Causes of constipation in children
Constipation can happen for several reasons.
Your child might be holding poos in because he’s too busy playing, because it hurts to do a poo (or has hurt before), or because he doesn’t want to use the toilets at his preschool or school.
Constipation might also happen if your child isn’t eating enough fibre, or because of an illness that has made your child eat and drink less.
These situations can all lead to a build-up of poo in the bowel. When this happens, the poo gets too hard for your child to push out easily.
There are some underlying medical conditions that might cause constipation in children, but these aren’t common.
Symptoms of constipation in children
A normal poo should be easy to push out and look like a sausage.
But if your child is constipated and her poo is hard to push out, she might feel pain and discomfort when she’s trying to do a poo or doing one. This might make her avoid going to the toilet.
Hard poo might overstretch your child’s anus and cause small, superficial tears, which might lead to pain and bleeding.
Your child might also have tummy pains that come and go. He might show ‘holding on’ behaviour like rocking or fidgeting, crossing his legs or refusing to sit on the toilet. He might also seem generally cranky.
If your child has been constipated for a long time, she might poo in her pants without meaning to. It could be a small or large amount of poo and can happen at any time of the day. This is called soiling or faecal incontinence.
Faecal incontinence happens because the hard poo is stuck and stretches the rectum. Your child might then lose the urge to go the toilet because his rectum always feels stretched. Liquid poo might overflow around the old hard poo, without your child feeling it or meaning to let it go.
When to see your doctor about constipation in children
You should take your child to the GP if:
- you need to give your child a laxative more than a few times a year
- your child’s constipation doesn’t get better after you give her a laxative
- your child hasn’t done a poo for seven days
- your child poos in her pants without meaning to
- your child has constipation and also fever, vomiting, blood in her poo or weight loss
- your child has painful cracks in the skin around her anus
- your child has constipation and you’re worried she isn’t eating or drinking enough.
Treatment for constipation
Your child needs healthy bowel habits.
The first step towards healthy bowel habits is diet. A healthy diet that has enough fibre helps to prevent constipation. Foods that are high in fibre include wholegrain breads and cereals, fruit and vegetables.
If your child is constipated, encourage him to get into the habit of sitting on the toilet regularly and pushing. It’s good if he can do this for five minutes about 20-30 minutes after he finishes eating breakfast, lunch and dinner.
It can help if your child has a footstool or box to put her feet on while she sits on the toilet. Get her to put her feet flat, knees apart, and lean forward slightly while pushing.
You can also teach your child to be aware of and respond to his body’s urge to poo. One way to do this is by starting a sticker or reward chart to praise your child for going to the toilet.
You might need to give your child a laxative if she’s constipated, so she can pass the hard poo without pain.
Prune juice is a mild natural laxative that works in some children. If this doesn’t work, you should see your doctor.
Possible laxative medications include:
- osmotic laxatives like lactulose, Movicol® or OsmoLax®, which increase the water in your child’s poo and soften it
- liquid paraffin oil, which softens and lubricates the poo
- stimulants like Senekot® or Dulcolax SP® drops, which stimulate the bowel to get rid of the poo.
Some children with chronic constipation will need to keep taking laxative medications for several months. Your doctor will let you know about the appropriate course of treatment.
Constipation in babies
Your baby might be constipated if his poo is dry and crumbly or like pellets, and doing a poo seems to cause him pain and discomfort.
It’s rare for breastfed babies to be constipated. If your breastfed baby is constipated, it’s possible she isn’t getting enough breastmilk. You might need to feed her more often.
Formula-fed babies might be constipated because the milk formula isn’t made up correctly and doesn’t have enough water in it. Getting the formula mix right and giving your baby extra fluids might help.
Some babies can get constipated if a hard poo has caused a tear in the rectum or anus, which hurts them. They instinctively hold on, so the remaining poo gets hard and more difficult to push out.
If you think your baby is constipated or your baby is very unsettled, see your GP or child and family health nurse.
It’s common for many babies to go red in the face and strain when doing a normal poo.
In babies under six months, how often they do a poo depends on what they’re fed.
Breastfed babies might poo up to five times a day, or only once every five days. Their poo is soft and yellow or mustard coloured.
Formula-fed babies usually poo 1-2 times per day. Their poo is firmer and more green-brown.