Constipation and children

Constipation is when a person has difficulty passing a hard bowel motion (poo). This can cause pain and discomfort. A healthy diet, having enough to drink, exercise, correct toilet training and regular toilet habits are important to prevent and help treat constipation in children. Treatment for infant constipation requires expert medical advice.

It’s not how often that’s important

Constipation is not just how often a child goes to the toilet. It also refers to how hard the stool (poo) is when it is passed. When a child is constipated, it hurts when they go to the toilet. They may also have regular tummy pain and bloating. Babies are constipated if their poo is dry and crumbly or like pellets.

Some children may use their bowels (poo) only one to two times a week, while others do so every day. If this is a child’s normal pattern, they don’t have any pain when they do a poo and it is not hard, there is no reason to be concerned.

Constipation that goes on for a long time can cause other problems for children, such as soiling – softer poo leaks out around a solid lump of poo and dirties underpants.

Causes of constipation in children

Constipation is a common problem. The causes of a child’s constipation may not always be clear, but may include:

• If a child is drinking too much milk and not getting enough solids, the lack of fibre can cause constipation.
• A tear in the skin next to the anus (called an anal fissure) may be caused by doing a hard poo. This will make the child try to hold on for longer because it may hurt to go to the toilet.
• Some children ignore the urge to go to the toilet because they are too busy playing.
• Some children hold back when they are being toilet trained.
• Some children don’t want to use school or preschool toilets for various reasons, such as lack of privacy or a smelly toilet.
• The child may not be getting enough exercise.

Signs of constipation in children

Some of the signs of constipation in children include:

• saying that it hurts when doing a poo
• showing signs of holding on – such as crossing legs, running around, crying or refusing to sit on the toilet
• complaining of tummy pain
• soiling their pants (with ongoing constipation).

Treating constipation in children

Suggestions for treating constipation in children include:

• Encourage your child to exercise more.
• Establish a regular toilet routine. ‘Bowel training’ requires motivation and encouragement. Use a star chart system of rewards to help your child to go and sit on the toilet. This will help your child get used to doing a bowel movement at a similar time each day.
• Discuss the school toilets with the teachers if this is a problem.
• Limit the use of laxatives. They should not be used more than once or twice. They don’t solve the underlying problem and may change the way your child’s bowels work.
• Use laxatives that increase bulk and fibre in the gut, if you do use them.
• Try to solve the problem quickly – the longer your child remains constipated, the worse it may become and the longer it may take to treat.
• See a doctor if constipation is a long-term problem.

Add fibre to your child's diet

A healthy diet is very important. Suggestions for improving your child’s diet include:

• Offer more wholegrain or wholemeal breads, rice, cereals and biscuits with high fibre. Fibre intake should be increased slowly.
• Offer more fruits, dried fruits and vegetables.
• Encourage your child to drink lots of water.

Causes of constipation in babies

Breastfed babies are hardly ever constipated, although they may not have a bowel motion for several days or up to a week. Even then, their poo will usually be soft. Many babies strain and go red in the face when doing a normal poo. This is not a sign of constipation unless the poo is hard and causes pain and discomfort. True constipation in babies is rare and should always be checked by a doctor.

Causes of constipation in babies include:

• formula is too strong – if your baby is bottle-fed, make sure the formula is made up correctly, so that there is not too much formula powder for the amount of water
• using a different formula – changes to the milk formula (especially when swapping to ‘follow-on’ formula or cows milk)
• not enough drinks – in warm weather, bottle-fed infants require extra fluid such as cooled, boiled water between formula feeds. Breastfed infants may require more frequent feeds
• solids that are not right for the baby – use the correct solid foods for the age of your baby. Be aware that excessive use of legumes (peas, lentils and so on) and high fibre cereals are not appropriate for young infants
• difficulty passing poo – sometimes a hard poo can cause a little tear or crack in the skin around the anus and this can hurt the baby. The baby seems to know that it hurts to do poo and so ‘holds on’. Then the poo becomes even harder and will be more painful to pass.

Treating constipation in babies

Increasing fibre from wholegrain cereals and consuming large quantities of fruit, vegetables and water may not be suitable for an infant with constipation. Follow the usual advice from your child health nurse or doctor regarding introduction of solids for infants less than one year.

Suggestions to treat constipation in babies include:

• If your baby is bottle-fed, check the formula tin to make sure the formula is being made correctly. Always measure the water first and then add formula powder.
• Offer extra drinks of water.
• Gentle tummy massage can help.
• A warm bath may help the baby’s muscles to relax (be prepared for them to poo in the bath).
• Give only medication prescribed by your doctor.

Things you should NOT do when a baby is constipated

There are some things you should not do to treat constipation in babies:

• Don’t give prune juice to infants under six months of age – it contains a natural bowel irritant, even when diluted.
• Don’t add any form of sugar, malt extract or rice cereal to formula – it will not help the constipation.
• Don’t introduce solids before four to six months of age – it’s not recommended as a way to treat constipation.

Complications of chronic constipation

There are no health problems from occasional bouts of constipation. However, if the constipation lasts for a long time and a large mass of poo (faeces) is held in the gut, soiling may begin. This can lead to serious social and emotional problems.

Where to get help

• Your GP (doctor)
• Maternal and child health nurse
• The Maternal and Child Health Line Tel. 13 22 29
• Nurse-on-Call Tel. 1300 606 024 – for expert health information and advice (24 hours, 7 days)
• Dietitians Australia
• The Royal Children’s Hospital
• NSW Health Multicultural Health Communication Service – for multilingual child health fact sheets