Table of contents
- Child constipation; when to worry?
- How long can a child go without pooping?
- Child constipation causes
- What to do when your child holds their poop?
- What can you give a child to help them poop
- Foods for child constipation
- Helpful toilet habits
- Other lifestyle changes for child constipation
- To sum it all up
If you’ve been searching for remedies for child constipation, this post is for you!
I recently received a question from a viewer whose one year old is struggling with constipation for many months already.
Here’s what she asked:
I know this might sound strange, but we have been struggling with constipation with our 1 year old for many months. He is a big fan of legumes and eats quite a lot of them, can that be affecting his digestion?
I found this question quite interesting and thought it would be the perfect opportunity to discuss constipation in children, what causes it, remedies for child constipation including what parents can do to help their little ones be more regular.
Child constipation; when to worry?
Just so that we’re all on the same page, let me quickly define what constipation is.
Constipation refers to abnormally delayed or infrequent hard stools that are usually accompanied by straining and/or pain.
Constipation can be organic or functional.
- Organic constipation: is constipation which has a known cause. For example, it can result from a medical disorder such as celiac disease, cystic fibrosis or inflammatory bowel disease.
- Functional constipation: is constipation for which there is no known medical cause.
Functional constipation is the one we’re going to be talking about today. It’s relatively common, affecting about 30% of children worldwide (1).
Health professionals use specific criteria – known as the Rome IV criteria – to diagnose constipation in children (2).
The ROME IV criteria are dependent on your child’s age, because what may be normal at 3 months may not be normal at 3 years.
For example, in their first week of life, infants tend to have an average of four stools per day. Around two years old, a child’s stool average is closer to two per day.
By four years old, most children’s bowel frequency will start resembling that of adults, which varies from three times per day to three times per week (3).
How long can a child go without pooping?
Here’s how to tell a normal stool frequency from one that could be diagnosed as constipation (2).
Infants up to 4 years of age
To be considered constipated, your child must have less than three stools per week or have experienced at least two of these additional criteria for at least one month.
- Excessive stool withholding.
- Painful or hard bowel movements.
- Stools that are large in diameter.
- Large fecal mass present in the rectum
It’s worth mentioning that, in healthy breastfed babies, bowel movements may not happen for several days. This is considered absolutely normal, as long as your baby doesn’t show any signs of distress when passing stools.
So try not to panic if your baby is breastfed and you haven’t seen a poopy diaper in a little while(3)!
If your child is under four years old but toilet trained, two additional criteria can be added to the list above.
- At least one episode of incontinence per week after having acquired toilet skills.
- Stools so large in diameter that they obstruct the toilet.
Children older than 4 years
To be considered constipated, your child must have experienced two or more of the following criteria, at least once per week, for at least one month.
- Fewer than three stools per week.
- At least one instance of fecal incontinence per week.
- Stool withholding.
- Painful or hard bowel movements.
- A large fecal mass in the rectum
- Stools so large in diameter that they obstruct the toilet.
In sum – Functional constipation is relatively common. A constipated child will typically have fewer than three stools per week, and/or fulfil the additional ROME IV criteria appropriate for their age.
Child constipation causes
Functional constipation in children can be caused by several factors.
Common causes of constipation in babies
The two most common causes are an allergy or intolerance to cow’s milk protein or introducing solids too early.
If you suspect an allergy or intolerance to the protein in cow’s milk and you’re breastfeeding, consider cutting out dairy from your own diet.
If you’re currently formula-feeding, it’s worth discussing alternativefeeding options with your paediatrician or registered dietitian. A soy infant formula, an amino acid-based formula or a hydrolysed infant formula are a few options worth considering.
Introducing solids too early may also lead to constipation in babies.
This may be especially true if you feed your baby a lot of rice-based baby cereal, which is naturally poor in fiber. If this is the case, consider swapping it for fruit-, legume-, or vegetable-based options, which are naturally richer in fiber.
If your baby is under 6 months old and is constipated, it’s possible that their gut may not be ready for solids quite yet. Consider switching back to exclusive breast- or formula-feeding to see if it helps.
If so, you can try reintroducing solids a few weeks later, to see if your baby tolerates them better (4).
Common causes of constipation in toddlers
The introduction of cow’s milk in your toddler’s diet may be one cause of constipation in this age-group. If you suspect this being the case, try offering over to calcium-fortified plant milks instead, to see if it helps.
Toilet training is another possible cause, especially if your child feels anxious about it or feels excessive parental pressure.
It can take only one unpleasant toilet experience for your child to start withholding stools. For instance, a toddler that wasn’t ideally hydrated on a hot summer day may have harder stools that day.
These can cause them pain when trying to pass them. In turn, this can lead them to withhold stools the next time they feel the urge to use the toilet from fear of experiencing pain again (5).
Common causes of constipation in preschoolers and older children
Withholding stools is the most common causes of constipation in this age group.
Your child may withhold stools for many reasons. For example, due to unpleasant toilet facilities when away from home, or a painful toilet experience in the past. Voluntary withholding so they can play for longer is also quite common.
Constipation can also be caused by dehydration, illness, trauma to the perianal area, or by sexual abuse. It may also pop up following stressful events, like moving, starting kindergarten, or the arrival of a new sibling (3, 5).
Constipation is also frequent in children with neurodevelopmental disorders such as autism spectrum disorder or may also occur as a side-effect of certain prescription meds(3).
In sum – Constipation can be caused by several things. The most common are an allergy or intolerance to cow’s milk, introducing solids too early, and situations that lead to the withholding of stools.
What to do when your child holds their poop?
The “withholding” I mention in the section above refers to a child holding their poop. Withholding is very common in functionally constipated children.
It’s also worth mentioning that in up to 84% of cases, functional constipation can also result in fecal incontinence (1).
So don’t be surprised if your constipated child soil themselves at times. As aggravating as it may be, functionally constipated children who soil themselves have little control over this. This condition even has a name; encopresis.
Here’s how functional constipation can cause encopresis(3):
- A child starts withhold stools, causing the stools to accumulate in the colon.
- The longer stools stay in the colon, the more water is reabsorbed from them. This makes them gradually harder and more challenging to pass.
- As they continue accumulating, these hard stools stretch the muscles of the rectum, which eventually become less sensitive.
- Over time, this causes the child to begin losing the sensation of needing to pass a stool.
- As a result, softer stools can start leaking around the harder plug when the sphincter relaxes, without your child necessarily being aware of it, in turn, soiling their underpants.
If your child is currently withholding their poop, a great place to start is figuring out what’s fuelling this behavior.
If the withholding is caused by hard, painful stools, laxatives, diet and lifestyle changes, and new toilet habits can be a helpful part of the solution.
What can you give a child to help them poop?
Laxatives are one of the first-line remedies for child constipation, especially if your child has impacted stools.
In children with impacted stools, disimpaction – which refers to the emptying of the hard stools from the colon – is a good idea. Disimpaction can be done through manual removal, suppositories, enemas or laxatives (2).
In past, manual removal, suppositories or enemas were the most common ways to do this. Nowadays, laxatives such as polyethylene glycol (PEG 3350) have become the first treatment, especially in children, because it’s well-tolerated and much less invasive(2).
Disimpaction is followed by maintenance therapy. The goal here is to keep the stools very soft, to prevent them from reaccumulating while the colon returns to its normal size and function. Stool softeners and laxatives are often used to help with this.
As a parent, you may be weary of giving your child stool softeners or laxatives from fear they may become “dependent” on them to pass stools(2).
If this is a fear you have, I encourage you to reframe it in this way.
The stool softeners and laxatives are purely a temporary solution to help break the cycle of constipation.
Laxatives or stool softeners can help your child start having a more pleasant experience when passing stools, hopefully reducing their reflex to withhold stools.
This will give the colon and rectum time to start functioning normally again. Hence, why they’re amongst the list of helpful remedies for child constipation.
But in order for this to happen, the laxatives or stool softeners should be used consistently used. They also should ideally not be stopped until your child has had normal bowel movements for at least 1 month(3).
Diet and lifestyle changes
Third phase consists of lifestyle changes, particularly regarding your child’s diet, hydration, and physical activity.
Foods for child constipation
Dietary changes are considered the first-line natural remedies for child constipation. That’s because one of fiber’s main roles is to add bulk to the stools, and help them move along more easily.
That’s why high-fiber foods such as whole grains, nuts, seeds, fruits, vegetables, beans, lentils and peas are worth including in your child’s diet. These will make it easier for your child to meet their daily fiber requirements below, based on their age:
- 1-3 years old: 19 grams of fiber per day.
- 4-8 years old: 25 grams of fiber per day.
- 9-13 years old: 26 grams of fiber per day for females, and 31 grams for males.
- 14 years and older: 25 grams for females, and 38 grams for males.
You may also want to include naturally laxative foods in your child’s diet. Great options include kiwis, chia seeds, flaxseeds, oat bran, rhubarb and, of course, dried prunes.
I’m sometimes asked whether probiotics and prebiotics are also considered useful remedies for child constipation.
There’s currently not enough research to suggest this. That said, probiotic and prebiotic rich foods can offer your child various other benefits, and there’s little downside to them. So as far as I’m concerned, they’re definitely worth a shot.
Other lifestyle changes for child constipation
In terms of lifestyle changes, stress management and regular physical activity are the two remedies for child constipation which will likely have the biggest impact.
Helpful toilet habits
Creating a consistent toileting routine can help your child get in the habit of passing stools more regularly.
For example, it can be helpful to encourage your child to sit on the toilet for 5-10 minutes at the same time each day, ideally, after a meal.
This will take advantages of the gastrocolic reflex – in which the colon naturally contracts after a meal, making it easier to pass stools.
Making going to the toilet a stress-free, pleasant activity may also help. For instance, try sitting with your child to read a book while waiting for those 5-10 minutes to pass.
If, after this time, they still haven’t had a stool, help them off the toilet and simply try again later.
In sum – Withholding is a common cause of constipation in children. Identifying the cause behind it is a good place to start. Laxatives, toileting habits, as well as diet and lifestyle changes can also help.
To sum it all up
Functional constipation is very common in children. In many cases, child constipation is caused by your child withholding their stools.
Identifying why they are doing this can help you come up with the best plan of action to help them stop. More often than not, this plan will include a combination of (natural) laxatives and improved toilet habits. A fiber-rich diet, optimal hydration, regular physical activity and a low-stress environment are also helpful.
If you’d like to view my specific answer to the question that spurred on this article, you can do so by clicking on the video above.
And if you have any specific child constipation-related question, I encourage you to leave them in the comments below!