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Constipation

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What is Constipation?

Many parents worry if a child goes three or four days without having a bowel movement. As long as the stool is soft and easily passed, the child is likely not constipated. Constipation is defined as less than three bowel movements per week and/or hard and painful bowel movements with soiling or abdominal pain.

What are signs of Constipation?

  • Babies who pass stools that look like pebbly rabbit droppings are constipated. It is normal for babies to grunt, squirm or get red in the face when having a bowel movement. If the stool is soft, the baby is not constipated.
  • Toddlers who routinely strain to pass hard stools may be constipated.
  • Stool accidents may also be signs of constipation in a child.
  • Stool holding may also be a signs of constipation in a child who is toilet trained.
  • A full or big abdomen and a decreased appetite may be a sign a child of any age is constipated.
  • Having pain during a bowel movement is a sign of constipation. If your child is old enough to speak, he may tell you he has pain.

What causes Constipation?

All kinds of things affect how well children’s bowels move: certain diseases, medications, psychological factors, and of course, diet. If your child is constipated, consider possible dietary and lifestyle causes:

Not Enough Fiber -  Most children in the U.S. don’t eat enough fiber. Fiber is the part of plant foods that we don’t absorb. Unlike vitamins, minerals, fats, and proteins, fiber passes though us. Fiber can also help lower blood cholesterol, reducing the risk of heart disease. Eating fiber-rich foods may also helps reduce the risk of Type 2 diabetes, and some cancers. Fiber guidelines for children and adults are listed below. Serve plenty of fiber-rich fruits, vegetables, whole grains, nuts and beans. Do not give nuts or other crunchy food to children younger than 4 years of age. Crunchy food such as nuts and raw fruits and vegetables can cause young children to choke.  

Large Quantities of Cow's Milk - Large quantities of cow’s milk may cause chronic constipation in certain children. Talk to your child’s doctor or a dietitian if you think cow’s milk might be causing your child to be constipated. They will help you choose other foods that have calcium and vitamin D if your child needs to drink less milk to prevent constipation.

Not Enough Liquids - Some children may not be drinking enough water or other liquids to meet their needs, which may contribute to constipation. It is important to drink plenty of water to move bowel movements through the body. Fiber absorbs water, making stools large and heavy, helping to keep the bowels moving smoothly. Children need 4 to 6 cups of liquid every day to help prevent constipation. Teenagers need 6 to 8 cups of liquid daily.

Not Enough Activity - Physical activity helps to move bowel contents through the body. Many children may not be getting the recommended amount of daily physical activity. Sometimes health conditions prevent children from being active. For the average child and teenager, 60 minutes per day of activity is recommended.

How Much Fiber?

6-24 months of age: Work up to 5 grams/day

2-18 years of age: Child's age plus 5 grams/day

Adults: 25-35 grams/day 

Treating Constipation

Make sure your child is drinking enough liquids. (Be careful not to exceed recommendations, as too much fluid can be harmful.) 

Prune, pear, and apple juice all contain sorbitol. Sorbitol will help bowels to move.

  • Mix prune juice with an equal amount of water.
  • Give a few sips for a baby or up to a cup for a toddler.

Increase the opportunities for your child to be physically active.

  • Children 2-5 years should participate in short periods of active play multiple times per day.
  • Children 5-17 years should aim for 60 minutes of activity. This can be divided into as little as six 10 minute periods of activity everyday.

Adding fiber to children’s diets is easy.

NOTE: Children less than 4 years old may choke on crunchy foods if they do not chew them well enough. Use these tables to choose the right food for your child’s age.

These foods are great sources of fiber:

Children 1 - 4 years old  

  • Apples (cooked)
  • Applesauce
  • Broccoli (cooked)
  • Bulgur wheat
  • Carrots (cooked)
  • Hummus
  • Kidney Beans
  • Lentils
  • Oatmeal
  • Pears (canned)
  • Peas
  • Raisins
  • Refried beans
  • Wheat germ
  • Whole wheat bread

Children 4 years old and older  

Include all food on the list above but older children may have fruits and vegetables cooked or raw. 

Additional items: 

  • Almonds
  • Flax seed
  • Oranges
  • Peanut butter
  • Popcorn

Simple Tips for Increasing Fiber:

  • Choose breakfast cereals with 3 or more grams of fiber per serving
  • Add wheat germ to yogurt
  • Substitute whole wheat flour for half the white flour in pancake, muffin and quick bread recipes
  • Serve fruit instead of juice
  • Offer fruit and/or vegetables at almost every meal and snack
  • Serve more beans: Most children like chili, beans and rice, refried beans, and baked beans

If increasing fiber doesn’t help, talk to your pediatrician about other options. Your child’s doctor may recommend fiber supplements or short-term use of glycerin suppositories, stool softeners, or laxatives such as, lactulose, Miralax™ or Milk of Magnesia. Caution: Frequent use of suppositories, enemas or rectal thermometers to cause bowel movements may harm your child. Do not use stool softeners or laxatives without a doctor’s advice. The best way to help your child have normal bowel movements is to give him high fiber foods and make sure he drinks enough fluids. 

Call the doctor when your child is constipated if your child:

  • Is less than 12 months of age
  • Is constipated for more than 3 weeks
  • Starts vomiting or refuses to eat
  • Appears ill
  • Eats more fiber and drinks more fluids but it does not help
  • Has soiling accidents

Disclaimer: This information is not intended to substitute or replace the professional medical advice you receive from your child's physician. The content provided on this page is for informational purposes only, and was not designed to diagnose or treat a health problem or disease. Please consult your child's physician with any questions or concerns you may have regarding a medical condition.

Reviewed: 10/2012

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