Constipation is a common problem from infancy to adulthood. There are many factors that contribute to a child developing hard, uncomfortable and/or infrequent stools. Stool withholding is very common: if it hurts to have a bowel movement, children would rather hold it in instead of push it out. The more they hold it, the worse the constipation gets. Sometimes severe constipation can lead to stool accidents because soft stool can make its way around old stool in the colon and leak out uncontrollably. Rarely, constipation can be caused by an underlying medical condition. Pediatricians will try to help your child be more comfortable and more regular with the following tips:

  1. Encourage a healthy “laxative” diet. Foods that produce laxative effects include breast milk for infants, fruits and vegetables, some fruit juices, dried fruit, nuts, spicy foods, dark chocolate, popcorn and whole grain products such as bran. Some people find that high-fat meals may help. These foods work because they contain lots of fiber. Your child needs a certain amount of fiber per day. A rule of thumb is age + 10 grams. So, if your child is 4 years old, he’ll need 14 grams of dietary fiber per day.
  2. Limit constipating foods such as milk, cheese, yogurt, and bananas. Though limiting dairy helps constipation, your child needs several high-calcium foods per day for adequate nutrition.
  3. Encourage fluids. Your child should drink enough fluid so that her urine is clear or light yellow. Darker urine means she isn’t drinking enough fluids.
  4. Add a fiber supplement such as Benefiber, Metamucil or flax seeds.
  5. Develop a meal routine. When meals are adequately spaced, and snacks are limited in between meals, the bowels reflexively move better at these meal times.
  6. Encourage a bowel movement routine. About 20-30 minutes after meals, your child should sit on the toilet for 10-15 minutes. Use a timer if you need to so your child will spend enough time on the toilet. Eventually, the mind and the body get in sync and it’s easier for your child to have a bowel movement.
  7. Encourage your child to go on his own, but do not force him to sit or punish him for refusing to sit as this could foster more opposition to the whole process. Try to pick good times for gentle reminders and mention that “your doctor asked me to help you remember.” Teach your child to push while sitting on the toilet. The bowel movement won’t just fall out. Having your child bend forward while pushing may help.
  8. Give your child’s school a permission note for bathroom privileges. She should also have permission to carry a water bottle to school to stay hydrated. If needed, talk to the school about allowing your child to use a private restroom.
  9. Encourage your child to listen to his body. He must learn to stop any activity if he needs to have a bowel movement and go to the restroom.
  10. Don’t punish your child if she has an accident, whether it is stool or urine. It is quite common for children to have constipation (even unrecognized constipation) which causes urinary symptoms such as daytime urine accidents. Instead of punishment, use positive reinforcement like sticker charts, or special privileges for successful days.
  11. Don’t get discouraged if it takes a long time, and don’t think that the problem is solved if the child is not complaining. It can take 6 months to a year of taking daily stool softeners and behavioral training to reverse habits that sometimes developed in infancy.
  12. If you are trying to toilet train, back off until the problem is resolved. Your child may be feeling overwhelmed with pressure from you and holding her stools to avoid the whole process. Be patient, toilet training can resume once the child is more comfortable and becomes confident that having a bowel movement on the toilet won’t hurt.

Brad Mercer, M.D., is located at 3200 Riverfront Drive, Ste. 103, Fort Worth, TX 76107. To make an appointment with him or one of his partners, call 817-336-3800. Like him on Facebook.

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