Toddler Constipation

Toddler constipation is a common cause for concern for parents. It is one of the commonest causes of tummy pain in children.

Once toddlers are toilet trained, they often toilet themselves, so parents may not be so aware of what is happening with the poop (poo, stool). So problems with constipation can suddenly seem quite severe, but usually the problem has been building up (!) for a while.

This page gives an overview of how to deal with this problem and when to worry.

To read more about laxatives and natural constipation remedies, click here (opens in new page).

To read more about adjusting the dose of laxative and to download a constipation diary, click here (opens in new page).

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What is toddler constipation?

Constipation refers to the passage of hard stools (poop, poo). If your child hasn't passed a bowel motion (stool, poop, poo) for 4 days or more, we also call this constipation.

In babies, constipation is when there are hard stools (poop,poo) and it is not a problem that they go infrequently (often up to a week). In toddlers this is a problem. Read more below.

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Why do toddlers get constipation?

Toddler constipation is common. There are many reasons a toddler might have a hard stool (poop, poo) and passing a hard stool is often painful.

A toddler decides she doesn't want that pain and so tries to hold on to her stool. This aggravates the problem as any delay in passing the stool only makes it harder. Usually toddler constipation occurs when this cycle of hard stool - pain - withhold stool - hard stool - pain etc occurs.

Once toddlers are more independent with toilet training, it is hard for a parent to always know what is happening with the poop (poo) as you don't see it. Your child may be sitting on the toilet and even passing a small poop (poo) and then they will say that they have been. However, they may be only passing a very small amount and actually they are building up more and more poop (poo) in the bowel. If you think your child has symptoms of constipation, like tummy pain, tell them to let you look before they flush the toilet.

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Why did my toddler get a hard stool (poop, poo)?

There are many possible reasons for toddler constipation:

  • Not drinking enough fluids
  • Delay in passing the stool, which means the body reabsorbs fluid from the stool making it drier and so harder
  • Not much activity, like when your child has a cold and is less active than normal
  • Not eating much, like when your child has a cold
  • A diet high in diary products and low in fiber and bulk

Often, it is a combination of factors.

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What should normal toddler poop/poo/stool look like?

Ideally your child should have one soft but formed bowel motion per day.

The Bristol Stool Chart shows how this should look (see Type 3 and Type 4) - to view, click here.

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What can I do to treat my toddler's constipation?

Try simple measures first:

  • Increase the water he/she drinks daily - ensure your child has a good drink at each meal time and has extra drinks when it is hot. Give ice blocks if your child won't drink.
  • Decrease the amount of complex carbohydrates (especially junk food) and increase fruit and vegetables in the diet.
  • Try giving undiluted apple juice or KiwiCrush (a kiwi fruit drink) daily - do not give undiluted juice to infants under 6 months of age
  • Encourage a regular toileting habit.
  • Encourage exercise.

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How much fiber does my child need in the diet?

There is evidence that increasing fiber in the diet helps constipation and children should have some fiber as part of a healthy diet.

Children should not be given fiber supplements such as bran but should get fiber naturally in the diet from:

  • Fruits
  • Vegetables
  • Legumes (including beans)
  • Cereals
  • Breads (especially whole-grain bread) - only give white bread to children less than 15 months
  • Potatoes

Children require (age in years + 5) g of fiber per day up to a maximum of (age in years + 10) g per day.

So a 3 year old needs 8 g and should have no more than 13g of fiber per day.

There is about 2g of fiber in:

  • A serving of bread or cereal
  • A small fruit
  • ½ cup of vegetables
  • 1 medium potato

Ensuring your child has enough fiber in the diet will help toddler constipation.

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What is the toileting habit I should encourage for my child?

Get your child to develop a regular toilet habit by sitting on the toilet for at least 15 minutes per day. It is best to sit on the toilet about 30 minutes after a meal.

To start with, you could get encourage your child to sit on the toilet 30 minutes after a meal three times a day for about 15 minutes each time - even if she doesn't pass a stool, still get her into this habit.

  • Make sure she is comfortable on the toilet - get a stool for her to rest her feet.
  • Ensure her knees are above her hips
  • Encourage her to lean forward and rest her elbows on her knees
  • Teach her to push her abdomen out when pushing - blowing up a balloon is a fun way to get your child to do this
  • Make it fun, so read a book if necessary.
  • Make it a habit.

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What are laxatives?

Laxatives help the body to get rid of stool (poop, poo). There are two main ways in which laxatives for toddler constipation work:

  • some soften the hard stool (softeners)
  • some help the bowel push the stool out (stimulants or emptiers)

You will need to see your doctor for laxatives. To read more about laxatives, click here.

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How long are laxatives for toddler constipation necessary?

For as long as it takes. Children sometimes need laxatives for months rather than weeks. Remember that the purpose of laxatives is to allow the bowel to develop a normal habit.

Ideally, we are aiming for 1 soft but formed bowel motion per day.

So laxatives are required until the body can manage one soft but formed bowel motion per day without help. You will need to adjust the dose over time.

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Could toddler constipation be due to an abnormal bowel?

It is hardly ever due to an abnormal bowel. Most bowel problems show up in early life and are diagnosed within the first few months. If your baby passed meconium (the green/black stool newborn babies pass) within 24 hours of birth, it is unlikely your child has a bowel problem causing constipation. The most likely cause is an abnormal habit caused by with-holding stool, usually because of pain.

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What causes soiling accidents?

Sometimes, when the bowel is full of poop (poo), the more liquid stool coming down from the small intestine leaks around the outside of the hard stool (poop, poo) and this just leaks out causing soiling accidents. Your child is usually unaware that she is about to soil. This can also cause smearing on the underpants (knickers).

Sometimes, it almost seems as if your child has diarrhea.

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What is the treatment of soiling?

Firstly, the stool that is blocking the bowel must be removed. This is usually done by powerful laxatives given orally as a one-off dose or by suppository or enema. I prefer using oral laxatives to clear the bowel.

Once the bowel is unblocked, the soiling should stop but you child will need laxatives for a while (months rather than weeks) until her body unlearns the constipation bowel habit and relearns the normal habit.

Remember, the aim is for one soft but formed bowel motion (stool, poop, poo) per day. Until the body can manage that alone, it will need help (from laxatives).

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References

  • Williams C. Dietary Fiber in Childhood. J Pediatr. 2006; 149:S121-130
  • Rubin G. Constipation in Children. Clinical Evidence. 2007. BMJ Publishing Group

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To go to the top of the Toddler Constipation page, click here

To go to the Baby Constipation page, click here

To read more about Treatments for Constipation, click here

To read about adjusting the dose of laxatives, click here

To view what normal poop / poo / stool looks like, click here.

To go to the main Constipation page, click here

To return to the Home page, click here


Last reviewed 13 May 2011

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Dr Maud MD

Dr Maud MD (MBChB, FRACP, FRCPCH), a specialist pediatrician, provides health information and medical advice for parents of babies and toddlers. Read more about Dr Maud.



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