Chronic Constipation In Children

What causes chronic constipation in children? Find out here and how simple diet and lifestyle changes can help.

Chronic Constipation In Children photo

It is common for infants and children to suffer with constipation. There are several reasons why a child can become constipated and it is helpful for parents to understand these so that they can break the cycle and manage chronic constipation successfully.

Signs that your child is constipated

The amounts of times your infant or child goes to the toilet can vary, particularly as a baby, but there are certain signs to watch out for to tell if your child might be constipated. These include:

  • Passing a stool less than three times a week
  • Straining when trying to open their bowels
  • Passing large, dry, hard, lumpy or pellet-like stools
  • Foul-smelling flatulence (wind) or stools
  • Loss of appetite
  • A firm or bloated abdomen
  • Less energy than normal and seeming distressed or teasy

It may be useful to use the Bristol Stool Chart as a tool to asses s and monitor your child’s stools. If they pass mostly type 1 or type 2 stools at least 25% of the time, then it is likely that they are suffering with constipation.

Common causes of constipation in children

Certain life stages for a child are often associated with constipation. These milestones and other common causes include:

  • Weaning – any change in diet, such as changing from breastfeeding to infant formula or eating processed foods, can cause constipation as these can be harder to digest than breast milk.
  • Toilet training – it is common for children to develop a fear of going to the toilet during potty training and they may feel pressured to go at certain times.
  • Starting nursery or school, or going to the toilet in public places – children often become anxious about going to the toilet in certain situations outside of the home. This can lead to them holding back and then becoming more constipated. If constipated, they are likely to find passing stool harder and more painful which then starts a vicious cycle.
  • Poor toilet posture – due to their small size, it can be difficult for children to be in the correct position on the toilet to pass stools easily
  • Illness – children are prone to developing fevers which can be associated with a decrease in appetite and fluid intake, resulting in mild dehydration and increasing the risk of constipation
  • Lack of fibre – infants and children often don’t get enough fibre in their diet, particularly if they are fussy eaters and don’t eat a good diversity of vegetables and fruit. Fibre is important for bulking up the stool and supporting regular healthy bowel movements.
  • Dehydration – a lack of fluids can make stools harder to pass and increase the risk of constipation. This may be due to dehydration through illness or simply not drinking enough.

Constipation with overflow diarrhoea or soiling

Another sign of constipation is if your child soils their pants with what looks like diarrhoea. This can happen from the age of 1 year and can continue until they are much older unless the problem is addressed. This happens when chronic constipation leads to hard stool blocking the bowel which causes watery stools from higher up in the bowel to leak out around the blockage, looking like diarrhoea. This can be extremely distressing for a child, particularly when they start nursery or school, and may require specialist support to address the underlying factors.

Tips for avoiding or alleviating childhood constipation

For babies and infants:
  • Gently move their legs like they are riding a bicycle whilst lying down and lightly massage their tummy to help get things moving
  • Keep them well hydrated with extra water between feeds if bottle-fed
  • Provide plenty of fibre in the diet if they are on solids. Apples, pears or prunes can be a good way of providing fibre which helps to alleviate constipation.
For children:
  • Encourage daily activity tailored to their age and ability to keep things moving and relieve pain
  • Be patient with your child and do not make toileting an unpleasant experience by putting pressure on them to go, stay calm and relaxed
  • Be consistent and have a toilet routine – put them on the potty or toilet at the same time each day, or before certain pre-planned activities, even if they don’t go. This might be after every meal for five minutes, before bedtime, or before going out to play.
  • Ensure they are in a good squat position – children should be able to rest their feet flat on the floor, so use a child’s toilet seat and step or stool to allow them to do this. You should aim for their knees to be above their hips.
  • Reward them using a system such as star charts to praise them when they go to the toilet to make it a pleasant experience.
  • Ensure your child is drinking enough fluids – you can find out how you’re your child should be drinking for their age in this guide from NICE (National Institute for Health and Care Excellence) .
  • Include high fibre foods in their diet such as a wide diversity of brightly coloured vegetables and fruits, wholegrain bread, rice, pasta and beans.

It is advisable to seek advice from a qualified medical practitioner if your child has constipation or frequent soiling so that they can advise on the best treatment and assess for other causes such as an obstruction, developmental delay or behavioural problems that require further investigation.

Laxatives or natural remedies can sometimes be helpful in alleviating childhood constipation and it is recommended to discuss this with a medical practitioner and/or registered Nutritional Therapist to ensure the appropriate dosage and safe use.

Ho, J., & How, C. H. (2020). Chronic constipation in infants and children. Singapore medical journal, 61(2), 63–68.