A Constipated Child: A Paediatric Dietitian's guide to helping your baby, toddler or young child with constipation

Constipation in children is a common but often distressing issue that can impact their well-being and daily activities. It's important to know the signs and have a better idea of what a normal bowel movement looks like and when it’s something that needs attention. As a Paediatric Dietitian with extensive experience, I'm here to guide you through understanding the causes, recognising the symptoms, and finding effective dietary strategies to alleviate your child's constipation. This guide will help you navigate through this challenging issue most children will experience at some point in their growth and development.

How do you know when your baby, toddler or young child has constipation?

Constipation is common amongst children of any age and can occur at any stage of their development. In fact, about one-third of children will experience constipation, with these milestones being the most prevalent times:

Introduction of solid foods
Toilet training
When school starts

Depending on the severity of the situation, you may start working with a Paediatric Dietitian, like myself, or consult your Paediatrician first if the conditions are ongoing and persistent.

As a Paediatric Dietitian I can determine if allergies are the primary cause of constipation or your fussy eater needs assistance by increasing fluid or adding fibre to the diet. As the lead Paediatric Gastroenterology Dietitian at The John Radcliffe Hospital in Oxford (England), I have years of experience solving constipation issues in babies and children. I’m here to help your child too.

What are the common signs and symptoms my child is constipated?

There are many signs to determine if your child is suffering from constipation. It's often a combination of symptoms, the most common of which are:

Infrequent bowel movements:
One of the primary indicators is a decrease in the frequency of bowel movements. If your child has fewer than three bowel movements per week on a regular basis, constipation may be a concern.
Hard, dry stools:
Constipated stools are typically hard, dry and difficult to pass. Think of pebbly poos. Changes in the consistency of your child's stool may indicate constipation.
Faecal overload:
Stool can become so hard that it's difficult to pass, leading to what's known as faecal impaction. As a result the bowel begins to leak out watery stools around the poo. This can make it look like your child has diarrhoea but it could in fact be constipation.
Straining during bowel movements:
Difficulty or discomfort during bowel movements, such as visible straining, can be a sign of constipation. Watch your child's expressions and behaviour when they are on the toilet, to see if they are experiencing discomfort.
Stomach pain and discomfort:
Complaints of abdominal pain or cramping are common in constipated children. If when asked where the pain is and they point to their stomach area, this is a sign it may be constipation, especially if this is a frequent occurrence.
Refusal to go to the toilet:
Some children may avoid using the toilet due to the discomfort associated with constipation. This reluctance can make the issue worse, leading to further complications.
Changes in behaviour:
Constipation can affect a child's overall well-being. You know how bad it makes you feel when you can’t go to the toilet. Children are no different, they just can’t express the reasons like an adult can. Watch for changes in behaviour, such as irritability, mood swings or a lack of desire to engage in normal activities.
Loss of appetite:
Constipated children may experience a decreased appetite. If you notice a sudden change in your child's eating habits, it could be linked to constipation.
Bloody streaks on the stool or toilet paper:
Constipation is regularly associated with hard stools. Hard stools can cause small tears in the rectum, resulting in bloody streaks on the stool or toilet paper.
Incomplete emptying of the bowels:
Sometimes your child may have to use the toilet multiple times, complaining of a feeling that they haven't fully emptied their bowels each time.

Are the symptoms different for babies?

Most of these signs and symptoms are common in children of all ages, including babies however, I do tend to look at the overall well-being of the baby such as reduced feeding volumes, straining to pass and constant fussiness. These are signs to look for:

Infrequent bowel movements:
While the frequency of bowel movements varies, if a baby consistently goes several days without a bowel movement, it may suggest constipation.
Hard, dry stools:
Stools that are hard, dry, and difficult to pass can be a sign of constipation in a baby. This may be accompanied by straining or visible discomfort during bowel movements.
Changes in behaviour:
If a baby seems unusually fussy, irritable, or uncomfortable, particularly during or after bowel movements, it could be related to constipation.
Refusal to eat:
Constipation may lead to a temporary loss of appetite or reluctance to feed. If a baby is avoiding feeds or seems disinterested in feeding, it's essential to investigate further.

How often should my child have a bowel movement?

For toddlers, the general guideline is to poo every day, or at the very least, more than 3 times per week. Any less than 3 times per week is a reason to look for any of the other symptoms listed above.

How often should my baby have a bowel movement?

The frequency of bowel movements in babies can vary widely, and what's considered normal can change as a baby grows and their diet evolves. In the early months of life, especially for exclusively breastfed infants, it's normal for a baby to have several bowel movements a day. Breast milk is easily digestible, and frequent pooing is common. However, it’s not unusual for a breastfed baby to not poo for a couple of days. So I assess things on a case by case basis.

As babies transition to solid foods, typically around 6 months of age, the frequency and consistency of bowel movements may change. It's common for bowel movements to become less frequent as the digestive system adapts to new foods. At the early stages of food introduction, bouts of constipation can last for a couple of weeks.

For more on transitioning to solid foods, read Introducing Solids to Baby. And download my Introducing Solids in the First 12 Mths, a handy one pager to help guide you through this important developmental stage.

Here are some general guidelines broken down by age:

Newborns (0-3 months):
It's normal for breastfed newborns to have several bowel movements a day. Formula-fed newborns may have fewer, possibly one to two per day.
Infants (3-6 months):
As babies continue to grow, the frequency may decrease slightly, but breastfed babies can still have multiple bowel movements a day. Formula-fed babies may have one to two per day.
Infants (6 months+):
As solid foods are introduced, the frequency is likely to change. It's not unusual for some babies to have bowel movements less frequently, even skipping a day or two.

These are guidelines rather than hard and fast rules. What’s of greater importance is the consistency of the stool. For a breastfed baby, stools are typically soft and yellow. Formula-fed babies may have stools that are slightly firmer or a more brown, less yellow in colour.

As long as the baby is comfortable, gaining weight appropriately, and their stool is within a normal consistency, the frequency alone may not be a cause for concern.

Why is my child constipated and what is causing it?

Constipation in children can result from a variety of factors, such as inadequate fluid intake, insufficient fibre in the diet or even a lack of physical activity. Some children may also experience constipation due to emotional stress or changes in routine.

And in some cases it’s related to a medical condition or a surgical situation, with the most common listed below. If this is the case, a Paediatric Gastroenterologist will be involved.

Coeliac disease
Hypothyroidism
Hypercalcaemia
Slow-transit constipation
Neurological disorders
Hirschsprung disease
Meconium ileus
Anatomic malformation of the anus
Spinal cord abnormalities

When are typical times constipation can happen?

Whenever there is a change in schedule or a transition from one stage of development to another, constipation can occur. Some examples of this include:

Changing from breast feeds to formula or cow’s milk
Starting solids
Toilet training when the child is not ready
Starting school and stress levels are high
After a bout of gastroenteritis

Sometimes constipation will happen for a couple of days as a result of this change. This is normal and no need for concern, but stay alert. If this continues overtime, and bowel movements haven’t reached a consistency, it’s time to raise this with your paediatrician.

How can I encourage my child to drink more water?

Not drinking enough water is one of the most common reasons a child experiences constipation. It’s also a common cause in adults…

Encourage your child to drink water throughout the day by making it readily available and appealing.

Try these tips to make it more interesting:

Use colourful or character water bottles
Have them drink water through a funnily shaped straw
Add a splash of natural flavour like strawberries or a slice of lemon (not as popular with kids…)

Remember to be the positive example by staying hydrated yourself. If you are drinking water, likely they will crawl over to you and steal it. So as I said, drink up!

Which specific foods help relieve constipation?

For children at the solids stage, some foods can provide relief from constipation by promoting bowel regularity. Add prunes, pears, berries, and kiwi to your child's diet, as these fruits are rich in fibre that support digestive health. Additionally, yoghurt with probiotics can contribute to a healthy gut microbiome, aiding in smoother bowel movements.

Is there a link between dairy and constipation in children?

For some children, excessive dairy intake may contribute to constipation. Some children may have a non IgE allergy to dairy from a young age. If you suspect a connection between dairy and constipation, I can advise alternative sources to consider, along with a nutritionally sound feeding plan.

Constipation can also be a sign of a non-IgE allergy. It’s a clinical speciality of mine, helping children overcome non IgE allergies. For more information refer to my article on non IgE allergies. Or book an appointment with me to discuss your child’s particular situation.

Could some popular kids foods contribute to constipation?

Some well known toddler foods can contribute to constipation due to being highly processed and therefore low fibre content. Pay attention to these as possible contributors to your child’s constipation. The most common ones I look out for are:

Rice Cereal: Often chosen as an initial food for infants, rice cereal can sometimes lead to constipation. Introducing cereals with higher fibre content, such as oatmeal, might be a better option for your child's digestive well-being.
Bananas: A convenient and soft food, they can be binding and contribute to harder stools. Moderation is key when including bananas in your child's diet.
Applesauce: A favourite of many infants, when consumed in large quantities, applesauce can lead to constipation due to its high pectin levels. Offering other fruits like pears and apricots might alleviate this issue.
Cheese: Being a dairy product, cheese can cause constipation in some children, especially those with a milk allergy.
Highly Processed Foods: Foods such as white bread and certain baby snacks are low in fibre. Opt for whole grain alternatives instead.

What actions can I take to help my child with constipation?

If your child is experiencing frequent constipation and has symptoms discussed above, consulting with your Paediatrician should be your first step. However, for mild cases or if the symptoms are just a new occurrence, here are some strategies I have used to offer relief:

Regular Feeding Schedule:
Establishing a feeding routine can help regulate bowel movements.
Belly Massage:
Gently massaging your baby or child's tummy in a clockwise direction can stimulate their digestive system and potentially ease constipation.
Bicycle Leg Movements:
While your baby or child is lying on their back, gently move their legs in a cycling motion, as though they are on a bike.

What is disimpaction in a child and what’s the treatment?

Disimpaction is a medical term for a child facing severe constipation, meaning their stool has become very hard and is stuck in their bowels. It may be necessary to follow a stronger course of action, a disimpaction regime, rather than using gentle laxatives or foods known to have a laxative effect like prunes. These special medications are designed to soften and break down the stool, making it easier for your child to pass it. Our goal here is to ease your child's discomfort and help them get back to regular, pain-free bowel movements.

Constipation in a child with disability and low muscle tone

Children with low muscle tone often experience constipation. This is due to the fact that they just find it physically more challenging to push their poo out. It’s important to consult your paediatrician, but in general, these are indicative signs of a kid with low muscle tone:

Sitting with legs splayed in a W position, where feet are out to the side, and knees in front
Frequent slouching, or trouble sitting up straight
Feeling tired quickly, from simple activities like walking or running
Delayed in crawling or walking

If your child is experiencing frequent constipation and has one or more of these signs, please consult your paediatrician and raise this as a concern or discuss this with me.

How can a certified Paediatric Dietitian help?

Once constipation has been diagnosed we’ll work together to implement a feeding plan. If there are behavioural issues that need addressing, I can refer you to a specialist in these cases, and we’ll work as a team to help your child overcome the root cause of their constipation. With a feeding plan in place, I’ll stay in touch to make sure the desired results are being achieved and make adjustments if needed. At any time you can ask any questions or raise concerns you and your child experience. I’m there to support you and your child to overcome the discomfort associated with constipation.

Working with me is easy. Just follow these 3 steps and we’ll get you and your child on the road to peace, health and happiness.

Book an appointment: in-person or online video call

I’ll meet with you and your child via telehealth or face to face. We’ll discuss your child’s full history from birth until today and answer all your questions.

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You’ll receive a nutrition plan that meets your child’s specific needs.

See your child thrive and their confidence grow

As your child’s digestion improves happiness will return to your mealtimes.

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