KidsMD Health Topics

Constipation in Children

  • What is constipation?

    Constipation is a common concern among children and is commonly seen in toddlers as they potty train. School-aged children also commonly experience constipation. In fact, almost 3% of all pediatrician visits are in some way related to constipation. (At least 25% of visits to pediatric gastroenterology specialists are due to problems with constipation.)

    Constipation is when a child has either a decrease in the frequency of bowel movements or when moving the bowels is painful. Children ages 1 to 4 years typically have a bowel movement once or twice a day, and more than 90% will go at least every other day.

    Constipation is typically described as being either organic or functional. Organic constipation is caused by a diagnosed medical condition, like colon disease or a neurological problem. Functional constipation means there is no identifiable cause. Functional constipation is the most common form of the condition. While it still is a concern, there typically are no more serious medical conditions associated with it. 

    What causes constipation?

    Some infants experience difficulty moving their bowels, because their nervous systems are still developing.  Also worth noting, some healthy, breast-fed infants will go several days without having a movement.  

    In older children, constipation often begins with the introduction of changes in their diet, disruptions to their day-to-day routines, during toilet training or after becoming sick. Public bathrooms—especially unclean or less private ones—also can make a child reluctant to use the toilet, which can lead to a pattern of withholding or ignoring the need to move their bowels.

    If a child is constipated for several days, the retained stool can fill up the large intestine (the colon), causing it to stretch. An over-stretched colon will not function properly, and more stool is retained. Once this occurs, defecation becomes very painful. As a result, the child avoids the pain by withholding thus creating a cycle that can make constipation worse.

    How does Boston Children's Hospital treat constipation?

    To best understand the cause of your child's constipation, a clinician from the Division of Gastroenterology, Hepatology and Nutrition, will

    assess how serious your child's constipation is by asking if your child:

    • has hard or small stools that are difficult or painful to pass

    • consistently skips days without having normal bowel movements

    • has large, uncharacteristically large stools

    • has stomach pain, poor appetite, crankiness and/or bleeding from the anus

    In most cases, there is no need for testing prior to treatment for constipation. However, depending on the severity of the problem, your doctor may order x-rays or other tests to properly diagnosis the source of the constipation.

    Once the root and/or severity of your child's constipation have been determined, a treatment plan will be designed based on your child's age and personality. For some, constipation can be corrected by changes in diet, like increasing their intake of water, fiber or fresh fruit. Other children may need medications like laxatives or stool softeners to help them go. 

    In rare cases, children may need to have an excessive build-up of stool "flushed" from their colon. This usually is done with laxatives, suppositories or enemas if needed.  

    For more information on constipation or to speak with a member of Boston Children's Division of Gastroenterology, Hepatology and Nutrition, please call 617-355-6058.

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The future of pediatrics will be forged by thinking differently, breaking paradigms and joining together in a shared vision of tackling the toughest challenges before us.”
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