Constipation in children: Why it happens, what to do

Does your child put off bathroom trips because he or she is busy doing more important things? Or does your child avoid the bathroom for fear of a painful bowel movement? Either pattern may lead to constipation.

You might expect thoughts about your child's stools to end with the final diaper. But successful toilet training doesn't prevent occasional troubles with bowel movements. Constipation is among the most common.

How often is enough?

Most babies have at least several bowel movements a day. By age 3, however, most kids are down to about one bowel movement a day — or even less. In children, signs and symptoms of constipation may include:

• No bowel movements for several days
• Bowel movements that are hard, dry and difficult to pass
• Abdominal pain
• Nausea, vomiting or weight loss
• Traces of liquid or clay-like stool in the child's underwear — a sign that stool is backed up in the rectum
• Bright red blood on the surface of hard stool

What's the culprit?

Various factors can contribute to constipation in children, including:

• Early toilet training. If you begin toilet training too soon, your child may be afraid of the toilet or rebel and hold in his or her stools. If toilet training becomes a battle of wills, a voluntary decision to ignore the urge to poop can quickly become an involuntary habit that's tough to break.
• Low-fiber diet. Too many processed foods — and too few fiber-rich fruits and vegetables — may contribute to constipation. For some children, excess milk can lead to constipation as well.
• Lack of physical activity. Inactivity sometimes leads to constipation.
• Medications. Certain cold medicines, antacids, antidepressants and various other drugs can lead to constipation.
• Medical conditions. Rarely, constipation is caused by a medical condition, such as a low-functioning thyroid gland (hypothyroidism) or a problem with the intestines.

Painful bowel movements may play a role in constipation as well. If it hurts to poop, your child may try to avoid a repeat of the distressing experience. Unfortunately, trying to hold in a bowel movement (encopresis) only makes matters worse.

What's the cure?

Constipation usually goes away on its own. Start by making sure your child gets enough fiber. Fiber is bulky and holds water in the stool, making it softer and easier to pass. Eating more fruits, raw vegetables, bran, and whole-grain breads and cereals — and limiting milk and other dairy products — can help. Drinking plenty of water can help, too. So can regular physical activity.

If your child strongly resists toilet training, wait a few weeks — or months — and then try again. If your child resists having bowel movements, try an over-the-counter stool softener in addition to high-fiber foods and plenty of water. It might help to stick to regular mealtimes and take scheduled bathroom breaks as well. Reward your child's efforts to use the toilet, even if he or she doesn't have a bowel movement.

If the accumulation of fecal material becomes so large and hard that it gets stuck, your child's doctor may suggest an enema or laxative to help remove the blockage. Keep in mind that long-term use of laxatives can prevent children from learning how to have regular bowel movements, so follow the doctor's instructions carefully.

If your child is taking a medication that causes constipation, ask your child's doctor about other options.

Remain compassionate

Constipation is a common problem for kids. Frustrating as it may be, do your best to keep it in perspective. With your patience and support, your child will eventually establish regular bowel habits.

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