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 children of preschool-age, but it also can 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.

Here's how normal bowel habits break down by age:

• Newborns — Expect four soft bowel movements daily
• First 3 months for children who are breastfed — Expect three soft bowel movements daily.
• First 3 months for children who are formula-fed — Expect two to three soft bowel movements daily.
• 6 months–1 year — Expect two bowel movements daily.
• 1–3 years — Expect one to two bowel movements daily.
• 4 years and older — Expect one bowel movement daily.

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 are abnormal when they become hard or pellet-like, or they cause straining and discomfort. Other signs of an abnormal bowel movement include blood in the stool or on the toilet paper due to straining or size of the bowel movements, leakage of stool in underwear, and urinary accidents in correlation with infrequent bowel habits that previously were not occurring

When does constipation commonly occur in children?

Constipation in children commonly occurs during the transition to a solid diet, such as moving from breast milk or formula to solid foods. It also can occur during toilet training, where withholding can occur when a child isn't ready or painful bowel movements are an issue, and when school starts, where an unfamiliar setting, privacy issues or concerns of time can result in withholding.

What are common symptoms of constipation?

Signs of constipation include:

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

Tips to avoid constipation

You can try several things 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, typically three to five cups 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 2-4 ounces of 100% fruit juice - apple, prune or 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 to see your child's primary care provider

You should see your child's primary care provider when your child:

• Is having hard, formed, painful stools
• Doesn't want to eat and is losing weight
• Has blood in his or her stool or diaper.
• Is having repeated episodes of constipation.

You also should see your child's primary care provider when 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.

Sara Herrmann, M.D., is a pediatrician in Menomonie, Wisconsin.