Health Library

Pediatric Constipation

What Causes Constipation in Children?

There are many reasons why children may have trouble pooping. Most of the time, constipation is not caused by a serious health problem. It often happens when a child’s diet, bathroom habits or daily routine changes. In some cases, medical conditions or muscle coordination problems may play a role. The causes of constipation can also depend on your child’s age and stage of development.

Infant Constipation (0–12 months)

• Most infant constipation is functional, meaning there is no clear medical cause.
• Formula-fed babies may poop less often than breastfed babies.
• Switching from breastmilk to formula, or starting solids, can change stool patterns.
• A past painful poop can lead to fear and stool holding.
• Rarely, a medical condition (like anal stenosis or Hirschsprung disease) may be the cause.

Constipation in Toddlers (1–3 years)

• Many toddlers get constipated during toilet training because it’s a change of routine to go from using a diaper to a potty chair or toilet. These changes can disrupt natural bathroom habits.
• They may hold their poop if they feel stressed or pressured or as a way to stay in control.
• They may be distracted by playing and hold it in instead of stopping to go to the toilet.
• A diet high in milk and low in fiber (fruits, vegetables, whole grains) can cause problems. Dairy contains fat and protein but no fiber. Large amounts can thicken stool. Without fiber, poop moves slowly through the intestines and becomes harder and drier.
• Some toddlers don't know how to push the right way (called dyssynergia).

Constipation in School-Aged Children (4+ years)

• Skipping meals, not drinking enough water, not getting enough exercise or eating too little fiber can slow digestion.
• Many children don’t poop at school because they feel embarrassed or dislike the bathroom.
• Busy routines, stress or new environments can lead to stool holding.
• Thyroid issues or celiac disease can have symptoms of constipation.

Reasons Constipation is a Concern

While it is hard to see your child in pain from constipation, there are other concerns if your child has trouble with constipation for a long time. These concerns include:

• Hard stools and passing large poops can cause a tear in the anus. This tear is called a fissure. Fissures can bleed and be painful.
• Straining to poop can cause blood vessels inside the child’s anus to become swollen or inflamed (hemorrhoids) and can cause burning pain and bleeding.
• When a child holds in their poop, over time the poop builds up inside the rectum. This causes the poop to become larger and harder to pass. This can also stretch out the rectum. Runny poop can leak out around this build up of hard, large poop and cause the child to soil their underwear. This soiling is called encopresis (in-co-pre-sis). Children may not feel this leakage of poop and are often not able to even smell that they have soiled in their underwear. Children may try to hide their underwear when this happens.

How Do You Know It's Constipation?

During an office visit, a doctor (or advanced practice nurse) will ask you questions about your child’s medical history and complete an exam. The provider might ask questions like:

• How old was your child when they had their first poop as a newborn baby?
• How often does your child poop?
• Does your child complain of pain with pooping?
• Have you been trying to toilet train your child lately?
• What is your child’s diet like?
• Has your child had any increased stress lately?
• Does your child soil their pants? If so, how often?

Your child may need to have a rectal exam. The doctor or nurse can help explain this special exam to your child before the exam is done.

Sometimes, your child may need special tests to help find a cause for the constipation. These tests might include:

Abdominal X-ray: This is a special X-ray picture to evaluate the amount of stool in the large intestine.

Contrast enema: This is a test that uses X-rays and a special kind of enema solution to take pictures of the colon or large bowel, which is the lower part of the intestines. The test shows the doctor if there is anything wrong inside the colon and how well it is working.

Anorectal manometry: This is a test that measures the strength of the muscles in the anus, nerve reflexes, the sense that the rectum is opening, and coordination of muscles when pooping.

Rectal biopsy: A tissue sample is taken from the lining of the rectum to look at under a microscope for any problems.

How is Constipation Treated?

Treatment depends on your child’s age and needs.

• Infants: Small changes in feeding may help. If the baby is formula-fed, your provider may suggest switching brands. Gently moving the baby’s legs or doing a tummy massage can also help. Some infants may benefit from a stool softener if diet changes do not help.
• Toddlers: Treatment usually includes behavior changes, such as regular toilet time and rewards for trying. A stool softener like polyethylene glycol (Miralax^Ⓡ), or a stimulant like senna, may be prescribed. Try to limit dairy to three servings a day, or limit milk to 24 ounces a day. Sometimes parents think their child needs more fiber, and if they are a picky eater, the parent will give fiber gummies. This may give the child too much fiber and bulk the stool too much.
• Older children: Older kids may need a mix of medicine, behavior therapy and diet changes. Getting them involved in their care helps. Encourage regular bathroom breaks, especially after meals.

Long-Term Outlook

The outlook for treating children with constipation will depend on if there is a complex problem causing the constipation. Children with diseases of the intestine may have long-term issues with constipation. Up to 90% of children will have no long-term or recurring problems.