Constipation, Age 11 and Younger

Topic Overview

Constipation occurs when stools become hard and are difficult to pass. Some parents are overly concerned about how often their child has bowel movements because they have been taught that a healthy child has a bowel movement every day. This is not true. The frequency of bowel movements is not as important as whether the child can pass stools easily. Your child is not constipated if his or her stools are soft and pass easily, even if it has been a few days since the last bowel movement.

Newborns younger than 2 weeks should have at least 1 or 2 bowel movements a day. Babies older than 2 weeks can go 2 days and sometimes longer between bowel movements. It's usually okay if it takes longer than 2 days, especially if your baby is feeding well and seems comfortable. Breast-fed babies are more likely to have frequent stools and may have a stool as often as every feeding. Constipation is likely to occur when a baby changes from breast milk to formula, especially if this change happens during the first 2 to 3 weeks of life.

As babies grow older, the number of bowel movements they have each day gets less and the size of their stools gets bigger. A child age 3 or 4 may normally have as many as 3 bowel movements a day or as few as 3 a week.

It is important for parents to recognize there are many "normal" patterns for bowel movements in children. Some children may appear to have difficulty passing a stool. The child's face may turn red, and he or she may strain to pass stool. If the stool is soft and the child does not seem to have other problems, this is not a concern.

Most children will occasionally become constipated. The problem is usually short-lived and does not cause long-term problems. Home treatment is usually all that is needed to relieve occasional constipation. Causes of constipation include:

• Changes in diet, such as when a child starts eating more adult foods. Constipation may also occur if your child drinks too much cow's milk. This happens most often in children younger than age 2.
• Not drinking enough fluids. Sometimes the normal amount of fluid a child drinks is not enough, such as when the weather gets hot or the child increases his or her physical activities.
• Not taking the time to have a bowel movement. A child may be so interested in play that he or she ignores the need to have a bowel movement.
• Reluctance to use the bathroom. A child might become constipated when he or she is in a new environment, such as when traveling.
• Changes in daily routine, such as when traveling or after starting school.
• Medicines. Many medicines can cause constipation.

Constipation may occur with cramping and pain if the child is straining to pass hard, dry stools. He or she may have some bloating and nausea. There may also be small amounts of bright red blood on the stool caused by slight tearing (anal fissure) as the stool is pushed through the anus. All of these symptoms should stop when the constipation is relieved.

Chronic constipation

For reasons that cannot always be identified, some children often develop constipation that does not get better or go away with treatment (chronic constipation). The most significant factor may be the painful passing of a hard, dry stool. After a while, the child may be unable to resist the urge to have a bowel movement and will pass a large mass of stool. The child may have to "push hard" during the bowel movement, which may be painful. Passing the stool relieves the pressure and pain until another mass of stool collects, and the cycle is repeated. Fear of pain may cause the child to try to hold the bowel movement.

Other causes of chronic constipation may include:

• A crack (fissure) around the anus, which can make bowel movements painful and cause the child to resist passing stools. Fissures are a common problem that gets worse every time the child passes a large stool.
• A brief illness with poor food intake, fever, and little or no physical activity, which may upset normal bowel habits.
• Emotional problems or toilet training problems, which can lead to voluntarily withholding stools. A child may have fought the toilet training process, been pushed too fast, or been punished for having accidents. Struggling with parents for control may cause a child to hold stools back as long as possible.
• Change in environment. At school, children may withhold stools because they are afraid or embarrassed to use school bathrooms, their schedules are too busy for them to take time for a bowel movement, or school activities interrupt their normal bowel movement time.

The child may be unable or unwilling to pass the stool regardless of its size. Liquid or loose stool may leak out, soiling the child's underwear. When this occurs in a child who is past the age of normal toilet training, it is called encopresis.

Chronic constipation usually requires several months of treatment and cooperation between the parents, the child, and the doctor to overcome the problem. Don't be discouraged if the problem comes back during these months. The rectum is made of muscle tissue; when a child has had chronic constipation, the muscle becomes stretched. It may take several months to get the muscle back into shape.

In rare cases, constipation in children may be caused by other health problems, such as:

• Cystic fibrosis.
• Hirschsprung's disease.
• Lead poisoning.
• Overactivity of the parathyroid gland (hyperparathyroidism).
• Underactivity of the thyroid gland (hypothyroidism).
• Spinal cord injury.

Review the Check Your Symptoms section to determine if and when your child needs to see a doctor.

Check Your Symptoms

If you answer yes to any of the following questions, click on the "Yes" in front of the question for information about how soon to see a health professional.

Review health risks that may increase the seriousness of your child's symptoms.

If your child has any of the following symptoms, evaluate those symptoms first.

• Fever: Go to the topic Fever, Age 3 and Younger or Fever, Age 4 and Older.
• Sharp or severe abdominal pain: Go to the topic Abdominal Pain, Age 11 and Younger. To evaluate the severity of your child's pain, see evaluating pain in children age 3 and younger.
• Vomiting: Go to the topic Vomiting, Age 3 and Younger or Nausea and Vomiting, Age 4 and Older.

	Yes	Does your child have rectal bleeding? When to See a Doctor See significance of constipation and rectal bleeding if you need information to help you answer the questions below. Review health risks that may increase the seriousness of your child's symptoms. Call your child's health professional immediately if you answer "Yes" to any of the following questions. Yes Does your baby younger than 6 months of age have more than a streak of blood on the stool or on the diaper? Yes Has your child age 6 months or older passed a large amount of blood in the stool (enough to leave a red stain on his or her diaper or to turn the water in the toilet bowl red)? Call your child's health professional today if you answer "Yes" to the following question. Yes Has your child age 6 months or older passed two or more stools containing a moderate amount of blood (enough to leave a pinkish stain on his or her diaper or to turn the water in the toilet bowl pink)? You may wait to see if your child's symptoms improve over the next 24 hours (or specified time period) if you answer "Yes" to the following question. Yes Has your child age 6 months or older passed a small amount of blood on the stool more than one time in the last 24 hrs? Your child needs an appointment within the next 1 to 2 weeks if you answer "Yes" to any of the following questions. Yes Has your baby younger than 6 months passed a stool with a streak of blood on it or on a diaper more than one time, and a doctor has not evaluated this problem? Yes Has your child age 6 months or older had a very small amount of rectal bleeding (streak of blood) for longer than 1 week or more than 1 time a day? If you have answered "No" to the above questions, go back to Check Your Symptoms and continue to answer the questions to evaluate your symptoms.
	Yes	Do you think that your child's constipation may be caused by physical or sexual abuse? When to See a Doctor See significance of constipation caused by physical or sexual abuse if you need information to help you answer the question below. Review health risks that may increase the seriousness of your child's symptoms. Call your child's health professional immediately if you answer "Yes" to the following question. Yes Do you think that your child's constipation may be caused by physical or sexual abuse? If you have answered "No" to the above questions, go back to Check Your Symptoms and continue to answer the questions to evaluate your symptoms.
	Yes	Does your child have new constipation? When to See a Doctor See significance of new constipation if you need information to help you answer the questions below. Review health risks that may increase the seriousness of your child's symptoms. Call your child's health professional today if you answer "Yes" to the following question. Yes Does your child have painful constipation despite home treatment? You may wait to see if your child's symptoms improve over the next 24 hours (or specified time period) if you answer "Yes" to any of the following questions. Yes Does your baby younger than age 3 months have constipation that has not improved after 24 hours of home treatment? Yes Does your child age 3 months or older have constipation that has not improved after 1 week of home treatment? If you have answered "No" to the above questions, go back to Check Your Symptoms and continue to answer the questions to evaluate your symptoms.
	Yes	Does your child have rectal pain? When to See a Doctor See significance of constipation and rectal pain if you need information to help you answer the questions below. Review health risks that may increase the seriousness of your child's symptoms. Call your child's health professional today if you answer "Yes" to any of the following questions. Yes Does your child have severe rectal pain after passing stool? Yes Does rectal pain prevent your child from passing stool? Your child needs an appointment within the next 1 to 2 weeks if you answer "Yes" to the following question. Yes Does your child still have mild to moderate rectal pain that persists after 1 week of home treatment? If you have answered "No" to the above questions, go back to Check Your Symptoms and continue to answer the questions to evaluate your symptoms.
	Yes	Do you think your child's constipation may be caused by a medicine? When to See a Doctor See significance of a medicine if you need information to help you answer the question below. Review health risks that may increase the seriousness of your child's symptoms. Call your child's health professional today if you answer "Yes" to the following question. Yes Did your child's constipation begin after taking a medicine? Note: If your answer is 'Yes': Before your child's next dose (the same day), call the doctor who prescribed the medicine to see whether your child should stop taking the medicine or take a different one. An appointment may not be needed. If you gave your child a medicine not prescribed by a doctor (nonprescription), stop giving the medicine. If you feel your child needs to take the medicine, call your doctor. If you have answered "No" to the above questions, go back to Check Your Symptoms and continue to answer the questions to evaluate your symptoms.
	Yes	Does your child have persistent constipation (chronic constipation)? When to See a Doctor See significance of chronic constipation if you need information to help you answer the questions below. Review health risks that may increase the seriousness of your child's symptoms. Your child needs an appointment within the next 1 to 2 weeks if you answer "Yes" to any of the following questions. Yes Does your child have constipation that has not improved or is getting worse after 1 week of home treatment? Yes Does your child have new bowel habit changes that have not improved or are getting worse after 1 week of home treatment? If you have answered "No" to the above questions, go back to Check Your Symptoms and continue to answer the questions to evaluate your symptoms.
	Yes	Is your toilet-trained child leaking liquid or loose stool into his or her underwear? When to See a Doctor See significance of leaking formed or liquid stool if you need information to help you answer the question below. Review health risks that may increase the seriousness of your child's symptoms. Your child needs an appointment within the next 1 to 2 weeks if you answer "Yes" to the following question. Yes Does your child have constipation and: Leaks formed or liquid stool into his or her underwear and Is unable to correct the problem when it is brought to his or her attention? If you have answered "No" to the above questions, go back to Check Your Symptoms and continue to answer the questions to evaluate your symptoms.

If a visit to a health professional is not needed immediately, see the Home Treatment section for self-care information.

Home Treatment

Constipation can usually be treated effectively at home.

• Make sure your child is drinking adequate amounts of fluids.
• If you are switching from breast milk to formula, give your baby no more than 1 fl oz (30 mL) to 2 fl oz (60 mL) of water and no more than 2 times each day for the first 2 to 3 weeks. Be sure to give your baby the suggested amount of formula for feedings plus the extra water between feedings. Do not give extra water for longer than 3 weeks unless your doctor tells you to.
• If your child is older than 6 months, add fruit juices, such as apple, pear, or prune juice, to relieve the constipation.
  • After age 6 months, give 0.5 Tbsp (7 mL) to 2 Tbsp (30 mL) of prune juice. Increase the amount slowly over time.
  • At age 9 months, add 1.5 Tbsp (22 mL) to 3 Tbsp (45 mL) of strained prunes per day.
• If fruit juices do not help, add baby foods with a high fiber content twice a day. High-fiber baby foods include cooked dried beans or peas (legumes), apricots, prunes, peaches, pears, plums, and spinach.
  • For children 1 year and older, increase your child's fiber intake by adding at least 2 servings of fruit, such as apricots, peaches, pears, raisins, figs, prunes, dates, and other dried fruits. Also add at least 3 servings of vegetables, such as cooked dried beans or peas (legumes), broccoli, or cauliflower, each day. Add whole-grain foods, such as bran flakes, bran muffins, graham crackers, oatmeal, brown rice, and whole wheat bread.
  • Children older than 4 years may be offered unbuttered, unsalted popcorn as a snack. To avoid choking, do not offer popcorn to children who are younger than 4.
• Follow the diet outlined in the Prevention section of this topic to help relieve and prevent constipation.
• Gently massage your child's belly. This may help relieve discomfort. You can also have your child lie on his or her back, legs flexed onto his or her belly, and rotate his or her legs in a clockwise direction.
• If your child is having rectal pain because he or she is unable to have a bowel movement, try the following:
  • A warm bath in the tub. This may help relax the muscles that normally keep stool inside the rectum (anal sphincter) and help pass the stool.
  • If your child is age 6 months or older and the warm bath does not work, use 1 or 2 glycerin suppositories to lubricate the stool, making it easier to pass. Use glycerin suppositories only once or twice. If constipation is not relieved or develops again, discuss the problem with your doctor.
• Do not give laxatives or enemas to children without first talking to your doctor. Children should not need an enema or laxatives to have a bowel movement.

Symptoms to Watch For During Home Treatment

Use the Check Your Symptoms section to evaluate your child's symptoms if any of the following occur during home treatment:

• Constipation or changes in the stool persist after 24 hours of home treatment in a baby younger than 3 months.
• New constipation persists after 1 week of home treatment in a child age 3 months to 11 years.
• Chronic constipation:
  • Is causing new problems.
  • Has gotten worse.
  • Is accompanied by other bowel habit changes, such as changes in the size, shape, or consistency of stools.
• Rectal pain develops, increases, or lasts longer than 1 week.
• Abdominal pain develops or increases.
• Fever develops.
• Blood in the stool develops, increases, or lasts longer than 1 week.
• Your child's symptoms become more severe or frequent.

Prevention

Diet

A nonconstipating diet is the best way to prevent constipation. If constipation develops, a nonconstipating diet will help restore normal bowel movements.

For babies younger than 12 months:

• Breast-feed your baby. Constipation is rare in breast-fed babies.
• Make sure you are adding the correct amount of water to your baby's formula.
• For babies ages 6 to 12 months, give an extra 2 fl oz (60 mL) of water twice a day. Instead of water, you can add 2 fl oz (60 mL) to 4 fl oz (120 mL) of fruit juice, such as grape, pear, apple, or cherry juice, twice a day.
• Make sure to add only one new food at a time, and watch for signs of an allergic reaction or food intolerance.

For children age 12 months and older:

• Make sure your child is drinking enough fluids. When the weather gets hot or when your child is getting more exercise, make sure he or she is drinking more fluid.
• Add high-fiber foods.
  • Add at least 2 servings of fruit, such as apricots, peaches, pears, raisins, figs, prunes, dates, and other dried fruits, each day.
  • Add at least 3 servings of vegetables, such as cooked dried beans or peas (legumes), broccoli, or cauliflower, each day.
  • Children older than 4 years may be offered unbuttered, unsalted popcorn as a snack. To avoid choking, do not offer popcorn to children who are younger than 4.
• Increase whole-grain foods, such as bran flakes, bran muffins, graham crackers, oatmeal, brown rice, and whole wheat bread. Offer your child whole wheat bread instead of white bread.
• Make sure your child is not eating or drinking too many servings of dairy products. At age 1, a child needs 4 servings a day. Dairy products such as milk, ice cream, cheese, or yogurt can cause constipation when a child has too many servings in one day. One serving size of a dairy product is:
  • ¾ cup (6 oz) of milk.
  • 1 oz of cheese.
• Set a good example for your child by drinking plenty of fluids and eating a high-fiber diet.

Toilet training

Constipation sometimes becomes a problem when children start toilet training:

• Encourage your child to go when he or she feels the urge. The bowels send signals when a stool needs to pass. If your child ignores the signal, the urge will go away, and the stool will eventually become dry and difficult to pass.
• Set aside relaxing times for having bowel movements. Urges usually occur sometime after meals. Establishing a daily routine for bowel movements, such as after breakfast, may help.
• Make sure your child has good foot support while he or she is on the toilet. This will help flex your child's hips and place the pelvis in a more normal "squatting" position for having a bowel movement.
• Make sure your child gets plenty of exercise throughout the day. Set a good example for your child by following healthy routines of eating, exercising, and going to the toilet.

Preparing For Your Appointment

To prepare for your appointment, see the topic Making the Most of Your Appointment.

You can help your doctor diagnose and treat your child's condition by being prepared to answer the following questions:

• When did the constipation begin?
• How often does your child normally have a bowel movement?
• Are the stools hard or soft?
• Does your child have a history of constipation?
• Has prevention or home treatment helped relieve the constipation?
• If your child has been toilet trained, has he or she had any leakage of soft or liquid stool that has stained his or her underwear?
• Has your child had a recent change in diet, daily routine, or environment?
• Has your child recently started taking a new prescription or nonprescription medicine?
• Are you giving your child any new herbal remedies or vitamins?
• Has your child been under any added stress recently?
• Does your child have any health risks?

Related Information

• Abdominal Pain, Age 12 and Older
• Fever, Age 3 and Younger
• Fever, Age 4 and Older
• Healthy Eating for Children
• Hirschsprung's Disease
• Hypothyroidism
• Intussusception
• Nausea and Vomiting, Age 4 and Older
• Vomiting, Age 3 and Younger

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