Your child has gone several days without a normal bowel movement (BM) or is having a hard time passing a stool. Children, like adults, can become constipated from time to time.

Constipation can happen for a variety of reasons and getting back on track can be frustrating. Once your child is back on track, preventing it from happening again or noticing some early signs is key to helping them have soft, easily passed BMs.

What is constipation?

There are many ways that constipation can be defined. The most agreed upon definition is having less than three BMs in one week. However, if they are soft and easily passed with no accidents or belly pain, this may be okay for your child.

Another recognized definition of constipation is when the BMs are hard and difficult to pass, sometimes causing pain or discomfort when passing them. In children, the focus is on the stools passing easily with no pain or strain.

The BMs should also be occurring on a regular basis, which can be child-specific. For instance, if your child was stooling daily and is now stooling only three times per week and they complain of pain during a BM or belly pains, then they are likely constipated. If your child is stooling three times per week and has always done so, then they are not likely constipated.

How long can constipation last?

This depends on how long the constipation has been occurring for your child. Sometimes the signs can be subtle and go unnoticed, which can cause a larger amount of stool to collect in the colon. If the constipation came on suddenly, making a few changes to some daily habits should resolve it within a few weeks. If the constipation has been occurring for longer than a few months, it will take a few months to get back on track.

Constipation can recur if good habits are not maintained, so it’s important to stay on top of it for at least one month (sometimes longer) after it’s resolved to ensure it has not happened again. If the constipation persists past this time period, you should consult a medical professional to determine if your child has “chronic constipation” or if some other medical condition is causing these issues.

If your child is having issues with stooling, it’s time to notify the doctor when you notice:

• If your child has one of the following medical conditions: Hirschsprung’s disease, anorectal malformations (imperforate anus or cloaca), or a history of surgery for issues such as anal stenosis or sacrococcygeal teratoma
• Constipation (resistant to medications) or diarrhea that has existed since infancy
• If your child did not have a BM (on their own with no assistance) in the first 24-48 hours of life
• Constipation lasts longer than one month
• Constipation that occurs with fever, lethargy, vomiting and/or abdominal distention
• Abdominal swelling, bloating or pain that is not resolving
• Refusal to eat, weight loss, vomiting
• Blood in the stool
• Urine incontinence (pee accidents) after age 5
• Recurrent UTIs (urinary tract infections)
• Fecal incontinence (poop accidents) after age 5
• Anal fissures, hemorrhoids, polyps or sore around the anus

What causes constipation?

Constipation can be caused by a multitude of factors such as diet, dehydration, recent illness, decrease in physical activity, surgery, stress, changes in routine, traveling, medications, some medical conditions, fissures/trauma from a difficult-to-pass stool, and withholding behaviors. Typically, withholding occurs from one of the other factors in this group that has led to this behavior.

How can I help my constipated child?

If your child is having small, hard stools that are difficult to pass or if you notice a decrease in the amount and times that they are passing stool, there are things you can do to help soften your child’s stools:

1. Encourage drinking water throughout the day.
2. Encourage eating foods that have more “soluble” fibers. These fibers create a softer stool that moves through the intestines easier. Some of these foods are oats, legumes, ground flax, chia, berries and melons.
3. Feed your child less starchy foods that can bulk the stools too much or create a drier, harder stool, such as rice, crackers, pastas, breads, apples and bananas.
4. Avoid giving your child foods with added apple and bananas. This can be difficult as most prepackaged foods for children have one of these two in their product. Remember to look at the ingredient list.
5. Limit sugary foods.
6. A note about juice: juice is high in sugar and most are apple-based. Also, if your child drinks too much juice then they won’t want to drink water, which is key to creating softer stools. If you give them juice, stick to one cup per day maximum and offer pear, mango or prune juice.
7. Make smoothies — these can be great as you can add needed fruits and vegetables to them. There is no current research regarding protein or other additives for smoothies so consult with your physician before adding these to your child’s smoothies.
8. Encourage regular exercise. Movement of your body equals movement of your digestive system and strengthening of your core muscles which are used to poop.
9. Establish a sitting routine. You cannot command anyone to have a BM. However, if you have your child sit in the morning, before bed and after every big meal you may be able to catch them having an urge to have a BM. This would be ideal as elimination is more efficient when you use the bathroom at the time your body is cueing you to do so. Sit time should not exceed 10 minutes as this will lead to hemorrhoids and a decreased desire to return to the potty.
10. Keeping a chart of time and type of BM can be helpful so that everyone is aware of your child’s daily bowel habits. There are some great charts online that you can print out that are useful in identifying BMs.
11. Once the chart has been done for a week at a time, let your child pick a fun activity to do together (not BM-related). You can give a daily reward, but this may get exhausting and may also lead to them forcing a BM when it is not really time.
12. Above all, try to remain calm. This can be stressful for all parties. You are there to coach and guide. Your child will need to understand their own bodies in order to have a more efficient daily bowel habit.

Bowel patterns vary in children, so what’s normal for your child may not be for another. If you suspect your child is constipated or if you have any concerns about his/her bowel habits, let your child’s doctor know.

Edward-Elmhurst Health offers Pediatric Specialty Clinics, including pediatric gastroenterology as well as a Pediatric Bowel Management program for children with the following colorectal conditions: Hirschsprung’s disease, anorectal malformations (imperforate anus or cloaca), chronic constipation with or without fecal incontinence (and a gastroenterologist has ruled out other causes), UTIs related to chronic constipation, an abdominal X-ray that reveals a dilated colon, and a history of surgery for issues such as anal stenosis or sacrococcygeal teratoma. If your child has any of these medical conditions, our expert team can help. Call 630-527-2910.

If your child is having constipation or diarrhea that is newly occurring, sudden weight loss, hemorrhoids, vomiting, GERD, chronic abdominal pain without constipation, or medical conditions such as Crohn’s, ulcerative colitis or Celiac disease, you may want to make an appointment with one of our pediatric gastroenterologists.

Learn more about our pediatric subspecialties.