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What is a normal bowel pattern?

Bowel patterns (when and how often stools are passed) vary from child to child just as they do in adults. What’s normal for your child may be different from what’s normal for another child. Most children have BMs 1 or 2 times a day. Other children may have BMs every other day or occasionally go 2 days without a BM.

What are signs and symptoms of constipation?

What is encopresis?

Sometimes a child with constipation may pass BMs that look like diarrhea. When a child holds back stools, the stools build up and can stretch the rectum. The larger formed stool gets too big to pass, but small amounts of liquid or mushy stool can come out in the underwear. This is called encopresis. Ask your child’s doctor about treatment with laxatives or enemas to help clear the large stool and prevent future build-ups. It can get better, but it may take months.

What causes constipation?

Here are some causes of constipation.

• Holding back, or withholding, stool. Your child may avoid or resist passing a BM for different reasons.

  • Your child may avoid going because it hurts to pass a hard stool.

  • Children aged 2 to 5 years may want to show they can decide things for themselves. Holding back their stools may be their way of taking control. This is why it is best not to push children into toilet training.

  • Sometimes children don’t want to stop playing or engaging in other activities, like watching a video, to go to the bathroom.

  • Older children may hold in their stools at school or camp because they don’t want to use public toilets.

• Illness. If your child is sick and loses their appetite, a change in their diet can throw off their bowel patterns. Constipation may be a side effect of some medicines or may result from certain medical conditions, such as hypothyroidism (underactive thyroid gland).

• Diet. Not enough fiber or liquid in your child’s diet doesn’t cause constipation. However, eating a healthy diet, including natural sources of fiber, can promote good bowel patterns.

• Other changes. In general, any changes in your child’s routine, such as traveling, hot weather, or stressful situations, may affect their overall health and how their bowels function.

How is constipation treated?

Treatment is based on your child’s age and how bad the problem is. Usually, no special tests are needed.

Constipation can get worse if it isn’t treated. The longer stool stays inside the large intestine (or colon), the larger and drier it gets. Then it is difficult or painful to pass. This starts a cycle. The child becomes afraid to have a BM and holds it in even more.

How can I help my child develop good bowel habits?

Here are tips to help your child develop good bowel habits.

• Help your child set a toilet routine. Pick a regular time to have your child sit on the toilet to try to poop. For example, once after breakfast or 2 times per day— after breakfast and after an afternoon snack. Put something under your child’s feet to press on. This makes it easier to push BMs out.

• Make sure your child is consuming the recommended amounts of healthy foods from the 5 food groups, including foods that are good sources of fiber.

How much fiber does my child need?

There are different fiber recommendations for children based on energy needs, age, and weight. A normal fiber intake is recommended in children with constipation. The following can be useful strategies:

• Eat 5! If your child is eating at least 5 servings of fruits and vegetables each day along with other foods that are good sources of fiber, there is really no need to count fiber grams.

• Add 5! If you find it helpful to keep track of total grams of fiber that your child is eating, add 5 to your child’s age. For example, a 5-year-old would need about 10 grams of fiber each day. (The total daily recommended amount of up to 25 grams for adults can be used as a general guideline for teens.) Beans, vegetables, fruits, and whole grains are good sources of fiber.

Visit www.HealthyChildren.org for more information.