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Constipation is very common for kids.

Since your kids will almost certainly become constipated, at least briefly, at some point in their lives, it is important to understand how to recognize the symptoms of constipation.

Symptoms of Constipation

How do you know if your child is constipated?

In addition to grunting and stomach pain, more traditional signs and symptoms of constipation include having:

• fewer than two bowel movements in a week
• bowel movements that are small, hard, and like little balls
• bowel movements that are very big and hard and which may frequently clog the toilet

Most importantly, your constipated child will have bowel movements that are painful and difficult to pass. Very big bowel movements might also lead to small rectal tears and bleeding (usually some bright red blood on the toilet paper when wiping, not blood that fills the toilet bowl).

Not surprisingly, large painful bowel movements commonly lead kids to avoid going to the bathroom, creating a viscous cycle of worsening constipation that can become chronic. Your child with chronic constipation may eventually develop encopresis, having soiling accidents that you mistake for diarrhea. Or because they are holding their stool, they might also hold their urine and develop multiple urinary tract infections or just have urine accidents.

What about grunting and straining? If your baby grunts, strains and even cries briefly, but then passes a soft bowel movement each day, then she probably isn’t constipated (Infant Dyschezia).

Young Children with Constipation

It is often most obvious when young children get constipated, as you are still changing diapers or helping them use the potty.

Keep in mind that:

• you should talk to your pediatrician if you think that your newborn baby is constipated (not pooping can be a sign that newborn babies aren’t eating enough) or if your child has had constipation problems since he was born (sign of Hirschsprung disease) or is constipated and isn’t gaining weight (Celiac disease)
• exclusively breastfeeding infants, especially before they start solid foods, once they are gaining weight well, are unlikely to get constipated, but they may only have their soft bowel movements every few days or weeks
• infants sometimes get constipated when they start rice cereal or other baby foods
• toddlers sometimes get constipated when they start potty training – this is an especially important time to make sure your child doesn’t get or stay constipated, or it will interfere with potty training

Again, be aggressive if your child becomes constipated when potty training. It is easy to imagine that your toddler is not going to want to have regular bowel movements on the potty if he associated them with pain.

Children with Constipation

Although it is typically harder to recognize, because you likely don’t know how often they are going to the bathroom, constipation is common in older children too.

Common times to develop constipation might include:

• when they start kindergarten, especially if they don’t feel comfortable going to the bathroom at school
• after going to camp, on a trip, or any other situation where their diet and routine might have changed
• after a brief illness, especially if they took or are taking a medication that might have constipation as a side effect
• during a period of stress, such as starting a new school, moving to a new house, bullying, or social changes (divorce, death in the family, etc.) at home

It is so common, you might even want to watch for constipation at those times, especially if your child has had issues with constipation in the past.

Hard To Control Constipation

Most parents know how to treat simple constipation – more fluids, more fiber, stool softeners, and the occasional glycerin suppository or pediatric enema (the last treatments should likely only be used when nothing else is working and your child is uncomfortable).

But what do you do when that’s not enough?

To help treat kids with hard to control constipation, it usually helps to:

• make long term changes to your child’s diet, including more fluids (especially water), less fat,  and more fiber, as kids with constipation may have a diet high in fat and low in fluids and fiber
• make long term changes to your child’s behavior, encouraging him to sit and try to go to the bathroom after breakfast and dinner, but not making him sit until he goes
• encourage your child to be physically active
• continue your child’s daily maintenance constipation medicine (usually polyethylene glycol (PEG), lactulose, Milk of Magnesia (magnesium hydroxide), or mineral oil) until he is having a soft stool each day for several months and continues having a daily soft stool as you gradually decrease (over several months) and then stop the medicine (stopping a laxative as soon as kids begin having regular bowel movements is the biggest mistake that parents typically make when their kids are constipated)
• consider a clean out regimen over a few days if your child is very constipated, using high dose polyethylene glycol or magnesium citrate, which unfortunately might cause some diarrhea as a side effect of getting a lot of hard stool out

What do you do if your child relapses? You usually just start over, especially if the relapse is because you stopped one or more of your child’s constipation treatments.

If your child relapses even though you had been consistent and had been continuing all of his previous treatments that had been working well, you might consider:

• switching to an alternative to cow’s milk, like almond or soy milk, as some people think constipation can be due to a cow’s milk protein allergy, plus they will likely be lower in fat than cow’s milk
• increasing the dose of stool softeners and make sure that you don’t stop them too soon
• avoiding treatments that have not been found to be helpful, including very high fiber diets, prebiotics or probiotics, biofeedback and other alternative treatments
• avoiding suppositories and enemas, as oral constipation medicines are just as effective and will be better tolerated by your child

Your pediatrician and/or a pediatric gastroenterologist can be helpful if your child has hard to control constipation. In fact, up to 25% of the visits to a pediatric gastroenterologist are for constipation.

For More Information on Constipation

• NIDDK – Constipation in Children
• GI Kids – Constipation
• Healthy Children – How do I know if my child is constipated?
• Healthy Children – Constipation
• Kids Eat Right – Ease the Pain of Constipation
• Constipation Remedies
• SBM – Constipation Myths and Facts
• Evaluation and Treatment of Functional Constipation in Infants and Children: Evidence-Based Recommendations From ESPGHAN and NASPGHAN