:

• Set aside toilet time every day. This will encourage your child to have regular visits to the toilet.
• Offer your child a foot stool or a toilet ring to help them sit in the right position on the toilet.
• Praise your child when they sit on the toilet, even if they don't have a bowel movement.
• Talk with your child if they are worried about going to the toilet. For older children, make sure they have easy access to toilets at pre-school or school.

Other lifestyle measures can help prevent constipation, such making sure your child:

• has a diet high in fibre
• drinks plenty of fluids
• is active each day

To learn more about constipation and incontinence in children, visit the Continence Health Australia page.

The Sydney Children's Hospital Network offers a factsheet on the signs and symptoms of constipation in children.

Languages other than English

The Royal Children's Hospital Melbourne has a fact sheet on constipation in children in multiple languages.

Health Translations Victoria offers a fact sheet on constipation in languages other than English.

Information for Aboriginal and/or Torres Strait Islander peoples

For Aboriginal and/or Torres Strait Islander peoples living in rural and remote communities, Continence Health Australia offers a brochure on constipation. This explains:

• what constipation is
• why it can cause urinary and faecal incontinence
• how to prevent it

You can also call the healthdirect helpline on 1800 022 222 (known as NURSE-ON-CALL in Victoria). A registered nurse is available to speak with you 24 hours a day, 7 days a week.