How to Deal With Chronic Constipation in Children

It takes time and patience to get things moving
child on toilet in bathroom

Unfortunately, your child’s toilet troubles might not be behind you just yet. As many as 1 in 10 kids experiences constipation. Chronic constipation can strike children of any age, but it’s most common in younger kids who have recently been potty trained. For some, it can become a chronic problem — a situation that’s often as frustrating for you as it is for your child.

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Although it takes patience, chronic constipation is treatable, says pediatric gastroenterologist Mohammad Nasser Kabbany, MD. He shares his tips to get things moving in the right direction.

Constipation symptoms in kids

Everybody’s bowels are different, which can make it hard to know if your child is constipated. Some kids need to go multiple times a day; others, every few days. In general, though, it’s a problem if your kiddo is going only a couple of times a week or less. Dry, hard stools especially if they are large in diameter or very small are also a sign of trouble.

Unsure if your child is going often enough? Keep an eye out for these common constipation clues:

  • Pain with pooping.
  • Straining and/or spending a long time on the toilet.
  • Big, toilet-clogging stools.
  • Putting off using the bathroom (you might notice crossed legs, grimacing or dancing).
  • Poor appetite.
  • Stomachache or bloating.

What causes constipation?

Sometimes, constipation is related to an underlying medical problem. Dr. Kabbany recommends talking to your pediatrician if you notice other symptoms, such as bloody stool (especially if it’s excessive), a distended (swollen) belly, vomiting, weight loss or severe abdominal pain.

More often, though, kids have what Dr. Kabbany describes as “functional constipation” — a backup caused by a combination of lifestyle factors and behavior.

“Constipation is often a vicious cycle,” he explains. A child might put off using the bathroom for any number of reasons: She’s busy playing, doesn’t want to poop at school, heard an urban legend about snakes in toilets.

But waiting only makes the stool get harder and more difficult to pass. The harder and more uncomfortable it gets, the more she’ll hold it. Before you know it, it’s a chronic problem. 

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Constipation treatment for kids

The goal of treating functional constipation in kids is to produce soft and painless stools regularly. This takes a three-pronged approach, says Dr. Kabbany:

  • Addressing behaviors that feed into the vicious cycle.
  • Taking medications.
  • Making dietary changes.

Behavioral intervention

Breaking the cycle is often very  important element of treating constipation in children, Dr. Kabbany says. He recommends having your child sit on the toilet for 5 to 10 minutes after meals.

“This takes advantage of the natural reflex triggered by eating,” he explains. “They don’t have to strain. They can sit there and play on a tablet or read. But eventually, that reflex will kick in, and they’ll go.” Positioning on the toilet is important. We recommend that the child uses a footstep to support the legs which will also help him/her defecate more effectively.

Encourage your kids to listen to their bodies. If they have cramps or feel rumblings in their belly, make sure they get to a toilet, STAT. And if you notice your kiddo dancing or grimacing, it’s potty time — no excuses.

Don’t be afraid to reward effort, Dr. Kabbany adds. “Sometimes, a reward system like a sticker chart can motivate children. But whether they poop or not, just sitting on the toilet should be praised,” he says.

Medication

For many kids, medication is part of the plan Especially at the beginning. Oral laxatives or enemas might be needed to get unplugged. Once things are moving again, children often continue to take medications such as polyethylene glycol, which pulls water into the intestines to soften stool. Consult with your pediatrician on what medication to use and the recommended dose.

Diet changes

Dr. Kabbany says that healthy balanced diet with adequate fluid and fiber is recommended. Drinking more water can be helpful as well as sorbitol containing juices like prune and apple juice.

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Other helpful changes include cutting back on excessive dairy and increasing fiber. Boost fiber levels gradually, since too much fiber can cause bloating and discomfort  Dr. Kabbany says.

Preventing a constipation comeback

Unfortunately, there’s no quick fix for kids’ constipation. Typically, children take medications for a couple of months before gradually weaning off of them. Even after that point, continue to push good habits, including regularly scheduled time on the toilet after meals.

And though it’s probably the last thing you want to do, keep tabs on what’s happening behind the bathroom door. Ask your child to report on how hard or soft his poops are — or go in and take a quick peek yourself. If you notice hard stools or other symptoms, you might need to talk to your doctor about revisiting medication.

Don’t wait to see if your child’s constipation gets better on its own. The longer it lasts, the harder it is to get things back on track, Dr. Kabbany says. “Studies show more treatment success if you intervene in the first three months.”

It can take time and patience, but it helps to remember that it’s not your kid’s fault. “Typically, children learn to withhold over a long time, and it takes time to retrain their bodies,” Dr. Kabbany says. “Try not to get frustrated if they relapse.”

Eventually, regularity will return — and your kid’s poop jokes might even start to be funny again.

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