What to do if your child is constipated

Constipation is a very common problem in children. Whether it's something temporary after an illness or diet change, or something more chronic, up to 20% of children suffer from it at one time or another. As much as it makes people uncomfortable to talk about poop, having trouble pooping is even more uncomfortable. Luckily, it is generally a very treatable problem.

Symptoms of constipation

Constipation plays out differently in different people. It can be any, or any combination, of

• stooling less than three times a week
• having stools that are hard and difficult to pass
• having stools that are very large (large enough to block the toilet)
• holding in stool, leading to large lumps of stool in the rectum
• having leakage of stool.

The last one, leakage of stool, can confuse people — how can it be constipation if there is leakage of soft stool into the underwear? What happens is that those large lumps of stool stretch out the rectum. This leads to two further problems: looser stool leaks around those lumps, and the stretching makes the nerves of the rectum work less well, and can't always sense that the stool is going to come out.

Here's what you can do if your child is constipated

• Get more fiber into their diet. Fruits, vegetables (it's recommended that children get five servings of fruits and vegetables a day for their overall health, and it helps prevent constipation too), and whole grains can make a big difference. Cereals with bran can help, as can prunes or prune juice. There are fiber cookies and fiber powders you can buy, but doing it with regular foods is better whenever possible.
• Give them more water to drink. If they don't drink much fluid, the stool will be harder before it even gets to the colon — and the job of the colon is to take water out of stool. Water is better than juice, soda, or other drinks. It's better than milk, too, because with constipation you need to…
• Watch their milk intake. Drinking a lot of milk can lead to constipation in some children. It can also lead to anemia, and can make children less hungry for other foods like fruits and vegetables, so keeping an eye on intake is a good idea for lots of reasons. Kids from 1 to 8 should have about 2 cups of milk a day, and older kids about 3 cups, (those growing bones). There are also other ways to get the nutrients that milk offers. You can talk to your doctor for ideas.
• Make sure they sit on the toilet regularly. As I said above, the job of the colon is to take water out of stool, so the longer the stool stays in the colon, the harder — and harder to get out — it gets. It's understandable for children who've had painful stool to want to avoid going to the bathroom, but avoiding is the worst thing they can do. Have them sit for a while after every meal, which is the time when the body is most likely to need to pass a stool. You can make it easier using comic books, magazines, or hand-held games. Set a timer for at least five minutes, better 10.
• If this doesn't work, try medications. There are many different kinds of medications that help with constipation. Some, like polyethylene glycol, work by pulling more water into the stool and making it softer. Others, like senna, work by helping to push the stool through. Sometimes using a glycerin suppository can help stimulate the passage of stool — and sometimes, when a child is really backed up, using an enema can be really helpful. You should always check in with your health care provider for advice before using a medication for constipation.

Speaking of checking in with your health care provider, you should call if your child has

• severe pain with stooling
• blood in the stool
• weight loss, or a noticeable drop in appetite
• vomiting along with the constipation
• a high fever along with the constipation
• constipation that isn't getting better despite dietary changes and other treatments.

Most of the time, though, it does get better. To learn more about constipation, visit healthychildren.org, the parent information website of the American Academy of Pediatrics.

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