Constipation (con-sti-PA-shun) in children can cause concern for parents. Sometimes children have poor stooling habits because they are not encouraged to go to the bathroom on a regular schedule. Sometimes, they are just "too busy" playing or doing something else to spend enough time on the toilet to stool.
Signs of Constipation
Constipation is a change in the child's stool or bowel habits. The child may have constipation if his or her stools are too hard, too infrequent, too painful, too large, too wide or if he cannot push it all out.
Other signs include:
- Pain or cramping in the abdomen (belly).
- Very infrequent, though soft, stools (less than 1 in 3 days).
- Soiling (the child has an "accident" in his pants).
- Painful stools or bowel movements; sometimes the stool will look like little logs, sausages or balls.
- Hiding in the corner of a room or all of a sudden becoming very quiet and still when they would otherwise be playful and talking.
What to Do
- If your child is toilet trained, have him or her sit on the toilet for 5 minutes after one meal, every day. Let the child eat, then wait 20 minutes after the meal to have him/her sit. It should be the same meal every day. It is okay to have them sit after breakfast, lunch and dinner. Or, try to figure out what time of day your child usually stools and do the sit time then. Place a footstool under his feet. Do not let his feet dangle and have him lean forward.
- Give your child praise and rewards (stickers, candy, etc.) just for sitting. This will help him or her to go on a regular schedule. Check the stool or bowel movement routinely so you will know what is normal and not normal for your child. The stool should be soft, like mashed potatoes, and not hard.
- Make sure your child eats fruits, vegetables and whole grain cereals every day (Picture 1). Adding a daily serving of raisin bran cereal or other high-fiber cereal to his diet can be helpful.
- Make sure your child drinks extra water and fruit juice between meals. A serving of prune juice or prunes once a day may help.
- Teach your child to come in from play every time he has the urge to have a stool or bowel movement.
- Use a reward system.
- Try to stay calm and not be too concerned if your child cannot have a bowel movement. Let him leave the bathroom and try again later in the day.
What Not to Do
Do not give enemas, suppositories or laxatives unless your doctor or nurse practitioner tells you to do so!
Never punish your child when he cannot have a bowel movement or if he soils his pants. Children do not have problems with stooling or bowel movements on purpose. Punishment only keeps them from developing good stooling habits.
Every child likes to see how well he is doing on a project. Everyone likes to be rewarded for success. Every time your child sits on the toilet long enough to have a stool or bowel movement, give him a reward. Do this whether he has a bowel movement or not. You can select a simple reward (such as favorite TV show or a sticker). Use a calendar or daily record to keep track of the extra fluids he drinks and when he sits on the toilet (Picture 2).
After a few weeks, agree on a greater reward for sitting on the toilet. If you use the reward system every day, in time your child will develop his own schedule for good bowel habits.
When to Call the Doctor
Call your child’s doctor if any of the following occurs:
- Bright red streaks of blood in the stool.
- Constipation continues for 3 days. Your child should stool daily to every other day. If it has been 3 days, you need to call your doctor or nurse practitioner for advice.
- Pain in the abdomen or rectum, along with the constipation.
- If your child continues to soil himself despite taking his medications by mouth as directed by the doctor or nurse practitioner and doing the scheduled toilet sit times.
If you have any questions, please contact the GI Services Department at (614) 722-3450.
HH-I-15 11/84, Revised 9/12 Copyright 1984-2012, Nationwide Children's Hospital