Constipation in Kids: Causes, Treatment, and When to Call Us

Constipation is one of the most common reasons kids see the doctor: about 1 in every 20 pediatric visits. It's uncomfortable, but it's very treatable, and the sooner it's treated, the faster it gets better.

Is my child constipated?

Every child's bathroom habits are different. What matters most is what the stool is like, not just how often it comes. Signs of constipation include:

• Hard, dry, or large stools that are difficult or painful to pass
• Fewer bowel movements than usual
• Belly pain, bloating, or a poor appetite
• Holding stool in (crossing legs, hiding, or stiffening up)
• Small streaks of blood from a tiny tear (fissure), or stool streaks in the underwear

Babies are different. It's normal for babies to grunt, strain, and turn red while passing a soft stool, and breastfed babies sometimes go several days between soft stools. Please call us before giving a baby juice, laxatives, or suppositories.

Why it happens

Most constipation in kids isn't caused by a disease. It's usually functional constipation: a child has one painful stool, then holds the next one in to avoid the pain, which makes the next stool harder and more painful. It often starts during toilet training, the start of school, travel, or after a stomach bug. Rarely, a medical condition such as celiac disease or a thyroid problem is the cause, which is why we'll ask questions and examine your child.

What helps

Food and fluids

• Offer at least 5 servings of fruits and vegetables a day.
• A simple fiber guide: your child's age plus 5 is roughly how many grams of fiber they need each day.
• Make sure they drink enough water. Water alone won't fix constipation, but it helps fiber work. Fiber supplements without enough water can make constipation worse.

Toilet habits

• Have your child sit on the toilet for a few minutes after meals, when the body is most ready to go.
• Use a footstool so their knees are higher than their hips. It makes stools easier to pass.
• Keep toilet time relaxed and use praise or small rewards. Never punish accidents.
• If toilet training is causing stress, it's okay to take a break.

Medicine, with your pediatrician's guidance

Many kids need a stool softener to break the cycle, and we'll give you a plan with the right dose. Polyethylene glycol (PEG 3350) is a common, safe choice for children. It isn't habit forming. The most common mistake is stopping too soon: treatment usually continues for at least 2 months, and then at least another month after stools have been soft and easy, so the bowel can get back to normal.

When to call us

Call us if your child:

• Has constipation lasting more than 2 weeks, or keeps coming back
• Has blood in their stool, or stool leaking into their underwear
• Has a swollen belly, is losing weight, or isn't growing well
• Is a baby with constipation, especially in the first months of life

Call us right away for severe belly pain, vomiting (especially green vomit), or a fever with belly pain.

We see constipation all the time, and we'll make a plan with you. Call 212-427-0540, send a portal message, or walk in for a sick visit, weekdays 9:30 am to 3 pm.

Source: American Academy of Pediatrics, HealthyChildren.org: Constipation in Children.