The loud flush. The cold seat. For newly potty-trained kids, the toilet can be scary. They may feel embarrassed to use the bathroom at school or day care. Sometimes, a painful poop can make children afraid of another one so they just hold it, making the problem worse. Stress, a change of routine or being away from home can also lead to constipation, especially for older children.
“There are a few medical reasons for constipation, but most often it occurs because children are holding or delaying having a bowel movement, even if they have to go,” said Bob Michael, MD, a pediatrician at Samaritan Lebanon Health Center. “Over a few days that urge to have a bowel movement lessens and then when they do finally poop, it hurts. That just reinforces not wanting to have a bowel movement and it can become a cycle of constipation.”
Children may experience the following symptoms when they are constipated:
- Painful bowel movements or straining while pooping.
- Very large or very small stools.
- Visible discomfort while trying to delay going to the bathroom.
- Stomach aches.
- Abdominal bloating.
- Decreased appetite.
How Often Is Normal?
Dr. Michael reported that children will develop their own schedule for having a bowel movement. Some may poop several times a day, and some every two or three days.
“As long as they are having a bowel movement at least once every three days and they aren’t complaining about pain while passing a stool or pain in their stomach, that is perfectly healthy,” said Dr. Michael.
For toddlers who you may be helping go to the bathroom or wipe their bottom afterward, it can be easier to keep track of their frequency. Check in every so often with school-age children who want to take care of bathroom business themselves. You can ask if they’ve had a bowel movement in the last few days, if it was hard or soft and if there was any pain. Making it a normal part of your discussion topics will make it less embarrassing over time and more likely they’ll talk to you if there is a problem, said Dr. Michael.
How to Help
You can help by ensuring your child has everything they need for a pain-free poop and developing healthy toileting habits.
1. Increase Fiber
It’s easy to see the fiber in an orange – the clear membranes separating each section are made up of fiber. It’s not always as easy to see in other foods, but dietary fiber is found in whole grains, legumes, nuts, fruits and vegetables.
Fiber isn’t digested or used as fuel for your body. Instead, it passes through the digestive tract relatively intact and that bulk holds moisture and helps to keep stools soft and easy to pass (in addition to a host of other health benefits). If you don’t get enough fiber in your diet, stools become dense, dry and painful.
The American Academy of Pediatrics recommends children get an amount of fiber that is equal to their age plus five, so your 3-year-old would need 8 grams of fiber a day. Teens who are fully grown can follow the adult recommendation of 25 grams of fiber a day.
“Younger children who are learning to like new foods often choose for themselves a steady diet of cheese and pasta, which can contribute to problems with constipation,” said Dr. Michael. “Make an effort to offer two or three fiber-rich foods for them at meals and snacks. Fresh or dried fruit is usually the easiest for kids to enjoy, but you can also adjust family meals to have more fiber overall.”
Dr. Michael notes that it can be helpful to limit bananas and rice, and dairy to less than 24 ounces a day while you’re working on improving constipation, as these foods can make the condition worse.
Natural Sources of Fiber
|Fruits & Vegetables – ½ cup||Grams Fiber|
|Pear (with skin)||2.5|
|Apple (with skin)||1|
|Legumes & Grains – ½ cup||Grams Fiber|
|Whole Wheat Pasta||4|
|Whole Wheat Bread (one slice)||3|
|Nuts – 1 oz.||Grams Fiber|
|Peanut Butter – 2 Tbsp.||2|
2. Increase Water Intake
Getting enough water is essential to preventing constipation. While milk or plant milk is a good choice for growing kids at mealtime, water is the best option between meals. Dr. Michael recommended having a water bottle always available. Let kids pick flavorful add-ins like fresh berries, cucumber or lemon slices to their water to increase the fun factor.
3. Make Time for Using the Restroom
As excrement sits in the colon, the moisture is absorbed and the stool becomes drier and harder to pass. It can be hard for kids to stop playing long enough to go to the bathroom, so build at least two bathroom breaks into the day as part of your routine.
“After a meal or snack the bowels are naturally stimulated, so that’s a good time to head to the toilet,” said Dr. Michael. “When there’s no rush and there’s nothing interesting that was interrupted, kids are more motivated to take an extra minute or two to have a bowel movement rather than just going potty and running back to playing.”
4. Customize Your Toilet
Toilets are made to fit adults, not kids. Using a step stool to raise your child’s legs so their feet are supported and close to their bottom in a squatting position can make having a bowel movement easier. For little ones, a child-sized seat that fits under the rim of the regular seat can help them relax and sit more confidently without having to worry about slipping in.
5. Encourage Activity
Getting at least 60 minutes of active play a day is important for kids’ health, and can also ensure regular bowel movements. Younger kids will likely do better with several 10- or 15-minute “recess” breaks throughout the day to run and jump, while older kids may enjoy practicing their favorite sport or taking a walk or bike ride.
6. Talk to Provider About Medication Options
If your child has chronic constipation or a painful stool that they cannot pass, talk to their doctor about a stool softener or suppository. These medicines are helpful but can be dangerous if used incorrectly, especially for children younger than 6.
“An oral medication like Miralax can be used daily if there is a cycle of constipation that you’re trying to break. Once good habits are in place you can wean off of it,” said Dr. Michael. “If your child is straining to poop and it’s clear that it’s very painful, a suppository can help.”
A suppository is inserted into the rectum. It works by bringing water from the surrounding tissue into the bowel to soften the stool and allow it to pass. Call your child’s doctor before administering a suppository.
“Treating chronic constipation can take a few months as children practice new skills and learn they don’t have to dread using the bathroom,” said Dr. Michael. “It’s a very common problem, so don’t feel discouraged if it seems your child isn’t improving quickly. Reach out to their doctor for tools and support.”
Find a provider who fits your growing child’s needs.
Learn more about constipation.