Constipation is common in childhood, particularly when children are being potty trained at around two to three years old. This advice is aimed at children after weaning (older than 6 months old).
Advice for professionals
What are the symptoms of constipation in children?
These can be tricky to spot. Your child may be constipated if:
- they don't poo at least three times a week
- their poo is often large, hard and difficult to push out
- their poo looks like "rabbit droppings" or little pellets
If your child is potty trained, soiled pants can be another sign of constipation, because runny poo (diarrhoea) may leak out around the hard, constipated poo. This is called overflow soiling.
If your child is constipated, they may find it painful to poo. This can create a cycle: the more it hurts, the more they hold on to poo. The more constipated they get, the more it hurts, and so on. Even if pooing isn't painful, once your child is really constipated, they may try to avoid going to the toilet altogether.
Why do children get constipated?
Your child may be constipated because they:
- Hold onto stool due to fear of using toilets (smelly / lack of privacy etc)
- aren't drinking enough
- aren't eating enough high-fibre foods like fruit and veg
- are having problems with potty (or toilet) training
- are worried or anxious about something, such as moving house, starting nursery or the arrival of a new baby.
Find out about other causes of constipation in children.
What should you do and when should you worry?
In general, children only need treatment for constipation if it is causing them pain or problems (such as soiling in school).
If your child is experiencing significant pain or regularly soiling their pants, despite being on treatment, you should take them back to see your GP. Some children need more intensive treatment of their constipation. Your GP may decide that a paediatrician needs to be involved in their care.
Not all tummy pain is due to constipation - if your baby/child develops new severe tummy ache, please click here for advice about what to do.
You need urgent help.
Go to the nearest Hospital Emergency (A&E) Department or phone 999
What if your child’s constipation continues despite changing their diet?
If your child remains constipated despite the options listed above, take them to their GP who can decide if they need medicines. The treatment for constipation depends on your child’s age. The longer your child is constipated, the longer it can take to get back to normal, so do get help early from your GP.
Laxatives often help children, alongside diet and lifestyle changes. Movicol is most commonly used as a stool softener, with stimulants such as senna added in if no improvement. For a significant blockage: disimpaction with Movicol is initially with 2 sachets a day for children under 5 years of age (with 60ml water per sachet) increasing by 2 sachets a day (max 8/day) until stools watery and clear/brown then halve dose then reduce by 1 sachet a week to a regular dose (maintenance) that helps keep the stools soft. Spacing out the doses through the day, and mixing squash or juice or keeping the dose cold in the fridge may help taste.
It may take several months for the treatments to work, but keep trying until they do. Remember that laxative treatment may make your child's overflow soiling worse for a time.
You need to contact a doctor or nurse today.
Please ring your GP surgery or call NHS 111 - dial 111
Firstly, try to stay calm
Getting constipated and soiling their clothes isn't something your child is doing on purpose, so please be patient. You may both find the situation stressful, but staying positive and relaxed is the best attitude to help your child, and praising positive steps is important.
Think about changes to your child’s diet
Make sure that children drink plenty of fluids and encourage them to eat fruit. Chop or purée it if it's easier for them to eat. The best fruits for constipation include apples, grapes, pears and strawberries.
If your child is potty training, they may be feeling anxious or stressed about using the toilet. This can cause them to hold in poo and leads to constipation. Give your child plenty of time (5minutes) to use the toilet while they are still learning. Encourage them when they do use the toilet. Some parents find a reward chart works. Your health visitor can also provide advice and support.
Continue providing your child’s care at home. If you are still concerned about your child, call NHS 111 – dial 111
How to prevent your child getting constipated:
- Make sure your child has plenty to drink – offer breastfed babies who aren’t eating solids yet plenty of breastfeeds. Formula-fed babies can have extra drinks of water between their formula feeds. See more advice on drinks for babies and toddlers.
- Give your child a variety of foods, including plenty of fruit and vegetables, which are a good source of fibre. See what to feed young children.
- Encourage your child to be physically active. For more information, read the physical activity guidelines for children aged under five years.
- Get your child into a routine of regularly sitting on the potty or toilet, after meals or before bed (for 5 minutes), and praise them whether or not they poo. This is particularly important for potty-trained boys, who may forget about pooing once they are weeing standing up. Reward schemes appropriate for age are important; as is consistency and patience.
- Make sure your child can rest their feet flat on the floor or a step when they're using the potty or toilet, to get them in a good position for pooing. Take a look at the Children's Bowel & Bladder Charity's leaflet, Children’s Bowel Problems for a picture of this.
- Ask if they feel worried about using the potty or toilet – some children don't want to poo in certain situations, such as at nursery or school.
- Stay positive and reassuring, so that your child doesn't see going to the toilet as a stressful situation – you want your child to see pooing as a normal part of life, not something to be ashamed of.
For more information and support:
Click here to hear Dr Mark Tighe (consultant paediatrician) talking about managing constipation in children.