Constipation can vary between monstrous toilet-clogging rocks that some children only pass every few days (or longer) to tiny rabbit pellets that they struggle to produce-but they do so daily. And some children are mistaken to have uncontrolled loose stools or accidents in their pants, because they are having seepage around a large load that they can't pass (or don't want to because of the pain they fear they might have).

The Symptoms

  • Hard stools (Large or small)
  • Infrequent stools
  • Long time on toilet
  • Refusal or reluctance to use bathroom
  • Stool leakage into underwear
  • Urine leakage
  • Abdominal pain, better after bowel movement (usually low or left sided, occasionally higher)
  • Decreased appetite until bowel movement
  • Reflux or vomiting (rare, and often lessens after bowel movement)

The Cause

You can think of the small intestine's job as absorbing the nutrients from what we eat and the large intestine's job as absorbing the fluids that are coming downstream (though it does scavenge the residue and absorb some nutrients too). It then eliminates what hasn't been absorbed.

When the large intestine, also known as the colon, doesn't absorb the water, we have diarrhea. When it pulls more water out (because the residue sits in there longer), the stool becomes harder. So anything that slows the intestine down, gives us a tendency towards constipation.

  • Low fiber diet
  • Dehydration
  • Holding back
  • Medications (cold medications, pain killers)
  • Nerve or muscle problems of the spine or colon
  • Narrowed intestine or problem at anus or rectum
  • Low thyroid
  • Celiac disease
  • Low calcium, potassium (rare)

In my experience with children and teens, a low fiber diet and holding back are more common than all of the other conditions combined. And the problem is that when this starts early in childhood, the toddler or young child falls into a cycle of withholding, which makes the stool larger and harder when he finally does go, which then causes more pain and gives the child more reason to hold back.

It may have begun when the child didn't want to interrupt an activity or go at school--or unintentionally, when he didn't eat well for a short while or when he first began taking milk at a year and didn't balance the dairy with enough fruits and vegetables. The stool then got firmer, and the child wasn't used to evacuating that somewhat harder stool.

Instead of pushing it out, the rectal muscles resisted. It's an automatic response. The rectal muscles tighten when there's pain--even though the real need is to let those muscles relax and let the intestine pass the stool.

Correcting the Problem

Sometimes a laxative can be used and that's the end of the problem, but often constipation returns because the real problem hasn't been corrected. T hat takes some investigation to find the root cause and then a 3-Step Solution to resolve the problem.

  • Remove the blockage
  • Lessen the tendency to withhold
  • Address the root causes

The Role of Good Nutrition

Having enough dietary fiber and fluids is essential. The fiber holds water and makes the stool soft (so it's important that the fiber is accompanied by fluids as well). Together, the fiber and fluid soften the stool and build up the bulk so your child also will have more sensation of needing to go without the pain of a hard evacuation. But there's also the potential for too much fiber, which can cause gas and pain.

Fiber can present a problem for infants, causing more discomfort. Often a milk laxative works better. And better yet is making sure that they are well hydrated, with enough breast milk or formula and not getting too much cereal. Water or a small amount of juice in the water (1-2 tablespoons in 3-4 oz of water), particularly pear or prune, may help as well. If that doesn't work, you'll want to see the baby's doctor.