Constipation is a common condition that affects people of all ages, but is particularly common in babies and young children. In Ireland, almost 1 in 3 parents have reported constipation at some point in their child's life.
What are the signs and symptoms of constipation in children?
Constipation occurs when your child is unable to pass poo regularly or completely empty their bowl. Your child’s poo can become hard and bulky, as well as unusually large or small.
Most childhood constipation is idiopathic. This means that no disease or illness has caused constipation. However, there are several factors that may contribute to the development of childhood constipation, or possibly make it worse. Poor diet, fear about using the toilet, poor toilet training and a lack of understanding on how bowels work can all be responsible for constipation in children.
In cases of chronic constipation, your child may experience soiling. Soiling is common with constipation and occurs when loose poo seeps out around the hard poo. This scenario can often be an embarrassing and upsetting experience for your child, so it is important to help your child understand why this is happening and more importantly that it not their fault.
Other signs of constipation include:
Loss of appetite
Lack of energy
Being irritable, angry or unhappy
Foul-smelling wind and stools
Abdominal pain and discomfort
Soiling their clothes
Top Tips for Parents
As a parent, there are many things you can do to help relieve your child's constipation. Treatment for childhood constipation requires a committed and positive approach as more than half of children suffering constipation will relapse and may need repeated doses of clear-out medication. Together, we will create a plan to ease your child’s worry, discomfort and pain.
Helping Your Child Understand their Constipation
It is important that you take the time to explain to your child how their body works. Help them understand how and why poo is made and why it is important to go to the toilet. The following two videos can help you explain the pooping process and constipation to your child.
Video for older kids: The Poo in You Educational Video
Video for younger children: How to Poo?
A Balanced Diet can Ease Your Child's Constipation
Providing your child with a balanced and healthy diet can significantly ease your child’s constipation.
Begin by keeping a food diary of what your child eats and drinks over the next few days. This diary will help you gain a greater understanding of meals/foods you need to change.
A high fibre diet and water intake can make a big difference to your child’s constipation. Children can be fussy eaters so changing to a high-fibre diet may be much easier said than done! But remember any change is a good change.
Fibre comes in two forms: (1) soluble fibres which dissolve in water and help to slow your child’s digestion and absorb nutrients in food, and (2) insoluble fibres which add bulk to your child’s poo, helping the poo to pass more quickly through the intestine. Fibre-rich foods include:
For children over two years, you can calculate the amount of daily fibre they need by adding the child’s age in years to 5 grammes. For example, if your child is eight years old, then you calculate it as 8 + 5 = 13. Therefore, an eight-year-old should be eating 13 grammes of fibre a day.
Dehydration is one of the most common causes of chronic constipation.
As explained in the videos above, the large intestine soaks up water from the food passing through. If your child is dehydrated, this will lead to a hardening of their poo and increase the chance of constipation.
Recommended Daily Fluid Intake for Boys & Girls
Fruit juice such as prune, apple or pear juice may be useful from time to time as they have a laxative action and may loosen the bowel.
To encourage your child to drink more water why not get them a special cup and straw to make it more fun!
You could also make a reward chart for your child and give them a sticker at the end of the day if they reach their daily target of fluid and fibre intake, and passing a poo (see below). Again, it is important to explain to your child what you are doing and how to play along. At the end of the week, if they reach their goals, reward them with a treat.
Toilet Training & Habits for Children with Constipation
Some children can feel stressed or anxious about using the toilet. Toilet training too early, painful pooping or constant intervening when they are trying to go, can increase stress when using the toilet.
Constipation can also happen if your child ignores the urge to poo (withholding) because he or she is afraid of the toilet. In other instances, they may simply not want to break away from play, or maybe they feel uncomfortable using public toilets, for example, at school.
Timed toileting is an essential part of the treatment for childhood constipation and must be carried out as a daily routine. It is vital to help your child to feel relaxed and at ease about using the toilet during this time.
Guidelines for Timed Toilet Training
- Use the body’s natural abdominal reflex, which is strongest in the morning and about 20-30 minutes after main meals
- Although it’s important to keep a routine, always encourage your child to go when they feel to urge to use the toilet
- 5-10 minutes on the toilet is usually long enough
- Keep your child company and teach them how to position themselves on the toilet to poop properly
- Ensure your child feels relaxed and comfortable. Smaller children may need an add-on seat or a footstool to help them feel supported
- When sitting, help them to lean forward and rest their elbows on their knees. Their knees should be higher than their hips
- Always discourage straining
- After a poop, encourage your child to look at their poo in the toilet and use the Bristol Stool Chart to help them identify and understand different types of poo
- The goal is to pass a poo that looks like poo type 3 and 4 which are usually easy to pass without being to watery
- Poo type 1 and 2 usually indicates constipation
- Poo type 5 and 6 usually indicates diarrhoea
- Promote good hygiene habits by encouraging them to flush the toilet and wash their hands after using the toilet.
- Avoid computer games, mobiles or anything that may distract them from concentrating on making a poo.
In cases of chronic constipation, medication may be necessary to clear out the build-up of poo in the bowel.
This medication may cause cramps, and your child will poo a lot, but that’s the outcome we are looking for. After the initial clear-out of poo with a high dose of medication, maintenance medication is required. Maintenance medication may need to be taken regularly and for some time before your child’s bowel return to normal. At this point the maintenance medication can be slowly reduced, but not stopped suddenly.
Please do not stop using the medication until you have discussed it with your GP who will advise you how to reduce the medication.
As always, we are here to help you to understand and manage your child’s constipation. We are happy to discuss any worries or questions you or your child may have.
Please contact reception for more information or to book your appointment.
The links below provide evidence-based guidance and care, and are particularly useful for helping you to understand your child’s condition and how best to manage it.
NHS Living Well – Constipation in young children
Patient - Constipation in children
ERIC – Let’s talk about poo game