Has your child ever come out of the bathroom in tears, saying, “Mommy, it hurts when I poop?” The likely cause is constipation, a very common problem in children.
Sometimes a constipated child might actually appear to have diarrhea, which can be confusing. What’s happening here is that a large formed stool has gotten stuck in your child’s rectum, and liquid stool gets passed around it.
When a child is constipated, they have less frequent bowel movements, and when they do “go,” their stool is dry, hard, and painful to pass. There are many possible causes for constipation, including:
- Withholding stool. This means that your child is trying to hold their bowel movements in -- maybe because they're stressed about potty training, maybe because they don’t want to use the toilet in certain places (like school), or maybe because they're afraid of a painful bathroom experience. (Constipation can become a vicious cycle -- if it hurts to “poop” once, the child may be more fearful of going the next time.)
- A diet that’s low in fiber or doesn’t include enough liquids (or both), commonly found in toddlers transitioning from formula to whole milk
- Side effects of certain medications
There are three primary treatments for most cases of constipation, and they usually work hand-in-hand.
- A high-fiber diet with plenty of fluids. This means loading your child’s plate with plenty of fresh fruits and vegetables, high-fiber cereals, whole grain breads (look for at least 3-5 grams of fiber per serving), and a variety of beans and other legumes, like chickpeas and lentils. Two good sources of fiber that kids are often happy to eat are trail mix (let them make their own) and popcorn with minimal salt or butter. Foods containing probiotics, like yogurt, can also promote good digestive health. While focusing on fiber, don't forget fluids. If your child is eating plenty of high-fiber food but not getting enough fluid to help flush it through their system, you can make matters worse. Your child should be drinking plenty of water throughout the day, along with some milk. Limit sugary drinks to 4 ounces a day in younger children and 6-8 ounces in school-aged kids.
- A stool softener to clear the bowels. These are typically safe in children. Two common mistakes that parents make when giving their child a stool softener for constipation is not using a large enough dose, or stopping it too soon. For example, you might think that you can stop giving a stool softener after your child’s first normal-looking bowel movement, but stopping too soon may just set up your child for another bout of constipation. Some children may need to stay on a stool softener for a few weeks. As you continue to make and reinforce dietary modifications, your child's pediatrician can advise you on the right dosing schedule for your child.
- Regular toilet time. Encourage your child to use the toilet first thing in the morning and after every meal or snack. Particularly for a younger child, you may get better results by telling, not asking. Instead of suggesting, “Do you need to go to the bathroom?” simply say, “Time to go to the bathroom now.”
You’ll get the best results if you combine all three of these approaches. A high-fiber diet isn’t likely to clear up a serious case of constipation on its own without the help of a stool softener; on the other hand, once your child stops taking a stool softener, if they stay on a low-fiber diet and doesn’t get enough healthy fluids, the problem is likely to happen again.