Constipation in kids: Prevention & treatment

Does your child have fewer than two bowel movements a week, or have stool that is hard, dry, small and difficult to pass? If so, your child is probably suffering from constipation. A fairly common condition in children of all ages, about 5% of visits to pediatricians and 25% of visits to pediatric gastroenterologists are due to constipation.

Causes of constipation in kids

Rinarani Sanghavi, M.D., director of neurogastroenterology and GI motility at Children’s Health℠ and associate professor of pediatrics at UT Southwestern, says the most common reason that children become constipated is related to diet. “Children are not getting enough water or fiber from fresh, green, leafy vegetables,” says Dr. Sanghavi.

Another common reason Dr. Sanghavi cites is that kids are overscheduled and simply don’t have enough time to sit on the toilet and try to poop. A small minority of children with constipation have a family history of the condition. Rarely, constipation is caused by a malformation in the nerves or muscles that control defecation.

Signs and symptoms of constipation in kids

Dr. Sanghavi says parents should watch for the following signs and symptoms of constipation:

• Accidents of stool in underwear – ranging from “skid marks” to actual bowel movements

• Belly pain

• Bowel movements that clog up the toilet

• Frequent urinary tract infections (UTIs)

• Hard stool

• Nausea and vomiting

• Pain while trying to poop

• Spending a long time trying to poop

• Blood when wiping or blood in the stool may be a sign of constipation or another GI condition

Preventing and treating constipation in kids

Dr. Sanghavi subscribes to a “three pillars of prevention” model for reducing your child’s risk for becoming constipated, as well as treating constipation:

1. Improve your child’s diet: “What goes in is what’s going to get digested and come out,” Dr. Sanghavi reminds parents. Children should drink plenty of water, and eat green, leafy vegetables (such as salads, celery and spinach), fresh fruits with skins on and nuts with high fiber content (such as almonds). You should also limit the amount of processed foods your child eats, including any food that contains all-purpose flour (such as pizza and macaroni and cheese). Dr. Sanghavi recommends making the switch from white to whole wheat or spelt bread.

2. Schedule bathroom breaks: You should make time in your child’s schedule for them to sit on the toilet. “The best time is in the morning after breakfast,” says Dr. Sanghavi. “Wake your child up a half hour earlier, have breakfast and then have him or her sit for ten minutes on the toilet and try to poop.” Make sure your child is using the correct posture for pooping, which prescribes that your knees are positioned above the hips in a seated position. Dr. Sanghavi recommends using a step stool under your child’s feet to help ensure the proper position.

3. Stay physically active: “One of my colleagues says there’s no such thing as a constipated runner,” Dr. Sanghavi says. Make sure your child gets 30 to 45 minutes of moderate exercise throughout the day. During the colder months, try indoor activities, such as jumping rope.

If you have applied the “three pillars” and your child is still constipated, you should see a pediatrician. The first line of treatment is usually mild laxatives and further modification of diet, says Dr. Sanghavi. Although some parents might be concerned about the use of laxatives in children due to recent publicity about MiraLAX®, Dr. Sanghavi says laxatives are generally safe and effective for treating constipation in kids.

If more treatment is needed, your child’s pediatrician will make a referral to a pediatric gastroenterologist for additional testing and treatment.

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