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.

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.

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.

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.

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.

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
• Make it fun, so read a book if necessary.
• Make it a habit.

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.

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.

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.

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.

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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