Constipation in children

Overview

Constipation is when a child has hard, dry bowel movements (poop) that are difficult or painful to pass. They may go fewer than three times a week, but every child is different.

Yes, constipation affects about 1 in 3 children at some point. It is one of the most common reasons parents bring their child to a healthcare provider.

Constipation can affect children from infancy through adolescence. It is especially common around the time of toilet training and when starting school.

Symptoms

Common symptoms

• Fewer than three bowel movements per week
• Hard, dry or lumpy stools
• Pain or discomfort when passing stool
• Straining or crying during a bowel movement
• Feeling like the bowel isn't completely empty

Symptoms in children

• Holding in stool – you may see your child crossing their legs, hiding, or rocking
• Soiling (leaking liquid or stool into underwear) because of a blockage
• Belly pain or bloating
• Loss of appetite or feeling sick
• Irritability or upset behaviour around toilet time

Causes

Main causes

• Not eating enough fibre (from fruits, vegetables, whole grains)
• Not drinking enough fluids
• Holding in stool – often because it hurts or the child is too busy playing
• Changes in routine (travel, starting school, new house)
• Toilet training stress or fear of the toilet
• Certain medicines (like some pain relievers or iron supplements)

Risk factors

• Family history of constipation
• Underlying medical conditions (such as thyroid problems or nerve issues)
• Being overweight or not active enough
• A diet high in processed foods and low in fibre
• Emotional stress or anxiety (including bullying at school)

When to see a doctor

See a doctor urgently if:

• Your child has any of the emergency or urgent symptoms listed above

Book a routine appointment if:

• Constipation lasts longer than a few weeks despite diet changes
• Your child is soiling their underwear
• You're unsure what to do or need reassurance

Diagnosis

A healthcare provider will ask about your child's symptoms, eating habits, and medical history. They will also do a gentle physical exam, which may include feeling your child's belly.

Tests that may be done

• Usually no tests are needed – diagnosis is based on symptoms and exam.
• In some cases, a rectal exam may be done (the doctor inserts a gloved finger to check the rectum).
• Rarely, an abdominal X-ray or other imaging is used if there's concern about a blockage.

What to expect at your appointment

The doctor will explain the cause and give you a plan to help ease the constipation. They may suggest changes in diet, fluids, and toilet habits. If needed, they can recommend safe treatments. You should never give your child laxatives or enemas without a doctor's advice.

Treatment

Treatment focuses on softening the stool and helping your child pass it comfortably. Most children improve with simple home changes, but some may need short-term medicine under a doctor’s guidance. The goal is to make pooping painless so the child doesn't hold it in.

Self-care at home

• Increase fibre slowly – offer fruits like pears, prunes, apples, and vegetables like broccoli and carrots.
• Make sure your child drinks plenty of water throughout the day.
• Encourage physical activity – running, playing, and moving helps the bowels work.
• Set a regular toilet routine – have your child sit on the potty for 5–10 minutes after meals, especially breakfast.
• Praise your child for trying, even if nothing happens – never punish for accidents.

Medical treatments

If home changes aren't enough, a doctor may recommend a stool softener or laxative for a short time. These are usually given by mouth and help draw water into the bowel to soften stools. The dose and type are chosen based on your child’s age and needs. Always follow the doctor's instructions exactly – never give your child any medicine for constipation without professional advice.

When is surgery considered?

Surgery is rarely needed for constipation in children. It may be considered only if there is an underlying condition like Hirschsprung's disease (a nerve problem in the bowel) or a physical blockage that doesn't clear with other treatments.

Living with this condition

Help your child establish a regular toilet routine. Make it a calm, positive part of the day. Use a footstool so their knees are higher than their hips – this helps with pooping. Celebrate small successes.

Lifestyle tips

• Create a consistent daily schedule for meals, play, and toilet time.
• Reward your child for sitting on the potty, not just for pooping.
• Talk openly about bowel movements – reduce fear or shame.
• Work with your child’s school to allow easy bathroom access.

Diet and exercise

Offer a balanced diet rich in fruit, vegetables, whole grains and legumes (beans, lentils). Limit processed snacks and sugary drinks. Encourage at least 60 minutes of active play each day. Even gentle walks help.

Mental health and emotional wellbeing

Constipation can cause frustration, shame, or anxiety for both child and parent. Some children may start avoiding the toilet or hiding their symptoms. If you notice signs of stress (like school refusal, tears, or withdrawal), talk to a healthcare provider or school counsellor. Reassure your child that it's not their fault.

Prevention

Constipation can often be prevented by building healthy habits early. A high-fibre diet, plenty of water, daily physical activity, and a relaxed attitude toward toilet time make a big difference. Avoid making toilet time a battleground.

Complications

If left untreated

• Chronic constipation can lead to a stretched bowel (megacolon), making it harder to sense when you need to poop.
• Long-term soiling (overflow incontinence) because liquid stool leaks around the hard blockage.
• Anal fissures (small tears) caused by passing hard stools, which can bleed and cause further pain.
• Recurrent stomach pain and a cycle of avoiding the toilet that makes constipation worse.

Long-term outlook

With the right steps, nearly all children improve. It may take weeks to months to break the cycle, especially if the child has been holding in stool for a while. Stay patient and positive – most children grow out of constipation once they learn that pooping doesn't have to hurt.

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