Constipation is one of the most common concerns parents bring to their pediatrician. For some families, it’s a short-term issue that resolves with a few tweaks to their child’s diet. For others, it can become a frustrating, recurring challenge that affects mood, behavior and daily life.
Dr. Alexis Phillips-Walker, a pediatrician with Children’s Memorial Hermann Pediatrics, stresses the importance of understanding what constipation is so that parents know when to worry and when to simply monitor.
“The true definition of constipation is when stool sits on the rectum, which is the last part of the large intestine, for too long,” she explains. “And it's a disorder where something's affecting the movement of the stool through the digestive tract.”
When stool moves too slowly, the stool becomes dehydrated and changes character. “As a result, the stool becomes hard, it becomes dry or lumpy, making it painful or difficult to pass,” she says.
What Causes Constipation in Kids?
There is rarely one single cause of constipation. Dr. Phillips-Walker notes that some of the most common contributors include the following:
- Dehydration
- A lack of fiber in the diet
- Lactose intolerance or dairy sensitivity
- Stress or acute illness
- Potty training
- Certain medications
- Too much sedentary time
- Diets high in processed foods
In particular, Dr. Phillips-Walker notes that not drinking enough fluids is a major factor. “Not drinking enough fluids in a day can make the child's stool hard and dry,” she explains. “Your child should have at least 8 ounces of liquid, preferably water, with every meal.”
Stress can also adversely affect the gut — a fact most parents may not expect. “It’s important to keep in mind that stress has different forms,” Dr. Phillips-Walker advises. “Stress can be external, such as a loved one passing away or adjusting to a new family rhythm, or internal, like an acute illness that is stressing the systems of the body.”
Learning how to use the bathroom can be another overlooked trigger. “Potty training is a big cause of constipation,” she says. “A child’s fear of using a restroom, specifically public restrooms that have louder and more aggressive flushes, contributes to them ‘holding it’ longer and can result in constipation.”
Is There a Link Between Picky Eating and Constipation?
A picky eater with a limited palate tends to experience constipation.
“If a child consumes more processed food each day, they’re missing out on the fiber that comes with more nutrient-dense whole foods such as fruits, vegetables and whole grains” Dr. Phillips-Walker explains.
When a child does not consume enough fiber, parents may need to compensate, whether that be through dietary adjustments or supplements recommended by a pediatrician.
As mentioned previously, dehydration is a major factor to constipation. So for those kids who don’t drink enough water with their meals serving “watery foods,” such as soups and fruits, can help make sure they get enough fluids.
When Do Public Bathrooms Become the Problem?
Fear of public toilets is more common than many parents realize. “Usually, it's the sound, like, the loudness of it all,” Dr. Phillips-Walker says.
One tactic she suggests parents can use to help overcome this kind of situation is to model calm behavior. “You can show them how it’s okay to use the restroom, despite the loud noises. Narrate for them: ‘I'm fine, I'm safe.”
Gradual exposure can also help a child get over this fear. When an opportunity to use a public restroom arises, encourage it. If the child is truly afraid of using a public restroom, try to get to the bottom of what that fear is: it could be the loud flushing, that a public restroom feels dirty or that they just do not like being in an area with multiple stalls. To effectively help them get over their fear, you need to understand why they became fearful in the first place and work through it.
Behavior Changes and Constipation
Many parents are surprised to learn that constipation can affect behavior. “Chronic constipation is linked to behavioral issues, particularly in children,” Dr. Phillips-Walker says.
She notes that children may become “irritable,” show “aggression” and experience “anxiety and temper tantrums.”
In fact, many children who experience constipation might have significant psychosocial behavioral issues. “The connection usually stems from the pain-induced stress and discomfort,” she says.
As a result, children who cannot clearly communicate their discomfort may act out with irritability and aggression.
There is also a connection between constipation and ADHD, with Dr. Phillips-Walker notes, explaining that children who struggle to sit still at the dining room table or in class may also have difficulty sitting long enough to have a bowel movement.
Social stress can worsen the issue. “Some kids might have a fear of school toilets and so begin to start withholding, which is going to make the problem even worse,” she says.
When to Call the Pediatrician
Not every skipped bowel movement is cause for concern, however. What matters most is stool consistency and comfort in the process. “Try not to focus so much on how often your child is going to the bathroom if the stool is not hard or difficult to pass,” Dr. Phillips-Walker says.
Breastfed infants, for example, may not go every day. “A mother’s milk is often so well digested that infants might skip a day or go only a few times a week. If their stool is soft and mushy, it's totally fine,” she says.
The same can be true for toddlers as a day without stooling is not necessarily a cause for concern provided that the child is not in pain or overly straining.
However, there are certain signs that warrant an evaluation by your pediatrician:
- Hard, painful stools
- Skipping days combined with discomfort
- Large stools that clog the toilet
- Soiling accidents associated with diarrhea
- Rectal bleeding
“When your child has hard, painful stools that are difficult to pass, that's when you know you have a really big issue on your hands,” she says. “Those small, pellet-like stools are a red flag.”
What Happens at the Doctor’s Visit?
Here’s what you should expect as a parent if you take your child to the pediatrician for constipation-related issues. The doctor’s evaluation usually starts with questions like the following:
- When did the was the child’s last bowel movement?
- What is your child eating every day?
- How much are they drinking in a day?
A pediatrician will also use a visual tool called the Bristol stool chart to better understand what your child’s poop looks like. This can help the provider better understand the severity of the situation and how to treat the constipation.
For mild cases of constipation, Dr. Phillips-Walker typically recommends her patients increase their fruits, vegetables and water intake. These changes alone could be enough to get things moving, but parents can also consider adding a daily probiotic or probiotic foods to promote healthy stool movement.
If those changes do not work, stool softeners or laxatives may be recommended. In more severe cases involving withholding or accidents, a bowel cleanout may be necessary. “The idea behind a cleanout is to allow the child to completely clear out their bowel system,” she explains.
In rare cases of fecal impaction, which is a severe form of constipation where a large, hard mass of stool gets stuck in the rectum or colon, hospitalization may be required.
A Reassuring Takeaway for Parents
Remember: If a child misses a day or two of bowel movements, there’s no reason to panic. If the stool is soft and easy to pass, there’s nothing to be concerned about.
And for those kids who are truly constipated, it is often manageable with early attention and consistent habits of staying hydrated and eating nutrient-dense foods.
However, if you are concerned for your child, don’t hesitate to contact your child’s pediatrician to discuss their symptoms and any potential action steps. “If you have any questions, it's always best to just ask your pediatrician,” Dr. Phillips-Walker says. “When it comes to your child’s health, no question is a silly question.”
