Constipation can cause plenty of pain and discomfort for toddlers. These expert-approved tips can help get things moving again.

By Nicole Harris and Melissa Willets
December 22, 2020
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Toddlers normally poop at least once per day, although some healthy children have bowel movements every few days. Stools that are hard, painful, or very large might signal constipation—a common condition that’s often misunderstood, says Steven Hodges, M.D., a pediatric urologist at Wake Forest University School of Medicine and the coauthor of It's No Accident and Bedwetting and Accidents Aren't Your Fault

Constipation will likely happen on occasion without any ill effects. But if your child’s stool doesn’t budge for an extended period of time, a large mass might form in their colon, says Dr. Hodges. This can cause uncomfortable stomach pain, bloating, crankiness, and other unpleasant symptoms. What’s more, if the backed-up stool pushes against your child’s bladder, it can lead to bedwetting and daytime accidents.

Keep reading to learn more about why some kids get backed up, with tips for how to help a toddler with constipation.

Is My Toddler Constipated?

Trying to decide whether your child is constipated? Because poop schedules vary so much, the appearance of your child’s stool matters more than the frequency, says Dr. Hodges. Here are some common signs of toddler constipation.

  • Fewer than three bowel movements per week (although this can be normal for some children)
  • Dry, hard stools
  • Bowel movements that are difficult to pass
  • Crankiness
  • Loss of appetite
  • Bloating
  • Painful bowel movements
  • Liquidy poop stains in the underpants; this means poop might be backed up in the rectum 
  • Resisting the urge to use the toilet. According to the American Academy of Pediatrics (AAP), signs include crossing their legs, making strained faces, clenching buttcheeks, and twisting their body.
  • Stool with a bloody surface 

Visit the pediatrician if your child’s constipation spans at least 2 weeks, or if you notice bloody stools, anal tears, fever, weight loss, lack of eating, vomiting, or other worrisome symptoms. Your doctor may conduct medical tests or X-rays before deciding on a course of treatment.

What Causes Constipation in Toddlers?

Intolerance to cow's milk is the most common cause of constipation for babies. If digestive issues continue into toddlerhood, experts might blame insufficient dietary fiber, exercise, or water intake. Indeed, any change in diet—including the introduction to dairy products or other new foods—can cause a toddler to get backed up. Too much processed foods may also be to blame. 

Constipation in toddlers can also be caused by a refusal to use the bathroom. Kids might hold in poop if they can’t be bothered to stop playing (especially at the beginning of toilet training), if they’re wary of public restrooms, or if they’re scared of the toilet. The journal Pediatrics once reported that a 3-year-old boy became terribly constipated after seeing a single television commercial, in which the toilet bowl turned into a monster and the toilet seat was a chomping mouth. Along those lines, some kids are so constipated that every poop is painful—and as a result they avoid going at all, which makes the situation worse.

Bouts of constipation can be triggered by other stressful events in a child's life, like the birth of a sibling, parental conflict, or toilet training too soon. Toddlers might also get backed up from uncommon conditions like spinal-cord defects, celiac disease (an autoimmune disorder triggered by eating gluten and similar proteins), lead poisoning, or thyroid trouble. Finally, certain illnesses or medications can also trigger constipation in toddlers.

Natural Constipation Remedies for Toddlers

If your toddler suffers from constipation, you can often relieve symptoms with natural remedies.

Change Their Diet

Eating fiber can help keep your child’s digestive system on track, and many American children don’t get enough of it.  But interestingly, altering a child's diet doesn't play the role in curing constipation that you might think it would. Dinesh Pashankar, M.D., a pediatric gastroenterologist at Yale School of Medicine, says that serving fiber-rich foods like prunes or raisins can certainly help a child who has a temporary problem pooping, but it hasn't been shown to be all that beneficial for kids who have a serious, chronic situation. It’s worth a shot though, so include plenty of fruits, vegetables, whole-grain breads and cereals, and beans in your child’s diet. The AAP recommends that toddlers eat “a daily amount of fiber that equals their age plus 5 grams of fiber.” Also, limit processed foods as much as possible.

Stay Hydrated

Staying hydrated helps the intestines and bowels move things along. Give your child plenty of liquids each day to encourage healthy bowel habits.

Go to the Potty Regularly

Is your child too preoccupied to use the toilet? Set aside a few times each day dedicated to using the toilet, especially after meals. Have your child sit for about 10 minutes at a time. Also, remind them that they should take a bowel movement whenever they feel the urge to go.

Encourage Movement

A 2016 study in the journal Gastroenterology found kids with constipation may benefit from something you probably haven't tried: exercise. Researchers looked at 53 kids between the ages of 5 and 16 and treated their constipation with toilet training, education, and laxatives. Meanwhile, 27 of those children also received physical therapy. After six months, 92 percent of the kids who got physical therapy no longer had functional constipation (which is when the problem is caused by psychological or neurological issues), versus 63 percent of kids from the control group. As lead study author Marieke van Engelenburg explained, "Effective, voluntary and involuntary, contraction and relaxation must be present when passing urine or feces on the toilet, to avoid dysfunctional voiding or constipation."

According to Dr. Hodges, "​Any kind of physical activity helps the colon move things along, so it’s important to find activities your child enjoys." He shared some exercises from his book with Parents.com, and explained that kids can do at home (daily, ideally) to help relieve the symptoms of constipation.

Frog Squat. "This exercise mimics the squatting posture that's so helpful for using the toilet, stretching the pelvic muscles to prepare for pooping and peeing. You will ask your child to squat down to the ground with her feet and knees spread wide, and heels and hands on the ground. Have your child look up, as if she is a frog looking for flies. Now, have her take deep breaths and be patient as she waits for the flies to come." This position should be held for 10 to 15 seconds, five times.

Invisible Chair. "This exercise strengthens the lower back muscles and helps train the child to keep his spine straight as he leans forward on the toilet. This exercise also stretches the potty muscles, which get tight from holding pee and poop and from all the time kids spend slumped over while playing video games." Instruct your kiddo to pretend they’re going to sit on a low chair, with their feet shoulder-width apart, weight in their heels, and their arms reaching overhead. Think chair pose from yoga! The goal is to have your child do ten to fifteen repetitions, holding for five seconds each time, twice a day.

Medical Constipation Remedies for Toddlers

Always consult your pediatrician before starting any medical course of treatment for constipation as they may want to conduct tests beforehand. Here are a few common tactics your pediatrician may recommend depending on your child's situation.

Laxatives

Constipation treatment might begin with a "clean-out," and this initial unclogging process can take several weeks. The object is to gradually get rid of the rock-hard stool that has accumulated in the colon. Your child’s doctor might recommend treatment with laxatives like Miralax or Milk of Magnesia.  Unfortunately, many chronically constipated toddlers need more than two months of intensive laxative treatment to get results. The AAP stresses that you should never give a child laxatives without a doctor’s approval.

Enemas

In rare instances, laxatives don't help enough and a child may need to undergo endoscopy, in which a soft scope is inserted through the rectum into the colon and the doctor breaks up and extracts the poop. This procedure is typically performed by a pediatric gastroenterologist while the child is under sedation. Generally, pediatricians recommend at least three months of ongoing medication, such as a low daily dose of a laxative, after the clean-out. 

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