Constipation is one of the most common intestinal problems in children, accounting for 3% to 5% of all visits to pediatricians. It is a symptom, not a disease. Fortunately, most constipation in infants and children is not caused by any serious medical disease. The cause of most constipation is functional or idiopathic, meaning there is no sign of injury or infection, blood, or anatomic abnormality to explain the very real symptoms. Children need help from their parents, and sometimes from a health care professional, to prevent or manage constipation.
How constipation is defined
There is no precise definition of constipation that fits all people. Constipation in children can be defined as the passage of painful stools or a reduction in frequency of stools. An important feature in this definition is the child's perception of pain or difficulty in passing stool – regardless of frequency. The experience of pain when evacuating can lead to avoidance of having a bowel movement.
Mean Average Frequency of Bowel Movements (BMs) in Children
Age BMs per Week*
0 - 3 months 5 - 40 (breast milk)
5 - 28 (formula)
6 - 12 months 5 - 28
1 - 3 years 4 - 21
4 years 3 - 14
* Approximately means ± 2 SD
In healthy children the number of bowel movements changes with age and diet. Newborns may average several bowel movements a day. In a few healthy breastfed infants there may be weeks between bowel movements, but the stools are soft. By around age 4 a child may average one bowel movement a day.
Nonetheless, it is not correct to assume that a bowel movement every day is "normal." There is no "right" number of bowel movements. Each person's body finds its own normal pattern, which depends on many factors. In general, 2 or less normal bowel movements per week may be a sign of constipation.
Causes of constipation
Constipation in children may be caused by a change in diet and fluid intake, during toilet training or a deviation from usual toileting routines, or avoidance of bowel movements because of pain such as anal irritation, fissures (small tears in the skin), or rashes. Other factors can play a role in causing painful bowel movements, such as changes in daily routine, stressful events, or postponing using the toilet when the urge is felt.
At one time or another, almost everyone is constipated. In most cases, it lasts for a short time and is not serious. By understanding factors that cause constipation, steps can be taken to help prevent it.
Preventing or treating constipation
Attention to what your child drinks, eats, and how much exercise your child gets, often helps prevent or relieve constipation. Providing guidance to prevent stool withholding, and helping establish regular times for going to the toilet are also important. Here are some steps you can take:
Eating more fiber
Fiber helps form soft, bulky stool. It is found in many vegetables, fruits, and grains. Be sure to add fiber a little at a time to let the body get used to it slowly. Limit high-fat, high-sugar foods and foods that have little or no fiber such as ice cream, cheese, meat, snacks like chips and pizza, and processed foods such as instant mashed potatoes or already-prepared frozen dinners.
Drinking plenty of water and other liquids such as fruit and vegetable juices and clear soups
Liquid helps keep the stool soft and easy to pass, so it is important to drink enough fluids. Avoid liquids that contain caffeine (found in many soft drinks) which tends to dry out the digestive system.
Juices containing sorbitol, such as prune, pear and apple juice can decrease constipation In infants older than 6 months. However, too much fruit juice can cause gastrointestinal and other problems. Be sure to limit its consumption appropriately.
Regular exercise helps the digestive system stay active and healthy. A person does not need to be athletic. A bike ride or a 20- to 30-minute walk every day can help. Encourage your child to exercise daily.
Allowing enough time to have a bowel movement
It is important not to ignore the urge to have a bowel movement. Waiting only makes constipation worse. Try getting your child up early enough in the morning to give them time to use the bathroom before school. Regular, unhurried time on the toilet after meals, particularly breakfast or dinner, can help.
Talking to a doctor
Call your child's doctor if you notice any of the following: constipation is persistent or recurrent; symptoms interfere with your child's daily activities; blood in or on the stool; diarrhea; fever; vomiting; straining with stool; complaints of pain or cramping; irritability; decreased appetite; or soiling underclothes.
The doctor will want to determine the cause of the constipation. Your child's doctor may recommend the use of laxatives in combination with other treatment approaches. Only use laxatives if the doctor says you should, and then only as directed. Laxatives come in many forms and your child's physician can help find the one best suited for your child.
Your child's doctor may also help you develop a bowel training program for your child. Children may delay using the toilet for several reasons, including being in school or busy with activities. Bowel retraining works by teaching new skills or strategies to develop a routine and predictable schedule for evacuation.
Be sure to tell the doctor about any prescription and over-the-counter medicines, including herbal supplements, your child may be taking. Some medications can cause constipation.
As your child gets older, he or she may find it embarrassing to talk about bowel movements. But children need to know that a bowel problem like constipation happens to virtually everyone now and then. Help them make healthy choices. Talk reassuringly and in a matter of fact way about bowel habits. Importantly, recognize the developmental stage of your child and, if necessary, be sure to work with your child's physician to plan treatment that takes into account the child's point of view.
Baker SS, Liptak GS, Colletti RB, et al. Constipation in infants and children: evaluation and treatment. A medical position statement of the North American Society for Pediatric Gastroenterology and Nutrition. J Pediatr Gastroenterol Nutr. 1999 Nov;29(5):612-26. Erratum in: J Pediatr Gastroenterol Nutr 2000 Jan;30(1):109.