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How to treat constipation in children

I have a mantra in my practice: Abdominal pain is constipation until proven otherwise. Constipation is just that common in kids. A Journal of Pediatrics study found that 18 percent of toddlers and 14 percent of adolescents experience constipation, which means millions of kids every day are dealing with symptoms. If as a parent this sounds familiar, here’s what you need to know to identify and manage symptoms of a backup:

Regular is different for everyone

Constipation is a change in the frequency or texture of the stool. What qualifies as constipation varies by individual. Some infants go just once a week, and some toddlers every two to three days. If the stool is soft and kids are gaining weight, this is perfectly healthy. For other children, being regular means going at least once a day. When kids start experiencing uncomfortable symptoms or haven’t had a bowel movement in a week, that’s when they likely have constipation.

Kids may surprise parents with symptoms

Some of the most common symptoms of constipation include:

  • Stomach ache or bloating
  • Pain or blood with passage
  • Large, firm stool
  • Lack of appetite
  • Bedwetting
  • Soiled underwear

Most parents who are changing diapers are quick to catch on to new bowel habits. It gets harder when kids start using the potty on their own, or when parents are caring for an older child who has a greater sense of privacy. I encourage parents to remind kids that everybody poops and that they shouldn’t be embarrassed to bring up issues. Making time for yearly well-child checks can also keep kids’ digestive health on track. Parents are frequently surprised by what kids say!

Fiber-filled diet eases digestion

Most parents are savvy about the connection between diet and constipation. Fruits, vegetables, and whole grains are good for kids and high in fiber, helping move food through the colon. However, getting enough of the good stuff into kids can be difficult, whether because of picky eating, budget restraints, or busy family schedules. What’s more, kids can become constipated even when they eat well.

Encouraging fresh fruits and veggies and offering kid-friendly options can help. Pears, applesauce, fruit and veggie puree pouches, fiber-filled breakfast bars, and fiber gummies can all help keep things moving. Fruit juice, while high in sugar, is also a good option. Many parents have luck reducing consumption of dairy and constipating foods such as bananas. Dietary changes don’t soften stool that’s already in the colon, but they can help prevent future problems.

Withholding common in toddlers

Another common cause, particularly among young children, is withholding. After kids potty train, they may decide that they are having too much fun playing to stop and use the bathroom. When they hold stool in it becomes larger, drier, and harder. This can lead to pain and further withholding.

In these cases, it’s usually best to “reset” the colon’s empty and fill cycle by completely cleaning it out. Polyethylene glycol powder is one of the most studied and safest options in children and clears the colon without cramping. A pediatrician can provide dosing instructions and advise if it should be used as a maintenance medication.

Hydration, illness, exercise all play a role

Other factors can also cause constipation. Kids who get sick may lose a lot of fluids and become backed up. Some children may not drink enough water. Medications, including common antibiotics and iron-containing vitamins, can be an issue. Stress and schedule disruptions can interfere with kids’ systems. Too much sitting is also a culprit. These are all causes that can be managed with the help of a doctor.

Consult a pediatrician

If you haven’t had a recent conversation with your child or adolescent about poop, I encourage you to check in. Be sure to make an appointment with your pediatrician if your child is experiencing symptoms. Accurately diagnosing constipation and coming up with a thoughtful treatment plan can make a huge difference in kids’ daily comfort.

Dr. Curtis McDonald is a pediatrician at Vancouver Clinic and the father of four children. His goal as a provider is to empower parents with information so that they can make the best choices for their families.