Is your child constipated, and what can you do about it?

Constipation can be very distressing for kids, and for their parents, but how can you tell if your child’s bowel movements are “normal”? Constipation is defined as hard stools (poo), passed infrequently, but we recognise it can be more complex than that as there is a lot of variation in what is “normal” in children.

Your child’s perception of pain or difficulty when doing a poo, rather than the frequency of doing poos, is the key. If your child has fewer bowel actions than normal and complains of pain while passing a poo, they may be constipated. For some children, who usually go a few times a day, constipation would be only going every two days. For others, it may be much less frequent, along with the pain and difficulty of passing a bowel action. The same is true for infants.

Most children don’t have an underlying medical problem causing their constipation. Constipation is more common at certain times, such as when an infant starts solids, around the time of toilet training or when children start school and are in an unfamiliar environment. Sometimes a short illness may trigger constipation with hard stools, and this can lead to withholding (avoiding going to the toilet) to prevent pain. Diseases causing constipation are rare and occur in less than five per cent of cases.

What are the symptoms of constipation?

Constipation can cause:

  • Bloating, tummy pain and distress.
  • Not wanting to eat as much or loss of appetite.
  • Irritable behavior.
  • Hard lumps of poo which can be felt in your child’s belly, especially down the left side if you press gently.
  • Soiling: if your child has been constipated for some time, their rectum might be so stretched and full that poo just comes out into their underpants during the day. When this happens, the child may have lost the ability to tell when they need to go or be able to feel when poo is being passed into their underpants. This is called “encopresis”.
  • Holding on and/or fear of passing a poo in the toilet. Some children might only do a poo in a pull-up, or be scared to go at school or kinder. Others are just too busy and don’t like to spend time sitting on the toilet.
  • Passing some blood if there is a tear around the anus from passing hard poos, called an anal fissure.
  • Daytime and night-time wetting.

How can I treat my child’s constipation?

Treatment usually involves optimising your child’s diet, developing good bowel habits and occasionally using softeners. Treatment usually needs to be continued for a few months, not weeks, to be effective.

Diet:

Most children with constipation already have a good diet, but sometimes increasing soluble fibre in their diet as a first step can help. Giving your child two to three serves of fruit or vegetables each day, especially prunes and apricots, changing to brown or wholegrain bread and offering less processed cereals are all great ways to increase your child’s fibre intake. Make sure they are drinking plenty of water, and be aware that consuming large volumes of cow’s milk can make constipation worse.

Regular sitting:

The next step is to encourage your child to sit regularly on the toilet. This can be done with the help of a star chart, which encourages your child to sit on the toilet two to three times a day after meals for three to five minutes each time. By sitting on the toilet or potty long enough to pass a poo, the child starts to properly empty their rectum. In this way, the sensation or feeling in the stretched bowel returns and they can once again feel when they need to go.

The position in which your child sits is also important: their feet need to be supported on a stool and make sure that their knees are bent and are higher than their hips. They need to lean forward and push out their tummy (like pushing out a fart), which relaxes their pelvic floor and makes it easier for the poo to come out. It can sometimes be very hard to get a child to sit on the toilet, especially if they are fearful and are holding on, and so it may be useful to speak to your GP or paediatrician. There are also physiotherapists who specialise in continence who can help. Sometimes a psychologist may be helpful if your child is really fearful about sitting on the toilet and the previous suggestions haven’t worked.

Stool softeners:

If your child is very distressed or their poo is very hard, you will most likely need to soften the poo. Softeners such as Osmolax, Movicol, Lactulose or Parachoc are good and some of these softeners also stimulate the bowel. The exact regimen that works best for your child should be discussed with your doctor. Don’t worry about your child becoming “dependent” on softeners – it is much better to treat the constipation properly to prevent ongoing problems.

Constipation in infants is best discussed with your doctor, as formula changes or adjustments to their solid diet, if they have started solids, may be needed. Children who have a developmental disability often struggle with constipation and there are different strategies that we may use with them. This will be discussed in another blog.

There are no ongoing health problems from occasional bouts of constipation. However, long lasting constipation (six to 12 months) with ongoing pain and soiling can lead to social and emotional problems, and so should be tackled as soon as possible.

Dealing with constipation can be difficult, so if you are worried about your child and have tried some simple measures, or you are concerned that there may be an underlying medical problem, seek help from your doctor, paediatrician or a continence specialist who works with children.

Has your child suffered from constipation?  How did you know, and what did you do to help?  Please share your experiences by making a comment on my Facebook post.

Other helpful resources:

Please note: Dr Margie is no longer monitoring this blog. If you are concerned about your child, please contact your GP for advice, or visit the above resources. 

42 comments for “Is your child constipated, and what can you do about it?”

  1. Lisa

    Hi doctor Margie by son has constently pooing himself yesterday and he definitely was constipated because his stools were soft he poo about ten times in the whole day and his stools were soft with every poo. He was in discomfort when he would do a poo but why?

    Reply
  2. Dr Margie

    Hi Lisa, your son most likely has a rectum full of poo that is quite stretched. He has lost the ability to tell when he needs to go and the poo just leaks out. When he goes, he is probably not emptying his rectum. His poo may be soft, so he probably doesn’t need a softener, but rather a good sitting routine to empty his rectum and return the stretched bowl to normal so that sensation returns. I would speak to your doctor as a first step. I hope you get on top of it soon. – Dr Margie

    Reply
  3. Lucinda Jones

    Hi Dr Margie,
    My daugther is constipated constantly she is currently on osmolax, parachoc and coloylx. Are these ok to keep using all the time? She won’t do poo on the toilet, constantly holds herself saying her bum hurts and we are toilet training her. It’s highly frustating because she has pretty much sorted out wee but refuses to do poo in toilet, but will dance around and do it in her knickers or nappy. What options do I have to get her to start using the toilet, she will be 4 in April next year.
    She has been tested for a gluten allegry that was fine, her diet is good doctor’s i have seen has said nothing can change in her diet. Can I give her slippery elm or other natural things i can hide in her food. Getting her to drink the osmolax no matter how i mix it is difficult.

    Thanks for any help, I’m starting to lose my mind over this

    Reply
    • Dr Margie

      Hi Lucinda, I would try to use a good dose of one softner only, such as Osmolax, rather than three. If she need s stimulant as well then perhaps try lactulose. She needs a behavioural sitting chart and to learn to not be afraid of sitting before she will be able to pass a poo in the toilet. I would discuss the strategies with your doctor. – Dr Margie

      Reply
      • Lucinda Jones

        Thanks for that, will try the osmolax. Tried it this morning unsuccessful so made her a milkshake this afternoon she has nearly drunk it all.

        Reply
  4. Lisa

    hi dr margie
    My daughter will be 3 in November
    She won’t eat much at all and she won’t eat any fruits apart from a pear or Apple she won’t eat any veg I’ve tried every trick in the book to hide it in her foods she dose like but I’m loosing that battle too.
    she will drink milk like anything but I try not to give her too much but I do also water her milk down so she gets water .
    She started being constipated about a year ago she’s had a few poos that have been hard I’ve had to help her and put a enema up her bum every now and then she’s also been given parachoc to help her .
    Some help would be great
    Thank u lisa

    Reply
    • Dr Margie

      Hi Lisa, I would very much limit her milk to no more than 500 mL, encourage water intake and start Osmolax, 1 scoop daily. I would also encourage sitting on the toilet as described in the blog. Please see my fussy eating blog for tips on her eating! – Dr Margie

      Reply
  5. Sarah

    Hi dr Margie, I have a 4yo daughter who just refuses to do a poo. She has been constipated for most of her life. At one stage she was going at least once a day. Now she just refuses. We have tried going pack to the potty,special treats I am now out of ideas. Do you have any suggestions? Thanks heaps

    Reply
  6. Dr Margie

    Hi Sarah, I would make sure her diet has enough water and fibre, would see if she needs a softener if her poo is hard and start a sitting chart that is led by her i.e. colour of chart, stickers etc Concentrate on sitting first and then appeasing poos. – Dr Margie

    Reply
  7. Danielle

    Hi Dr Margie. My son is 10 and has suffered with constipation and encopresis since 3. We have removed dairy and wheat, had blood tests and X-rays, see a Paed annually and have tried a dietician, naturopath and OT who is great, and gives him some improvement. Is there anything else we should look at? Thanks.

    Reply
    • Dr Margie

      Hi Danielle, thanks for your question. It seems as though you have explored a number of tests and treatments – I assume you have also tried softners and regular sitting with the OT and paed. I would recommend that you review things with your Paed if you are not getting on top of things. – Dr Margie

      Reply
  8. Rachael

    Hi Doctor Margie,

    My daughter is nearly 3 and has had an issue with withholding poo for about a year now. It seems to run in a cycle of 2 weeks where she holds on for up to 4 days at a time and then 2 weeks where she seems to be going normally. During the “withholding” time the poo is so large and I can’t believe it comes out of a little person! I have been using lactulose and reducing cows milk, feeding her fruit, brown rice, quinoa etc. I think it’s psychological but can’t figure out what starts it off each time. We haven’t started toilet training yet because I would like to sort it out first. Could it be physiological? I’ll also mention she was born with Gastroschisis.

    Thank you.

    Reply
    • Dr Margie

      Hi Rachael, I think it would be worth seeing your GP and/or Paed to see if there are any clear triggers to her withholding and whether a referral to a psychologist would be helpful. It sounds as though this may be worth exploring. Toilet training will be hard until you have a clearer idea what triggers her withholding. I hope you get on top of things soon. – Dr Margie

      Reply
      • Rachael

        Thank you Dr Margie. It’s frustrating and distressing for all of us (although we try not to show it) think a psychologist will be helpful. Fingers crossed 🙂

        Reply
  9. Amber

    Thank you for this blog dr Maggie. My son was born with a impreferate anus, he had it corrected when he was about 6 months. No real problems pooing up until we started toilet training him. Like some other people have mentioned, he is terrified of doing poo on the toilet and will hold on for as long as possible. He is completely wee trained but poo is a big struggle. At the doctors request we have been giving him a oral softener and a suppository been doing it for about 6 months, but it just not improving… I am at a loss…

    Reply
    • Dr Margie

      Hi Amber, helping children with withholding can be very hard. I would suggest seeing a paed to discuss his treatment regimen and a possible referral to a psychologist to assist with his fear of sitting on the toilet if you have tried the simple suggestions in the blog. – Dr Margie

      Reply
  10. cathilee whitmore

    Hi Dr Margie. My daughter is 4 and a half and has not gone to the toilet properly for 3 weeks. She has been on Actilax for a week and has had a suppository in which both have failed. I can now see a little prolapse (diagnosed by my GP). She’s very uncomfortable and has belly pains and a poor appetite. Is it normal to have a prolapse from constipation at this age?

    Reply
    • Dr Margie

      Hi Cathilee, it sounds as though your daughter has been straining with her stools for quite some time if she has a prolapse. I would get her reviewed by your GP or get a referral to a paed to see if she is on enough softener and to ensure her treatment regimen is adequate. Treatment will need to be long term (at least six months) I would think to minimize her straining and get on top of her belly pain and loss of appetite. – Dr Margie

      Reply
  11. Linda

    Hello Dr. Margie,
    My almost 6 month old has become constipated since starting solids. She has been having solids for over a month, at the start she had less bowel movements but now she has several small movements per day with straining and occasional crying. She has pureed prunes at least once a day and water with each meal. I’d be grateful for your advice. Thanks!

    Reply
    • Dr Margie

      Hi Linda, in addition to making sure that your baby is drinking enough fluids, I would try some Actilax to soften her stools in addition to the prunes.
      Dr Margie

      Reply
  12. Dani

    Hi there. My 22 month old son has been on Neocate Gold since being diagnosed with cows milk protein allergy at 3 months. At 12 months we tried soy milk and within 2 weeks he was severely consitpated. Since then he has been dependent on laxatives – we have finally weened him back to using osmolax only when needed (once per week). Our script for Neocate Gold will run out soon and we have been advised to start him on cows milk. He eats plenty of cheese and yoghurt but am worried about the volume of milk it will take to replace the formula (500-600mls per day) and if it will upset his constipation again. Is there a toddler formula that you would recommend that would be appropriate? We see both a paediatric dietician & gastroenterologist and both have suggest to go straight to cows milk – my instinct says opposite???? Any advice? TIA

    Reply
    • Dr Margie

      Hi Dani, I think t will be fine to try either soy or cows milk and limit the amount to 400-500mls. Most of the toddler formulas are cows milk based so they won’t be any any different to cows milk. Make sure he drinks plenty of water and touch base with your medical team to see how he goes. Thanks, Dr Margie

      Reply
  13. Ellie

    Hi. My daughter is 4.5. We have been on the stool withholding journey since she was constipated during toilet training at 2.5. Osmolax since February 2015 and we are nearly there. Regular night sitting is working well. Lately though, she is avoiding pooing if she feels it coming in the day time which is leading to smears in her knickers. She still says her bottom hurts after pooing even though I know her poos are soft (have been for over a year). I watch her diet & water intake. I feel like we are 95% of the way there (hurrah!) but we just can’t crack the last hurdle. She also says she just doesn’t like doing a poo. What do you recommend to help her? Thanks for your time.

    Reply
    • Dr Margie

      Hi Ellie, I would suggest that you do a start chart with three sits a day after meals where you reward the sitting and put an extra special sticker for the poo when it happens. Rewarding sitting is the key rather than water, diet and osmolax given how well you are doing with those. Only do the start chat for two weeks with a prize at the end of each week. Essentially you are aiming to just help her to empty her bowels regularly now to stop the poo leaking out. Good luck! – Dr Margie

      Reply
  14. Natalie

    Hi Dr Maggie,
    My daughter who is recently 3 has a fear of doing poo in the toilet. she is completely bladder trained since early 2 as well as almost night trained but when it comes to the poo its the nappy or nothing at all.
    We’ve tried the rewards and praise but nothing seems to be working. she is very agreeing in conversations about it, saying that she will try tomorrow and no more nappies coz I’m 3, but when it comes to it she become very distressed.
    any help or recommendations would be greatly appreciated.

    Thank You.

    Reply
    • Dr Margie

      Dear Natalie, I think it would be good to focus on your daughter learning to sit three times a day on the toilet with a focus on and reward for sitting, rather than pooing. If her fear is too great I would ask your GP for a referral to a child psychologist for some new strategies and management of her anxiety as well. Also make sure her poo is soft and she is not straining. Good luck! – Dr Margie

      Reply
  15. Zai

    Hi Dr Margie
    My daughter will be turning 2 in 3 weeks. She’s been taking actilax for a year now. She eats very less. 3tbsp of cereals in the morning plus one serving of fruit, lunch time fruit, and chicken and dinner rice and chicken and fruit. We always add veggie to plate during lunch and dinner but we have no luck yet on her actually eating it. She was fine with veggies before but for the past months she just decided not eating them at all. She was exclusively bfeeding up until 6months and continues to bfeed until now 2x during the day and 2x during the night but she doesnt feed so much at night. Usually just to settle her back to sleep quickly. She takes 10ml of actilax everyday. Because shes afraid to too. She had a bad incident of constipation wherein there was actually blood in her poo. Gp said she have anal fissue too. As she have a small extra skin on her anus. I dont know why she is constipated in the fist place because i bfeed her. But its seems after that pooing incident with blood she became very scared whenever she poos. Even now we give her actilax sometimes she would only poo after 3 to 4 days. She always cries whenever she poos. Im afraid of the fact as well that shes taking actilax for so long now. Should we be worried? I want to start toilet training her but im afraid we need to settle her bowel issue first to be actually successful with toilet training.

    Reply
    • Dr Margie

      Hi Zai, if your daughter needs the Actilax to keep her poo soft then I would not stop now. I would continue and when you are ready to start toilet training her I would start by just encouraging her to sit on the toilet without focusing on her pooing. It is a very tricky time between 2-3 years and it is better to keep her poo soft and to try to minimise her fear of the toilet. Down the track she may need to see a psychologist for a few sessions to help if it continues. Don’t worry about taking to stool softener, it is much better than the pain and stress of dealing with constipation, withholding and possibly anal fissures. If you need more help I would speak to your GP or try to see a paediatrician.- Dr Margie

      Reply
  16. bec

    Our just turned 4 year old absolutely refuses to poo on the toilet. She has been toilet trained for wee since she was 2 and a half, but just refuses to even try to poo on the toilet. She will only poo in a nappy standing up. The advice we had was to wait and let her work it out herself, but we’re not getting anywhere. She will agree to trying on the toilet when we talk about it, but when she has the urge to go, she will refuse to sit on the toilet. She also tends to hold on until the end of the day and then decide to make her poo at bed time. We have tried giving her some parachoc, but seeing she won’t even sit on the toilet when she needs to poo, it didn’t seem to makea difference. Can you give us some suggestions?

    Reply
    • Dr Margie

      Dear Bec, the key to trying to help your daughter to poo on the toilet is to try and encourage her to just sit on the toilet with no expectation of her doing a poo. You need to ask her to sit three times a day for about four minutes after meals and use a star chart just to reward the SITTING. If she is very resistant to this I would suggest seeing your GP or paediatrician to get a referral to a psychologist to help to reduce her fear of sitting on the toilet. It is good to ensure her poo isn’t hard with with parachoc or osmolax as well. With time she will eventually do a poo on the toilet, but it can be quite a long road as you know already! The first step would be to see your GP. Good luck! – Dr Margie

      Reply
  17. Kimberly Jackson

    I have a 5 year old girl who was born with gastroschisis and had been having constipation issues. The doctor prescribed her miralax but it seemed to really hurt her stomach and made her go a lot more than what she should. She is not toliet trained she doesn’t even want to go on the toliet she is scared of her bowels hurting she says. I have her on pull ups which I hate I want her to be toliet trained and I have tried everything. She is now having constant urges to go poop just today she pooped 5 times and she didn’t act like she did anything. I have thought of IBS and other things but I don’t know what it could be. Could you help me?

    Reply
    • Dr Margie

      Dear Kimberly, your daughter has a complex medical history and I would suggest speaking to your GP or paediatrician in the first instance. The first aim for her would be to get her bowels soft but not too runny by using a softer such as osmolax every day. Microlax will only soften the poo in her rectum. Once her bowel actions are soft and she is not complaining of pain then the second aim would be to try and get her to sit regularly on the toilet. This would not necessarily be to poo but just to sit, three times a day. I would use a star chart to motivate her and ask her to make it. If she is very fearful you may need the help of a psychologist for a while. Once she is sitting without fear, then you may be able to catch her poos in the toilet, again using a star chart. This is a long process and is very challenging for you and her so you will need some expert guidance. If you don’t have a paediatrician, you could obtain a referral to see a paediatrician in the community near you or here at RCH in general medicine or your nearest public hospital. Good luck! – Dr Margie

      Reply
  18. Elisabeth

    Dear Dr Margie,

    My daughter is nearly five and has been on laxatives of one sort or another since she was seven months old. Her constipation started at six months as soon as we introduced solids (rice cereal mixed with breast milk) – she had been entirely breastfed until then. The GP suggested coloxyl, which had no effect. At 7 months the paediatrician recommended lactulose, which worked beautifully until she refused to take it at around 11 months. The paediatrician recommended Osmolax. She started on a teaspoon and that dose moved up to half a scoop (1 tablespoon) by the time she was 3. She is still on the same dose. If we try to reduce the dose by even as much as 1/4 of a teaspoon she becomes constipated. I read in your article that parents shouldn’t worry about children become dependent on laxatives, but I do worry that she has been on this for too long – 4.5 years. Am I right to worry? I worry that it might interfere with iron absorption, for example, or that it could cause cancer. I’m not basing these fears on anything but my own worry – I just don’t know what the effects of long-term laxative use might be. I don’t know how to wean her off the Osmolax since all our attempts over the years have ended so badly, with enemas and an increased dose which we’re unable to come down from. Is it possible to switch from Osmolax back to Lactulose, and is this something I should consider? Are there tests she should be having to determine a cause? It takes two days for food to move through her bowel – is this normal? She passed meconium normally after birth but passed very smelly wind for weeks, which everyone commented on. She had trouble breastfeeding and became dehydrated at five days old, but this may have been a problem at my end, and it was sorted out quickly with the help of a breastfeeding consultant. I believe her diet is healthy. I really worry about the laxatives. Please help!

    Reply
    • walshh

      Hi Elisabeth, It sounds as though your daughter’s constipation is well managed by half a small scoop of Osmolax. Osmolax is virtually unabsorbed by the bowel, so it remains in the bowel and makes the poo more watery. This softens the poo as well as bulking it up, which stimulates the urge to go to the toilet. Lactulose works the same way. I think it would be wise to go back to your paediatrician and to discuss your child’s stool pattern and diet in detail to see whether any further tests may be necessary, although this is not usually the case. But in answer to your main question, there is no evidence that long term use of stool softeners is harmful – the pain, distress and social problems that can come with withholding poo, anal fissures or tears from hard poo and soling are more harmful to the child. However, it is always good to see what can be changed and to constantly ask, are the softners really needed as you are doing. – Dr Margie

      Reply
  19. David

    Dear Doc

    My Son (4 yrs), has been on Ozmolax now for over a year. We originally started ozmolax because some medication he was on at the time caused him to become constipated and the doctor believed it was the right move.
    Since than, his mother and myself have tried many times to wean him off of it with absolutely no luck. Whenever we decrease his doses or sometimes stop all together, his poo will slowely dry up until he becomes constipated again. Even after a year the doctor still recommends keeping him on it, even a specalist offered the same advice (only advice).
    I am so worried that he will/has become dependant on the product.
    He has vitamins, pro biotics, fruit and vegies and of course sweets as well.
    Is there any advice you can offer or perhaps a good roster to wean him off of ozmolax?

    Regards,
    David

    Reply
    • walshh

      Hi David
      It is common that some children need to take stool softeners for years and we do not believe that is causes any long term problems. It does not make the bowel lazy. Just like some adults, some children have constipation which they need to manage for life. I would recommend trying alternate days of Osmolax if you do want to reduce his doses and encourage him to drink good amounts of water, up to 5 glasses spaced through out the day. if you are still worried, please speak to your GP or doctor again who knows your child in case some tests may be needed, but this is very uncommon. – Dr Margie

      Reply
  20. Asad

    Hi Dr Margie,
    My daughter is 17 months old and due to constipation, she now has got anal fissure. I was wondering what exactly we can do to make it better. Can we use petroleum jelly?

    Reply
    • wattsc

      Dear Asad
      If your daughter has an anal fissure she needs a stool softener for at least 6 weeks to let it heal and to reduce the possibility of pain with hard bowel motions. Please see your GP to have her treatment monitored and to make sure there are not any other issues that need to be addressed. Good luck! – Dr Margie

      Reply
  21. Jo

    Hi Dr Margie, My 9 yo daughter has been suffering from stomach cramps and nausea for about 4 hours in the morning intermittently for 8 months now. Even after going to the toilet. Just recently it has been occurring every day. For a very long time now she has had…what i think. .. are problems with her bowel. She is not constipated as when she does go the stool is soft and she does not strain but it is nothing for her not go for 7 to 10 days. Her stomach becomes bloated and I give her nulax…which sometimes works. This seems to bother me more than her. She has a healthy diet with lots of water and this does not effect her weight or appetite. My GP isnt that interested but it concerns me that it seems to be getting worse slowly. Am I wasting everyones time by taking her to a specialist? Any advice is greatly appreciated, Thanks Jo

    Reply
    • Dr Margie

      Hi Jo, I think if you are still concerned I would ask to see a paediatric gastroenterologist. She should have coeliac serology to exclude coeliac disease and if she cannot pass a bowel action for up to 7 to 10 days then a regular softener may help, taken daily for 4-6 weeks. I think she needs to be fully reviewed and I would follow this up as you are still concerned. – Dr Margie

      Reply
  22. Angela

    Hi Dr Margie.
    Im at a loss with my 4.5yr old son. He has been wee toilet trained for about 4 months. He refused and we saw a counsellor after consultation with the health nurse. He has been on and off with poos. He was pooing in his pants and has stoppd that, possibly because of the frustration it caused me. He has done a few in the toilet, but refuses to sit on the toilet now. He will sit on the potty but with lots of refusal. We have tried bribery, using the ipad, resding a book, playing games, sitting amd helping. He just holds it for nearly a week. I had to encourage him to put a pull up on and poo in it just to stop his stomach from hurting. But some days he wakes up says help me on the potty. So feel like we take 1 step forward and 5 steps back.
    Do i keep persevering or should i consult the Dr and possibly a paediatrician?

    Reply

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