Childhood Constipation 101: Commonly Asked Questions - Part One

March 11, 2015


Childhood constipation is one of the most common, yet sometimes challenging conditions that parents can encounter. The majority of children will develop constipation at one time or another.  It may be triggered by relatively minor changes to the child’s daily routine such as: traveling, changes in eating, drinking or activity. Most of the time, constipation is a temporary condition that does not result in long-term health problems, but sometimes when it is not readily recognized or addressed, it can lead to chronic difficulties.

Due to the nature of the problem unfortunately, constipation isn’t always a topic that is freely discussed! Obtaining clear answers to your questions is probably the first and most important step to take when your child has been diagnosed with constipation, which is why I’m sharing answers to some of the questions that I hear most often in my clinic as a pediatric gastroenterologist:

What is constipation?

Constipation is defined as:

  • Less than three bowel movements per week or more than three days between bowel movements.
  • Stools that are large, hard and painful to pass.
  • Having incomplete bowel movements which leads to accumulation of stool in the bowel despite daily passage of stool.

What is a normal stooling pattern?

The stool pattern varies with the age and diet of the child. Infants who are breast-fed may range from several loose stools a day to going up to 10 days without a stool. Formula-fed infants often have pasty stools one to three times a day. Infants may cry, fuss, strain or turn red for several minutes when passing either stool or gas.As long as the stool is softand the infant is otherwise growing well and physical examination is normal, this is most likely a behavioral pattern that will improve as the infant “learns” how to pass stools.

Toddlers and children normally pass stools at least once every day to every three days. The form and color of their stools may vary from day to day. Changes in the color of the stool (unless it is red, black or white) usually do not mean there is a problem.

What causes constipation in children?

Sometimes there is no identifiable reason for constipation in children. However, some of the most common contributing factors include:


  • Eating foods that are high in fat and/or low in fiber.
  • Not drinking enough water and liquids.
  • Lack of exercise.

Emotional/Behavioral Issues:

  • Toilet training can sometimes be overwhelming for a toddler, especially when they may not be “ready” developmentally.
  • Pre-school and school-aged children sometimes avoid using public bathrooms when they are away from home and hold in their bowel movements, leading to constipation.
  • Once constipation occurs, a vicious cycle can develop. Hard, dry stools can be painful to push out and the child may avoid using the bathroom even more to avoid the discomfort.
  • Some children have trouble learning to relax their bottom as they try to push stool out. These children may push and hold at the same time, making it difficult to pass stool.
  • Stress at school, friends or family may also contribute to constipation

Distracted/Busy Children:

  • When children are too busy playing or distracted, they may ignore the usual signals to have a bowel movement and forget to go to the bathroom.

Physical/Medical Problems:

  • In general, the vast majority of children who have constipation do not have a serious, underlying medical condition. In rare cases constipation may be caused by:
    • Structural abnormalities of the digestive tract.
    • Neurologic problems such as spina bifida.
    • Endocrine problems, such as low thyroid levels.
    • Other medications, such as iron or narcotic pain medications such as codeine.

What are symptoms of constipation?

Each child may experience symptoms differently, but common symptoms include:

  • Stomachaches, cramps, or pain.
  • Feeling “full” or bloated.
  • Decreased appetite.
  • Small amounts of blood on the toilet paper with wiping or on the outside of the stool.
  • Small liquid or soft stool smears soiling the underwear.

Why does my child have soiling or stooling accidents?

When children have chronic constipation, the rectum -- which is the final portion of the bowel and functions as the “holding area” for stool before it is passed out of the body – can become stretched out because it is chronically filled with stool.  Over time, the stretched muscles of the rectum cannot push all of the stool out which leads to further stool accumulation or formation of a stool plug.  When this occurs, liquid stool may seep down around this stool plug and leak out onto the underwear without the child’s awareness.

When should I contact a physician?

Do not hesitate to contact your child's physician if you have any questions or concerns about your child's bowel habits or patterns. Sometimes the symptoms of constipation may resemble other medical conditions or problems. The National Institutes of Health recommends that you talk to your child's physician if:

  • Episodes of constipation last longer than 3 weeks.
  • Normal pushing is not enough to expel a stool.
  • Liquid or soft stool leaks accidentally.
  • Small, painful tears appear in the skin around the opening to the bottom.
  • Hemorrhoids develop.

I hope these answers are helpful to you – check out part two which covers more commonly asked questions. To learn more about Texas Children’s Gastroenterology Department, visit here.


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