Q&A: Constipation in children

Constipation can cause issues with bowel movements in as many as 30 percent of children. It’s a common concern for many parents. Most often, constipation affects preschool-age children but can also occur in older children. No common cause or medical condition consistently contributes to symptoms that lead to less frequent, hard, large or uncomfortable bowel movements. However, understanding what’s normal, depending on your child’s age, may help you to decide if it’s time to seek help.

Normal bowel habits broken down by age:

• Newborns — Four soft bowel movements daily
• First 3 months (breastfed) — Three soft bowel movements daily
• First 3 months (formula) — Two to three soft bowel movements daily
• 6–12 months — Two bowel movements daily
• 1–3 years — One to two bowel movements daily
• 4 years and older — Can have one bowel movement daily

NOTE: It can be common for a breastfed infant to have as many as one bowel movement after each feeding to as little as one bowel movement every five to seven days.

What should the bowel movement look like?

• A breastfed infant will have stool that can look more yellow and seedy.
• A formula-fed infant will have a peanut butter-consistency stool.
• As a child ages and solids are introduced, the stool can vary dependent on diet.
• As a child ages and becomes potty trained, a soft, formed banana-shaped stool each day is common.

When does a bowel movement become abnormal?

• Bowel movements become hard or pellet-like
• Bowel movements that cause straining and discomfort
• Blood in the stool or on the toilet paper due to the straining or size of the bowel movements
• Leakage of stool in underwear
• Urine accidents in correlation with infrequent bowel habits that previously were not occurring

In what kind of situations does constipation commonly occur in children?

• During the transition to a solid diet, such as moving from breast milk or formula to solid foods.
• During toilet training, where withholding can occur when a child isn’t ready or painful bowel movements are an issue.
• When school starts, where an unfamiliar setting, privacy issues or concerns of time can result in withholding.

What are common symptoms of constipation?

• Infrequent bowel movements
• Hard, formed and painful bowel movements
• Abdominal bloating
• Frequent complaints of stomach ache or abdominal discomfort
• Leakage of stool in the underwear
• Urinary leakage or incontinence
• Blood in the stool or diaper
• Changes in appetite
• Weight loss or poor weight gain

There are a number of things you can try to help your child develop better bathroom habits early on to avoid potential issues, including:

• Toilet train when your child is showing interest.
• Provide positive reinforcement.
• Incorporate a foot support, such as a stool, for proper positioning and comfort.
• Encourage routine, especially after a meal as eating stimulates the bowels.
• Allow for enough time (at least five to 10 minutes) to have a bowel movement.
• Encourage and offer plenty of water to drink throughout the day (three to five glasses daily).
• Choose a balanced diet that includes whole grains, fruits and vegetables. High-fiber foods include apricots, sweet potatoes, pears, prunes, peaches, plums, beans, peas, broccoli, berries or spinach. You also can utilize two to four ounces of 100 percent fruit juice (apple, prune, pear) diluted with water, as needed, for a child with a history or concerns of constipation.
• Taking a fiber supplement is an option to discuss with your child’s primary care provider.

When should you see your child’s primary care provider?

• Your child is having hard, formed, painful stools.
• Your child doesn’t want to eat and is losing weight.
• You see blood in your child’s stool or diaper.
• Your child is having repeated episodes of constipation.
• You have questions or concerns about your child’s bowel habits.

Constipation is a common occurrence is children. Thankfully, there are many options available to help. Your child’s health care provider is the best source of information for questions or concerns related to your child’s constipation.

Jennifer Marr is a pediatric and adolescent nurse practitioner in Mankato, Minnesota.