Constipation in Children: Causes and Treatment

Published on Tuesday, July 05, 2022 by Haley McGaha

Constipation is a common problem that many children experience and research shows that it affects up to 30% of children.

How is constipation defined?

Constipation is defined by having two or fewer bowel movements per week, pain with passing bowel movements, or large and hard stools that require straining with passing.

Children may have “recent-onset” or chronic constipation. Recent-onset constipation is constipation that has been present for eight weeks or less and can be resolved with brief interventions. Chronic constipation is constipation that is present for 3 months or more and needs more in-depth treatment, such as laxatives.

What are common causes of constipation?

Diet changes, toilet training and school entry are thought to be the biggest reasons for constipation.

Diet changes:

Many children’s diets are lacking enough fiber, which can increase the risk of constipation. The recommended fiber intake is equal to the child’s age, plus 5-10 grams/day. Excessive milk intake may also increase constipation. Over 32 ounces of milk/day has been shown to slow down how fast food moves through the digestive tract and can provide a feeling of being full, which leads to less water and fiber intake. 24 ounces of milk per day is enough to meet daily calcium needs for children between 1 and 5.

It is also very important to make sure your child is properly hydrated as insufficient hydration may increase constipation. Fluid intake recommendations are based on weight. For example, a 22 pound child needs 32 ounces of water per day, a 33 pound child needs 42 ounces of water per day, and a 44 pound child needs 50 ounces of water per day.

Toilet training:

Some studies show that a more stress-free approach to toilet training and having foot support while sitting on the toilet may help reduce constipation. Foot support is important for comfort and to relax the pelvic floor to help pass bowel movements. Ensure you wait until your child is fully ready to start toilet training and allow for easy-going time on the toilet (try not to rush a bowel movement).

School entry:

Once a child has entered school, constipation may become more common for many reasons. One being that children may not want to use the bathroom while at school/in public. Another reason is that the schedule at school may be different than at home, therefore, scheduling may interfere with going to the bathroom. Lastly, parents can be unaware of the lack of bowel movements while the child is at school unless the parent asks the child if they have had a bowel movement that day.

What can I do to help my child who is constipated?

Ensure your child is getting adequate fiber (>3 grams/serving) and fluid (32-64 ounces/day). If fiber supplements are used (fiber powder, etc), ensure your child is drinking adequate fluid for the fiber supplements to be effective. If fiber and fluid do not help improve constipation, talk to your child’s pediatrician about medications to help with bowel movements.