Constipation is such a common thing for kids. And if you’ve ever had a constipated kiddo you know it can be a really tough thing to navigate. Besides GI symptoms, it can also cause behavior changes due to persistent discomfort. Our triage nurses and doctors are full of ideas and suggestions for managing constipation and always happy to talk to you about it, but I wanted to share some quick notes here to get things moving (pun intended).
What is constipation?
Constipation refers to unhealthy poops that are hard, dry, or pebbly and are often difficult to pass or require lots of straining. Kids may feel like they need to poop but cannot. Constipation may also come with smears of stool in underwear/diapers or involuntary stool leakage (encopresis) which happens when more liquidy/looser stool is able to “run around” the hard stool. This can sometimes be confused with diarrhea, though is actually a result of significant constipation.
Oftentimes kids who are constipated have infrequent stooling, but infrequent stooling alone doesn’t mean someone is constipated. If a kid poops only a few times a week but the stools are soft and easy to pass, that may just be their normal, as opposed to a problem.
What are some causes of constipation?
- Low fiber diet
- Low water/fluid intake
- Too much milk/dairy (this is a big one for toddler age kids)
- Stool withholding. For example the child is afraid to poop at school/in public, or the child had a painful stool and doesn’t want that to happen again
- Diseases like hypothyroidism, celiac disease, or anatomical differences can cause constipation, but this is rare in kids
How can I help my child poop?
Diet changes:
- Increase fiber intake – high fiber foods include fruits, vegetables, beans/legumes, and whole grains
- Increase fluid intake – mainly water. Reminder – no water for babies under 6 months old
- Decrease milk/dairy products
- Provide prunes. For babies older than 2 months prune juice is my go to. They can have as many ounces as months old as they are, up to a max of 4 ounces. As they get older, prune purée/pouches or actual prunes are excellent. I mixed prune purée into everything I could for my daughter as she was starting solids
- Some kids don’t like prunes (I mean…I don’t really blame them). In that case, apple or pear juice/puree/food would be my next try
- Give Reguline formula for babies under 12 months old. Sometimes just a bottle or two of that a day will get them to poop
Medications:
If diet changes are not working, then we up our game to using medications:
- Polyethylene glycol 3350 (brand name Miralax) is the most common over-the-counter medication we use for constipation in kids
- Reach out to us to help determine the dosing for your child
- There isn’t a specific kids version; we just use lower doses for smaller kids
- It is most effective to put the powder in 2-6 ounces of juice or water, but kids need to be able to drink that in a relatively short time. Younger kids may not be able to drink that much volume of anything other than milk, so it can be mixed in milk in that case
- Studies shows that this medication is non-habit forming and safe for kids
- We can also treat constipation with over-the-counter suppositories, stimulant laxatives, or enemas.
How long should treatment be continued?
Some kids only get constipated every once in a while because of traveling or other one-off episodes. More commonly, kids with constipation have chronic problems pooping. For kids with frequent constipation, we set a treatment goal of one soft poop a day. Once that goal is met, they should continue treatment for at least 2-3 months before weaning them off of it. This gives their intestines time to reset from being constipated.