Constipation in Children: Symptoms, Causes & Home Remedies

What Are the Symptoms of Constipation in Children?

Children with constipation typically have fewer than 3 bowel movements per week, hard or painful stools, abdominal pain, and may resist going to the toilet. Other signs include large stools that clog the toilet, blood on toilet paper from anal fissures, and fecal soiling in underwear.

Recognizing constipation in children requires understanding both the physical symptoms and the behavioral changes that often accompany this condition. Many parents initially focus only on stool frequency, but the consistency and ease of passing stool are equally important indicators of digestive health. A child who has a bowel movement every other day with soft, easy-to-pass stools is typically healthier than a child who passes hard, painful stools daily.

The symptoms of constipation can vary significantly between children and may change over time. Some children experience acute constipation that resolves quickly with dietary changes, while others develop chronic constipation that persists for months or even years. Understanding the full spectrum of symptoms helps parents identify the problem early and seek appropriate treatment before complications develop.

Constipation affects children differently at various ages. Infants may show signs of straining and discomfort, while older children may develop sophisticated avoidance behaviors. Regardless of age, early recognition and intervention lead to better outcomes and prevent the cycle of pain and withholding that characterizes chronic childhood constipation.

Common Physical Symptoms

The physical symptoms of constipation are often the first signs parents notice. Children may have one or more of the following symptoms when constipated:

• Infrequent bowel movements: Fewer than 3 bowel movements per week
• Hard, dry, or lumpy stools: Difficult to pass and may cause pain
• Painful defecation: The child cries, becomes upset, or refuses to use the toilet
• Large stools: When the child does have a bowel movement, it may be unusually large and may clog the toilet
• Abdominal pain: Often described as cramping or general discomfort, may reduce appetite
• Blood on stool or toilet paper: From anal fissures (small tears) caused by hard stools
• Fecal soiling: Loose stool leaking around a hard mass in the rectum

Behavioral Signs to Watch For

Children often develop behavioral patterns in response to constipation that parents should recognize. A child who has experienced painful bowel movements may actively try to avoid having another one. This withholding behavior is extremely common and creates a vicious cycle: the longer stool remains in the rectum, the harder and more painful it becomes to pass.

Signs that your child may be withholding stool include standing on tiptoes, crossing legs, sitting on heels, stiffening the body, making facial expressions that suggest straining (but are actually efforts to hold back), hiding in corners or behind furniture, and suddenly stopping play to assume a rigid posture. Many parents mistakenly believe their child is trying to have a bowel movement when they are actually doing the opposite.

Urinary Problems from Constipation

A full rectum can press against the bladder, causing a range of urinary symptoms that parents may not connect to constipation. These symptoms include needing to urinate more frequently than usual, daytime wetting accidents, bedwetting (enuresis) in children who were previously dry, and recurrent urinary tract infections. When constipation is treated effectively, these urinary symptoms often resolve completely.

Fecal Soiling (Encopresis)

One of the most distressing symptoms for families is fecal soiling, where loose or liquid stool leaks into the child's underwear. This occurs when hard, impacted stool in the rectum creates a blockage, and liquid stool from higher in the colon seeps around it. Many parents initially believe their child has diarrhea, but this is actually a sign of severe constipation requiring prompt treatment.

Fecal soiling is involuntary and should never be punished. Children are often embarrassed and may try to hide soiled underwear. Understanding that this symptom indicates constipation rather than behavioral issues helps parents respond supportively while seeking appropriate medical care.

When Should You See a Doctor for Child Constipation?

Seek medical care if constipation lasts more than one week despite home treatment, if there is blood in the stool, severe abdominal pain, vomiting, a swollen belly, or if your child is not gaining weight. Infants under 4 months who appear constipated should always be evaluated by a healthcare provider.

While most cases of childhood constipation can be managed at home with dietary and lifestyle changes, certain situations require professional medical evaluation. Understanding when to seek help ensures that serious conditions are not overlooked and that chronic constipation receives appropriate treatment before complications develop.

Parents should trust their instincts when it comes to their child's health. If something seems wrong beyond ordinary constipation, or if home remedies are not working, there is no harm in consulting a healthcare provider for guidance. Early intervention often prevents mild constipation from becoming a chronic problem.

Situations Requiring Medical Attention

Contact your child's healthcare provider if any of the following situations apply:

• Infant constipation: Babies who are exclusively breastfed rarely become constipated; if you suspect constipation in a breastfed infant, seek medical advice
• Constipation lasting more than one week: Despite trying home remedies and dietary changes
• Recurring episodes: Frequent bouts of temporary constipation that keep returning
• Alternating constipation and diarrhea: This pattern may indicate a need for evaluation
• Pain during bowel movements: If your child is consistently upset or crying when trying to have a bowel movement
• Poor weight gain: Constipation combined with failure to thrive requires medical assessment
• Blood in the stool: While small amounts from anal fissures are common, any blood should be discussed with a healthcare provider

What Causes Constipation in Children?

Constipation in children is most commonly caused by dietary factors (low fiber, inadequate fluids), withholding behavior due to fear of painful bowel movements, lifestyle changes (starting school, potty training), and lack of physical activity. Most childhood constipation has no underlying disease.

Understanding why constipation develops helps parents implement effective prevention and treatment strategies. In the vast majority of cases, childhood constipation is "functional," meaning it has no underlying medical cause. Instead, it results from a combination of dietary habits, behavioral patterns, and lifestyle factors that can be modified.

The development of constipation often follows a predictable pattern. An initial episode of hard, painful stool leads to fear and avoidance of bowel movements. This withholding behavior causes stool to accumulate in the rectum, where more water is absorbed, making the stool even harder. The cycle continues unless interrupted by appropriate treatment.

Dietary Causes

Diet plays a crucial role in maintaining regular bowel movements. Children who consume insufficient fiber or do not drink enough fluids are more likely to develop constipation. The modern diet, often high in processed foods and low in fruits, vegetables, and whole grains, contributes to the high prevalence of childhood constipation.

Certain foods are particularly constipating, including white bread, white rice, pasta made from refined flour, bananas, and excessive dairy products. While these foods are not harmful in moderation, children who eat large quantities while avoiding fiber-rich alternatives may experience problems.

Paradoxically, increasing fiber without also increasing fluid intake can worsen constipation. Fiber absorbs water to add bulk and softness to stool; without adequate water, high-fiber foods can actually make stool harder to pass.

Behavioral Causes

Children can learn to suppress the urge to have a bowel movement. This withholding behavior develops for various reasons and is one of the most common causes of chronic constipation in children.

• Fear of pain: After experiencing a painful bowel movement, children may try to avoid another one
• Reluctance to use unfamiliar toilets: Children often prefer to use only their home bathroom
• Busy or distracted: Children deeply engaged in play may ignore the urge to use the bathroom
• Toilet anxiety: Fear of public restrooms, unsanitary conditions, or lack of privacy at school
• Control issues: Sometimes constipation develops during power struggles around toilet training

Transitions and Life Changes

Many children develop constipation during periods of transition or change. Common triggers include:

• Starting formula: Babies who transition from breast milk to formula may experience firmer stools
• Starting solid foods: Introduction of new foods changes stool consistency
• Potty training: The stress of learning to use the toilet can trigger withholding
• Starting school or daycare: New environments and routines disrupt established patterns
• After illness: Dehydration during illness can lead to hard stools
• Family stress: Emotional factors can affect bowel function

Physical Inactivity

Children who spend excessive time sitting, whether due to screen time, extended school hours, or sedentary hobbies, are more prone to constipation. Physical activity stimulates intestinal movement (peristalsis) and promotes regular bowel function. Children who have been ill and inactive for an extended period may develop constipation as a result.

Medical Causes (Rare)

While most childhood constipation is functional, occasionally an underlying medical condition may be responsible. These include:

• Celiac disease: Gluten intolerance affecting the small intestine
• Cow's milk protein allergy: Can cause constipation in some children (lactose intolerance does not cause constipation)
• Hypothyroidism: Low thyroid hormone levels slow digestion
• Hirschsprung's disease: A rare congenital condition affecting intestinal nerves
• Anatomical abnormalities: Rare structural problems present from birth
• Medications: Certain medicines can cause constipation as a side effect

How Can You Treat Constipation in Children at Home?

Home treatment for childhood constipation includes increasing fiber-rich foods (fruits, vegetables, whole grains), ensuring adequate water intake, establishing regular toilet times after meals, encouraging physical activity, and using proper toilet positioning with a footstool. Over-the-counter stool softeners may help when dietary changes alone are insufficient.

Most cases of childhood constipation respond well to home treatment focused on diet, fluids, and establishing healthy bathroom habits. These approaches address the underlying causes of constipation and help prevent recurrence. Consistency and patience are essential, as improvement may take days to weeks.

The goal of home treatment is to make bowel movements soft, comfortable, and regular. When children no longer associate having a bowel movement with pain, withholding behavior typically resolves on its own. Creating positive associations with toilet time helps break the cycle of constipation.

Dietary Changes

Increasing dietary fiber is the cornerstone of constipation treatment. Fiber adds bulk to stool and helps it retain water, making it softer and easier to pass. Good sources of fiber for children include:

• Fruits: Prunes, pears, apricots, kiwi, raisins, and figs are particularly helpful
• Vegetables: Peas, broccoli, carrots, sweet potatoes, and leafy greens
• Whole grains: Whole wheat bread, oatmeal, bran cereals, brown rice
• Legumes: Beans, lentils, and chickpeas

Introduce fiber gradually to avoid gas and bloating. A sudden large increase in fiber can cause abdominal discomfort and may even worsen constipation if not accompanied by increased fluid intake. For babies six months or older, fruit purees made from prunes, pears, or figs can be particularly helpful.

Simultaneously, reduce foods known to be constipating, including white bread and pasta, white rice, bananas, and excessive cheese or other dairy products. These foods are not harmful in moderation but should not dominate a constipated child's diet.

Fluid Intake

Adequate hydration is essential for preventing and treating constipation. Water is the best choice for children; sugary drinks should be limited. Signs that your child is drinking enough include regular urination with pale yellow urine.

The combination of fiber and water is particularly important. Fiber without adequate fluid can actually make constipation worse, as the fiber absorbs water from the intestines and creates hard, bulky stool. When increasing fiber intake, always increase water consumption as well.

Establishing Regular Toilet Habits

Creating a consistent bathroom routine helps train the body to have regular bowel movements. The best times to encourage toilet sitting are after meals, when the gastrocolic reflex naturally stimulates bowel activity. After breakfast, lunch, and dinner are ideal times for your child to sit on the toilet for 5-10 minutes.

Make toilet time relaxed and pressure-free. Never force, punish, or shame a child for not having a bowel movement. Praise effort rather than results. Some families find that books, music, or quiet games help children relax during toilet time.

Proper Toilet Positioning

Positioning matters for effective bowel movements. When children's feet dangle above the floor while sitting on a standard toilet, they cannot achieve the optimal position for defecation. Provide a sturdy footstool that allows your child to plant their feet firmly and lean slightly forward. This squatting-like position helps straighten the rectum and makes bowel movements easier.

For younger children still in diapers, encouraging a squatting position during bowel movements can be helpful. Children who habitually stand while having a bowel movement in their diaper may have more difficulty; sitting or squatting positions are more effective.

Physical Activity

Regular physical activity stimulates intestinal movement and promotes regular bowel function. Children should get at least 60 minutes of physical activity daily. Walking, running, playing, swimming, and other active play all help keep the digestive system functioning properly.

After periods of illness or inactivity, gradually increasing movement can help resolve constipation that developed during the sedentary period.

Over-the-Counter Remedies

When dietary and lifestyle changes are not sufficient, over-the-counter stool softeners can help. Osmotic laxatives such as polyethylene glycol (PEG, sold as MiraLAX or Movicol) and lactulose work by drawing water into the stool, making it softer and easier to pass.

These medications are generally safe for children when used as directed, but dosing depends on the child's age and weight. Consult with a pharmacist or healthcare provider to determine the appropriate product and dose for your child. Do not use stimulant laxatives or enemas without medical supervision.

Using Soothing Ointments

If your child has developed anal fissures (small tears) from passing hard stool, a soothing ointment applied to the anal area before bowel movements can help reduce pain. Ask a pharmacist to recommend an appropriate product. Reducing pain during bowel movements helps break the cycle of withholding.

What Medical Treatments Are Available for Childhood Constipation?

Medical treatment for childhood constipation typically includes prescription-strength osmotic laxatives like polyethylene glycol (PEG) for maintenance therapy, and sometimes disimpaction treatment to clear severe blockages. Treatment often continues for months to years, and stopping too early commonly leads to relapse.

When home remedies are insufficient, healthcare providers can prescribe more aggressive treatment. The goals of medical treatment are to clear any accumulated stool (disimpaction), establish regular soft bowel movements (maintenance therapy), and gradually restore normal bowel function. This process takes time and requires commitment from both the child and the family.

Initial Disimpaction

If a child has a significant amount of hard stool accumulated in the rectum (fecal impaction), this blockage must be cleared before maintenance treatment can be effective. Disimpaction typically involves higher doses of osmotic laxatives taken over several days to completely empty the bowels. In severe cases, a healthcare provider may need to administer an enema.

Disimpaction can be uncomfortable but is necessary to provide a "clean slate" for ongoing treatment. After disimpaction, the focus shifts to maintaining regular, soft bowel movements to prevent stool from accumulating again.

Maintenance Therapy

The mainstay of maintenance treatment is usually polyethylene glycol (PEG), a osmotic laxative that draws water into the stool. PEG is tasteless and can be mixed into beverages. The dose is adjusted to achieve one or two soft bowel movements daily.

Maintenance treatment typically continues for several months to over a year. Many parents are surprised by how long treatment lasts, but stopping too soon is the most common reason for relapse. The rectum has been stretched by accumulated stool and needs time to return to normal size and function.

The healthcare provider will guide gradual dose reduction once the child has been symptom-free for at least a month. If symptoms return during dose reduction, the medication should be increased again and continued for a longer period.

Behavioral Support

For some children, particularly those with significant anxiety about bowel movements or persistent withholding behavior, counseling or behavioral therapy may be helpful. Parents may also benefit from support and education about managing their child's condition without adding stress.

What Happens in the Body During Constipation?

During constipation, stool remains in the colon too long, allowing excess water to be absorbed, which makes the stool hard and dry. A full rectum stretches over time, dulling the sensation of needing to have a bowel movement. This creates a cycle where more stool accumulates and becomes increasingly difficult to pass.

Understanding the physiology of constipation helps explain why treatment takes time and why certain strategies are effective. The digestive system is designed to move waste efficiently through the intestines, but several factors can disrupt this process.

Normal Digestion

After food is digested and nutrients are absorbed in the small intestine, the remaining material moves into the large intestine (colon). The colon's primary function is to absorb water from this material, transforming liquid waste into formed stool. Under normal conditions, stool moves through the colon in about 12-36 hours.

When stool reaches the rectum, it triggers nerves that signal the brain that it's time to have a bowel movement. If conditions are appropriate, the person relaxes the sphincter muscles and evacuates the stool.

What Goes Wrong in Constipation

In constipation, stool moves too slowly through the colon or accumulates in the rectum. The longer stool remains in the colon, the more water is absorbed, making it increasingly hard and difficult to pass. When children suppress the urge to defecate, stool accumulates in the rectum, stretching it.

Over time, a chronically stretched rectum becomes less sensitive. The child no longer feels the normal signals indicating a need to have a bowel movement. More and more stool can accumulate without the child being aware of it. This is why fecal soiling occurs: the rectum is so full and stretched that liquid stool leaks around the hard mass without the child's awareness or control.

Breaking the Cycle

Treatment aims to empty the accumulated stool, keep new stool soft so it passes easily, and give the rectum time to return to normal size and sensitivity. This is why treatment must continue long after symptoms resolve: the rectum needs months to fully recover its normal function.

Normal Stool Patterns by Age

Normal bowel movement frequency varies by age and diet:

• Breastfed infants: May have several bowel movements daily, or may go several days between movements. Both patterns are normal as long as the stool is soft and the baby is comfortable
• Formula-fed infants: Typically 1-3 bowel movements per day; more prone to constipation than breastfed babies
• Toddlers and older children: Usually 1-2 bowel movements per day after starting solid foods

How Can You Prevent Constipation in Children?

Prevent constipation by ensuring a fiber-rich diet with plenty of fruits and vegetables, adequate water intake, regular physical activity, established toilet routines after meals, and addressing any toileting anxieties early. Respond promptly to signs of constipation before it becomes chronic.

Prevention is always preferable to treatment, and the same strategies used to treat constipation are effective for prevention. Building healthy habits early helps children avoid the cycle of painful stools and withholding that leads to chronic constipation.

Dietary Prevention

Establishing healthy eating patterns from an early age sets the foundation for good digestive health. Offer a variety of fruits and vegetables daily, choose whole grain breads and cereals, and limit processed foods high in refined carbohydrates. Make water the primary beverage and limit sugary drinks.

When introducing solid foods to infants, do so gradually. A rapid increase in solid foods, particularly low-fiber options, can trigger constipation. If constipation develops when starting solids, reduce the quantity slightly and increase it more gradually.

Hydration Habits

Encourage children to drink water throughout the day, not just when they're thirsty. Keep water accessible at all times. While the exact amount needed varies by age, climate, and activity level, children who urinate regularly with pale yellow urine are generally well-hydrated.

Active Lifestyle

Promote regular physical activity as a normal part of daily life. Children who move their bodies regularly are less likely to develop constipation. Limit sedentary screen time and encourage active play.

Healthy Toilet Habits

Teach children to respond to their body's signals and use the toilet when they feel the urge. Encourage toilet sitting after meals, but keep it relaxed and positive. Never punish or shame children for bathroom accidents or difficulties.

Ensure children have access to comfortable, private toilet facilities. If your child is reluctant to use school bathrooms, work with the school to address any concerns and ensure your child has opportunities to use the toilet during the school day.

Managing Transitions

Be proactive during periods known to trigger constipation. During potty training, maintain a relaxed approach and be patient with setbacks. When starting school or daycare, discuss toilet access with staff and maintain home routines as much as possible.

Early Intervention

Address signs of constipation immediately rather than waiting to see if they resolve. The longer constipation persists, the more difficult it becomes to treat. If you notice your child having hard stools, straining, or avoiding the toilet, increase fiber and fluids right away and establish a regular toilet routine.