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Constipation

Advice for professionals to be used with parents and carers

Constipation is common in childhood, particularly when children are being potty trained at around two to three years old. This advice is aimed at children after weaning (older than 6 months old).

What are the symptoms of constipation in children?

These can be tricky to spot. Your child may be constipated if:

  • They don't poo at least three times a week
  • Their poo is often large, hard and difficult to push out
  • Their poo looks like "rabbit droppings" or little pellets

If your child is potty trained, soiled pants can be another sign of constipation, because runny poo (diarrhoea) may leak out around the hard, constipated poo. This is called overflow soiling.

If your child is constipated, they may find it painful to poo. This can create a cycle: the more it hurts, the more they hold on to poo. The more constipated they get, the more it hurts, and so on. Even if pooing isn't painful, once your child is really constipated, they may try to avoid going to the toilet altogether.

Why do children get constipated?

Your child may be constipated because they:

  • Hold onto stool due to fear of using toilets (smelly / lack of privacy etc)
  • Aren't drinking enough
  • Aren't eating enough high-fibre foods like fruit and veg
  • Are having problems with potty (or toilet) training
  • are worried or anxious about something, such as moving house, starting nursery or the arrival of a new baby.

Find out about other causes of constipation in children.

What should you do and when should you worry?

In general, children only need treatment for constipation if it is causing them pain or problems (such as soiling in school).

If your child is experiencing significant pain or regularly soiling their pants, despite being on treatment, you should take them back to see your GP. Some children need more intensive treatment of their constipation. Your GP may decide that a paediatrician needs to be involved in their care

Not all tummy pain is due to constipation - if your baby/child develops new severe tummy ache, please click here for advice about what to do 

You need urgent help

Go to the nearest Hospital Emergency (A&E) Department or phone 999

What if your child’s constipation continues despite changing their diet?

If your child remains constipated despite the options listed above, take them to their GP who can decide if they need medicines. The treatment for constipation depends on your child’s age. The longer your child is constipated, the longer it can take to get back to normal, so do get help early from your GP

Laxatives often help children, alongside diet and lifestyle changes. 

Spacing out the doses through the day, and mixing squash or juice or keeping the dose cold in the fridge may help taste

It may take several months for the treatments to work, but keep trying until they do. Remember that laxative treatment may make your child's overflow soiling worse for a time

You need to contact your GP Surgery today

Please ring your GP surgery or contact NHS 111 - dial 111 or for children aged 5 years and above visit 111.nhs.uk

Firstly, try to stay calm

Getting constipated and soiling their clothes isn't something your child is doing on purpose, so please be patient. You may both find the situation stressful, but staying positive and relaxed is the best attitude to help your child, and praising positive steps is important. Please be aware that any medication or treatment will take time to take effect. You may need prolonged treatment which can be weeks or months depending on severity

Think about changes to your child’s diet
Make sure that children drink plenty of fluids and encourage them to eat fruit. Chop or purée it if it's easier for them to eat. The best fruits for constipation include apples, grapes, pears and strawberries

If your child is potty training, they may be feeling anxious or stressed about using the toilet. This can cause them to hold in poo and leads to constipation. Give your child plenty of time (anything up to 30minutes) to use the toilet while they are still learning. Encourage them when they do use the toilet. Some parents find a reward chart works. Your health visitor can also provide advice and support

Pharmacy/ Self care

Pharmacists can advise and treat a range of common symptoms. No appointment is needed and most pharmacies have a private consulting area. Click on this link to find a Pharmacy near to you

If you are still concerned about your child, contact NHS 111 – dial 111 or for children aged 5 years and above visit 111.nhs.uk

This guidance has been reviewed and adapted by healthcare professionals across the Black Country Integrated Care System.

How to prevent your child getting constipated:

  • Make sure your child has plenty to drink – offer breastfed babies who aren’t eating solids yet plenty of breastfeeds. Formula-fed babies can have a small amount of cool boiled water in between their formula feeds but usually no more than 1-2 fl oz per day. See more advice on drinks for babies and toddlers.
  • Give your child a variety of foods, including plenty of fruit and vegetables, which are a good source of fibre. See what to feed young children.
  • Encourage your child to be physically active. For more information, read the physical activity guidelines for children aged under five years.
  • Get your child into a routine of regularly sitting on the potty or toilet, after meals or before bed, and praise them whether or not they poo. This is particularly important for potty-trained boys, who may forget about pooing once they are weeing standing up. Reward schemes appropriate for age are important; as is consistency and patience.
  • Make sure your child can rest their feet flat on the floor or a step when they're using the potty or toilet, to get them in a good position for pooing. Take a look at the Children's Bowel & Bladder Charity's leaflet, Children’s Bowel Problems for a picture of this.
  • Ask if they feel worried about using the potty or toilet – some children don't want to poo in certain situations, such as at nursery or school.
  • Stay positive and reassuring, so that your child doesn't see going to the toilet as a stressful situation – you want your child to see pooing as a normal part of life, not something to be ashamed of.

For more information and support: