All children are different – and bowel patterns are no exception. Because of this, it’s sometimes hard to tell if your child is constipated. Infants, especially breast fed infants, may go a couple of days without a bowel movement and still not be constipated. Another might have relatively frequent bowel movements, but have difficulty passing stool.

What causes constipation?

  • Diet. Changes in diet, or not enough fiber or fluid in your child’s diet, can cause constipation.
  • Illness. a change in his diet can throw off his system and cause him to be constipated.
  • Withholding. Your child may withhold his stool for different reasons. He may withhold to avoid pain from passing a hard stool, which can be even more painful if your child has a bad diaper rash. Or he may be dealing with issues about independence and control—this is common between the ages of 2 and 5 years. Your child may also withhold because he simply doesn’t want to take a break from play.
  • Other changes. In general, any changes in your child’s routine, such as traveling, hot weather, or stressful situations, may affect his overall health and how his bowels function.

If constipation isn’t treated, it may get worse. The longer the stool stays inside the lower intestinal tract, the larger, firmer, and drier it becomes. Then it becomes more difficult and painful to pass the stool. 

What are the symptoms of constipation?

  • Many days without normal bowel movements
  • Hard stools that are difficult or painful to pass
  • Abdominal pain, such as stomachaches, ­cramping, or nausea
  • Rectal bleeding from tears, called fissures
  • Soiling
  • Poor appetite
  • Cranky behavior

You may also notice your child crossing her legs, making faces, stretching, clenching her buttocks, or twisting her body on the floor. It may look as if your child is trying to push the stool out, but instead she’s trying to hold it in. 

What is encopresis?

If your child withholds her stools, she may ­produce such large stools that her rectum stretches. She may no longer feel the urge to pass a stool until it is too big to be passed without the help of an enema, laxative, or other treatment. Sometimes, only liquid can pass around the stool and leaks out onto your child’s underwear. The liquid stool may look like diarrhea, confusing both parent and pediatrician, but it’s not. This problem is called encopresis.


In some cases, your child’s doctor may prescribe medicine to soften or remove the stool. Never give your child laxatives or enemas unless your child’s doctor says it’s OK; laxatives can be dangerous to children, if not used properly. After the stool is removed, your child’s doctor may suggest ways you can help your child develop good bowel habits to prevent stools from backing up again.  

You can…  

  • Encourage your child to drink plenty of water and eat higher-fiber foods.
  • Help your child set up a regular toileting routine.
  • Encourage your child to be physically active. Exercise along with a balanced diet provides the foundation for a healthy, active life.


If you are concerned about your child’s bowel movements, talk with your child’s doctor. A simple change in diet and exercise may be the answer. If not, your child’s doctor can suggest a plan that works best for your child.