Constipation in children | Mate tūtae kore

There's a wide range of normal pooing for breastfed babies. They may poo as often as after every feed, or as infrequently as once in 10 days. Breastfed babies' poo is mustard yellow, soft and can look like it has seeds in it.

Most bottlefed babies and older children will have a poo every day or every second day. Some have more than 1 poo a day. The poo should be like a soft sausage – like types 3 and 4 in the diagram below.

Image credit: John C Bullas Creative Commons(external link)

Your child may be constipated if they have some of the following:

• Large and hard poo.
• Hard 'pebble-like' poo.
• No poo for 3 or more days.
• Pain or crying when having a poo.
• Bright blood around the poo due to tears in the skin around the anus (anal fissures).
• Tummy pain.
• Urinary tract infections, wetting pants (urine incontinence), bedwetting – constipation can increase the risk of these.
• Liquid poo that may leak out at times in between harder poo.
• Soiling accidents (encopresis).

Constipation in children is common.

There are many possible reasons for your child's constipation. Often, it is several things:

• not drinking enough water
• weaning from breastmilk to formula
• starting solids
• not having enough fibre (vegetables, fruits, whole grains) – ready-made food and takeaways are low in fibre
• not doing much physical activity
• not eating and drinking as much as normal, for example when your child is unwell
• a natural tendency to having slower gut movement.

Toileting habits are important. Your child can become constipated if they:

• ignore the urge to do a poo
• don't let all the poo come out when going to the toilet
• don't sit on the toilet regularly.

Take a look at this video by the Pediatric Gastroenterology Clinic, Primary Children's Hospital, US, for more information. 

Video: Constipation in children: Understanding and treating this common problem

Constipation often starts after 1 hard poo has caused pain. The natural response to a painful experience is to try and avoid or escape it in the future. So, the next time your child feels the urge to poo, they 'hold on' in an attempt to avoid passing another painful poo. This results in the poo becoming firmer, larger and even more painful to poo out and your child becomes even more reluctant to poo in the future.

This leads to a vicious cycle of pain, hard poo, trying to avoid pain by 'holding on' to poo.

Image credit: Healthify He Puna Waiora

The key to stopping this cycle is making the poo soft again. Read more about how to treat constipation.

If constipation continues for a long time and all the poo doesn't come out, the bowel can become overloaded and stretched. The overloaded and stretched bowel means the feeling of needing to do a poo is lost and can cause soiling accidents. Read more about soiling.

Constipation is hardly ever due to an abnormal bowel. Most bowel problems show up in early life and are diagnosed within the first few months. Occasionally, constipation in children can be due to coeliac disease.

If your child passed meconium (the green/black poo newborn babies pass) within 24 hours of birth, it's unlikely your child has a bowel problem causing constipation.

Your healthcare provider may suggest your child sees a specialist nurse or doctor if:

• your child's constipation is proving difficult to treat after standard treatments, or
• they think there may be another condition causing your child's constipation.