Information for parents
Constipation in Children
Constipation is one of the most common reasons children see a doctor, and in the vast majority of children it is functional. That means there is no underlying disease; the bowel is healthy, but a cycle of hard, painful poos and holding on has taken over.
Constipation is not only about how often a child goes. A child who passes a small, hard or painful poo every day can still be constipated, especially if a larger amount of stool is building up behind it.
How do I know if my child is constipated?
Doctors look at the whole pattern rather than a single number. Signs that suggest constipation include:
- Poos that are hard, dry, pellet-like, or very large (sometimes large enough to block the toilet)
- Pain, straining or crying when opening the bowels
- Going fewer than about three times a week, although daily poos do not rule it out
- Withholding behaviours — hiding, stiffening, crossing legs or refusing the toilet
- Smears or accidents in the underwear
- Tummy pain, bloating or reduced appetite that improves after a big poo
- Occasional streaks of bright red blood on the paper from a small tear (fissure)
Why do children become constipated?
There is usually no single cause. Common triggers include a painful poo after an illness, a change in diet (for example starting solids or moving to cow’s milk), toilet training, starting childcare or school, travel, being too busy playing to stop, or not wanting to use unfamiliar toilets.
Once a child has had one or two painful poos, their natural response is to avoid it happening again. That is where the real problem begins.
The painful-poo → withholding → harder-poo cycle
When a child holds on, the lower bowel (rectum) keeps absorbing water from the stool. The poo becomes larger and harder, so the next one hurts even more, and the child holds on harder still.
Over time the rectum stretches. A stretched rectum sends weaker ‘I need to go’ signals, so children genuinely may not feel the urge. This is why treatment focuses on keeping poos consistently soft for long enough that the fear fades and the bowel can return to its normal size and sensation.
Why does my child hide, stiffen, cross their legs or refuse the toilet?
These behaviours often look like a child is trying to push, but they are usually trying to hold on. Standing on tiptoes, clenching the buttocks, going red in the face, hiding behind the couch or insisting on a nappy are all common ways children avoid a poo they expect to hurt.
This is a learned protective response, not defiance. Punishment or pressure tends to make it worse; calm routines and soft poos make it better.
Can constipation cause abdominal pain?
Yes. Constipation is one of the most common causes of recurring tummy pain in children. The pain is often crampy, can come and go, and may be worse after meals. It sometimes improves after a large bowel motion. Not every child with constipation complains of pain, and not every tummy ache is constipation, so it is worth looking at the whole picture.
Why can constipation cause stool accidents or soiling?
When a large mass of hard poo sits in the rectum, softer stool from higher up can leak around it. Children often cannot feel this happening and are genuinely unaware until they notice the mess or smell. Doctors call this overflow soiling (faecal incontinence).
Soiling can be very distressing for children and families. It usually improves once the bowel is properly cleared and kept empty, although it can take time for sensation and control to recover.
Does diet cause constipation?
Diet plays a part but is rarely the whole story. A balanced diet with fruit, vegetables and wholegrains, plus regular water, supports healthy bowel habits. Very large amounts of cow’s milk in toddlers can fill them up and crowd out other foods, and may contribute to constipation in some children.
Once withholding has set in, diet changes alone are usually not enough to break the cycle. Forcing high-fibre foods can also create battles at mealtimes, which is best avoided.
When are laxatives needed?
Laxatives are recommended when constipation is established, painful, or not settling with simple measures. Treatment usually has two stages: first, clearing out any hard stool that has built up (sometimes called disimpaction), and then a maintenance phase to keep poos soft every day.
Laxatives work best together with regular toilet sitting — for example a few minutes on the toilet after meals, feet supported on a footstool, and praise for trying rather than for results.
Are Movicol/macrogol-type laxatives safe for longer-term use when medically indicated?
Macrogol (polyethylene glycol) laxatives are recommended as a first-line option in international paediatric guidelines. They work by holding water in the stool so it stays soft, and very little is absorbed into the body. They have been used for many years in children, including for long periods when needed.
The dose varies between children and is adjusted to achieve soft, easy poos. Your doctor will guide the dose and how long to continue. Please do not start, stop or change laxatives in a young child without medical advice.
Why treatment sometimes takes months rather than days
It takes time for a stretched rectum to return to normal and for a child to lose their fear of opening their bowels. Many children need treatment for several months, and some longer. Stopping as soon as things look better is one of the most common reasons constipation returns.
Setbacks are normal, especially with illness, holidays or changes in routine. Treatment is usually weaned gradually once a child has been passing soft poos comfortably for a sustained period.
When constipation needs further investigation
For most children, a careful history, growth check and physical examination are all that is needed. Tests are considered when there are warning signs, when constipation starts very early in life, or when it has not responded to well-managed treatment. Depending on the situation this might include blood tests (for example for coeliac disease or thyroid problems) or, rarely, specialised tests of bowel function.
When should I be concerned?
Most constipation is not a sign of serious illness. See your GP promptly, and ask about specialist review, if your child has any of the following:
- Constipation that started in the first weeks of life
- Delayed passage of the first poo (meconium) after birth — more than 48 hours in a baby born at term
- A very swollen tummy, repeated vomiting (especially green vomit)
- Poor weight gain, weight loss or slowing growth
- Weakness in the legs, delayed walking, back abnormalities or changes in bladder control
- Persistent blood in the poo that is not explained by a small tear
- Unusual appearance of the bottom or spine
- Constipation that is not improving despite consistent, well-managed treatment
Green vomiting, a hard swollen tummy with severe pain, or a child who is very unwell needs urgent medical attention.
When should my child see a paediatric gastroenterologist?
Constipation is also a common cause of tummy pain — see our guide to abdominal pain in children.
Your GP or paediatrician can manage most childhood constipation. A paediatric gastroenterologist can help when constipation is severe, long-standing or not responding to treatment, when soiling persists, when there are red flags, or when the diagnosis is uncertain.
Complex and difficult-to-treat constipation, including gastrointestinal motility disorders, is a particular clinical interest of Dr Malik.
Straight answers
Questions parents often ask
Is my child constipated if they poo every day?
They can be. If daily poos are small, hard, painful or accompanied by withholding or soiling, stool may still be building up. The texture and comfort of the poo matter as much as how often it happens.
Why does my child hold their poo?
Usually because a previous poo hurt. Holding on is a protective reflex. The most effective way to help is to keep poos soft enough that they no longer hurt, so your child gradually learns they are safe to let go.
Can constipation cause accidents in underwear?
Yes. Soft stool can leak around a large, hard mass in the rectum, often without the child feeling it. It is not deliberate. Clearing and keeping the bowel empty usually helps, but improvement can take some time.
Will my child’s bowel become dependent on laxatives?
Macrogol-type laxatives are not considered habit-forming in the way parents often fear. Most children are able to wean off them once the bowel has recovered. Stopping too early is a bigger risk than continuing for too long under medical guidance.
Could this be Hirschsprung disease?
Hirschsprung disease is a rare condition where nerve cells are missing from part of the bowel. It usually shows up in the newborn period, often with delayed passage of meconium, a swollen tummy or vomiting. It is very unlikely in a child whose constipation started after a normal newborn period, for example around toilet training. If you are worried, talk to your doctor.
Could coeliac disease cause constipation?
Sometimes. Coeliac disease is more often linked with diarrhoea, bloating or poor growth, but some children have constipation. Doctors may suggest a coeliac blood test when constipation is persistent, difficult to treat, or accompanied by other symptoms.
Related children’s gut-health resources
Abdominal Pain in Children
Common causes of recurring tummy pain and the signs that deserve a closer look.
Disorders of Gut-Brain Interaction
Functional abdominal pain, IBS and dyspepsia — why the pain is real even when tests are normal.
Coeliac Disease in Children
Testing, when a gastroscopy is needed, and why not to stop gluten too early.
If your child has persistent gastrointestinal symptoms or your GP has recommended specialist assessment, you can find information about appointments with Dr Rohan Malik here.