Constipation is a pattern of delayed, painful, or hard bowel movements. Most people have an occasional hard poop, but if this happens frequently, it can cause problems. If the stools are thick, like clay, or hard and large, or like pebbles, then stool may get backed up in the GI tract. Constipation can cause pain, a swollen belly, loss of appetite, gastro-esophageal reflux (heart burn), and even loss of ability to control bowel movements. Pain from constipation in kids is usually crampy, sharp, or achy pain around the belly button or the sides of the belly. Usually this pain occurs while your child is awake and is worse after eating or with exercise. Although the cramps or aches may keep children from falling asleep, the pain does not usually wake them from sleep. Sometimes a child can accumulate so much poop in their rectum that it keeps the anus open, resulting in leaking, which can sometimes appear to be diarrhea or soiling.
Lower GI Tract
- Fluid intake—Inadequate fluid intake may contribute to constipation. Try to make sure your child drinks enough water every day. A child or teen should drink 5–8 cups of water per day; younger children should have 3–4 cups daily. Increasing water may be helpful, but can be difficult to do, particularly with a young child. Avoid using sweetened beverages, especially sodas, to increase fluid intake. 1–4 oz. per day of prune or apple juice can help with constipation in some children and infants.
- Fiber—Increasing fiber in the diet may reduce constipation. The best sources of fiber include whole grains, fruits, and vegetables. Avoiding highly processed and carbohydrate-rich foods that lack fiber may increase appetite and motivation to eat foods that are rich in fiber. If the child is tube-fed and using an enteral formula, consider switching to one with fiber.
- Stimulants—Some foods may stimulate the intestines to move more quickly. Prunes are the most common of these, but children may vary in which foods work best for them.
- Foods to avoid—Some foods can slow down digestion. Foods such as bananas, sweets, white breads, and fast food, foods that are high in fat, and large amounts of dairy products all tend to slow digestion and contribute to constipation. This varies among children.
- Refer to a nutritionist as needed (see all Nutrition/Dietary services providers (53) in our database.)
- Meals—Regular meals are helpful in keeping the bowels moving. Timing opportunities to use the toilet to follow meals can enhance the ease of passing bowel movements.
- Less snacks—Snacking, particularly “grazing” (eating small amounts of food, usually low in fiber, throughout the day), can limit the amount of food eaten at meal times and result in a poor gastro-colic reflex, resulting in poor gut motility and constipation.
- Exercise—Kids who get plenty of exercise seem less likely to get constipated. Assuring daily exercise has other benefits in terms of fitness and weight control.
- Behavioral issues—Positively reinforce all passage of stool. For children who are toilet trained, ensure adequate time and privacy for defecation (e.g., it isn’t going to happen in a public school bathroom stall). Treat accidents with a neutral approach.
- Toileting routine—It is helpful if your child goes to the toilet and tries to poop after meals. This is particularly important after breakfast on school days, when he or she may not have another opportunity to poop till evening. See Toilet Training for CYSHCN
- Positioning—Ensure child is adequately supported in an upright position to allow optimal defecation. For children with mobility issues, time in a stander or at a standing table may help with evacuation. An adapted toilet seat may be necessary for proper positioning. Speak with your child’s physical therapist or primary care physician about the best options and how to obtain this equipment through insurance or Medicaid.
- Warm baths—A warm bath once a day can help to relax the muscles of the rectum and make it easier for your child to have a bowel movement.
- Pain doesn’t go away or is getting worse
- Blood is in or around the stool (can be non-urgent, but check with your physician if this is new)
- Swollen, firm abdomen that is painful to the touch (seek immediate medical attention) or associated with fever
- Vomiting or dehydration related to the constipation or bowel problem
- Stool is not able to be passed despite interventions
- An enema has not come back out
About Kids and Teens GI Health (IFFGD)
Reliable digestive health knowledge, support, and assistance about functional gastrointestinal and motility disorders; International Foundation for Functional Gastrointestinal Disorders.
Learn how to know if your child is constipated and, if so, what to do about it; sponsored by the American Academy of Pediatrics.
Hungry Kids: Fill Them Up With Healthy High-Fiber Foods ( 66 KB)
Explains how to increase fiber in kids’ diets and provides information about fiber requirements and reading food labels.
Dietary Fiber (IFFGD)
Information about different kinds of fiber, how to incorporate fiber into the diet gradually, and serving sizes to help prevent constipation; International Foundation for Functional Gastrointestinal Disorders.
Let's Talk About Constipation in a Child: Bowel Clean Out (Intermountain Healthcare) ()
One-page guide for caregivers on bowel clean-out and daily care for constipation at home.
Let's Talk About Constipation in a Child: Bowel Clean Out (Spanish) (Intermountain Healthcare) ()
One-page guide, in Spanish, for caregivers on bowel clean-out and daily care for constipation at home.
You Can Poop Too Program (BeHealth Solutions)
Online program that provides education and ongoing tools to solve the physical, emotional and behavioral issues of encopresis; only available for purchase.
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