What is Constipation?

Jennifer E. Wolford, DO, MPH, FAAP
Children's Hospital of Pittsburgh,
Division of Child Advocacy

What is Constipation?

  • Not going to the bathroom to stool (poop) often. The pattern of how often is different for every person.
  • This might cause abdominal discomfort, cramps and having to push really hard.
  • Sometimes, hardened stools hurt coming out.
  • Some children start to "withhold" or refuse to go because it might hurt.
  • When a child is learning to potty train - this is a common problem.
  • When a child or teen has major transitions in life, a change in bowel routine is common.
  • Feeling stressed is often a contributing factor to constipation.
  • Constipation can often be treated with simple measures.

How often should a child/teen have a bowel movement?

  • As a baby, most infants have many stools every day.
  • By age 2, most kids have at least 1 stool every day.
  • For older children/teens, every child is different. Some go 2-3 times a day. Others have bowel movements every 2 to 3 days.

What are the signs of constipation?
A child/teen might:

  • Have fewer bowel movements than his or her normal pattern.
  • Feel pain when having a bowel movement.
  • Arch his or her back and cry (if still a baby).
  • Avoid going to the bathroom, do a "dance," or hide when he or she feels a bowel movement coming. This is common in potty training or when starting school.
  • Severe constipation can actually have leakage around the hardened stools, so it may dirty underwear. It can be confusing because it looks like watery diarrhea.

What happens if constipation is untreated?

  • Many children have periods of mild or brief constipation.
  • Constipation and avoiding painful stooling is often a repeating cycle.
  • Ongoing (> 2 weeks) or long term constipation can significantly inhibit daily activities and function in school and at home.
  • Very severe constipation can lead to long term changes in the child/teen's physical ability to control or evacuate stool.

What if a child/teen gets constipated?
Constipation usually gets better with some simple changes:

  • Eat more fruit, vegetables, cereal, and other foods with fiber.
  • Avoid refined sugar foods - cookies, sugar cereals, candy, soda pop.
  • Drink ½ cup of 100% prune juice, apple juice, or pear juice a day.
  • For older children, drink at least 32 ounces of water every day.
  • Sit on the toilet for 5 or 10 minutes after meals.
    • The child MAY NOT have a bowel movement, but this trains the child's body that this is agood time to relax.
    • This simple routine will help the child.
  • If you are "working on potty training" just take a break for a few days.
  • For school age children, having a routine of sitting on the toilet in the morning, after school and after dinner can help the child develop a pattern.
  • Giving the child space and privacy in the bathroom can help.

What might make constipation worse?

  • Stress.
  • Big changes in routine and home environment can be really difficult on a young person’s bowel habits. Many people (adults and children) have stomach problems when feeling stressed. Constipation can often flare.
  • New situations in school (big tests or making new friends) can also bring extra stress to the body and increase constipation.
  • Putting pressure on the child to stool, even if well intended, can add to the child’s fear. Be patient.
  • Shaming the child for accidents or struggles will increase the cycle of painful stooling and withholding. Constipation is a medical condition that takes patience and time to resolve.

When should I take a child to the doctor?

  • He or she is younger than 4 months old.
  • He or she gets constipated often.
  • There is blood in the bowel movement or on the diaper or underwear.
  • The child/teen is in serious pain.
  • Sometimes, constipation or blood in the stools is a symptom of an illness that should be addressed.
  • Rarely, in serious cases, hospital stays are warranted for a thorough evaluation.

Content Sources:
American Academy of Pediatrics: www.healthychildren.org
Center for Disease Control: www.cdc.gov
KidsHealth, Nemours Center for Children's Health Media: www.kidshealth.org
National Center for Environmental Health: www.cdc.gov/nceh
Up To Date: www.uptodate.com
U.S. National Library of Medicine: www.nlm.nih.gov/medlineplus

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