Toddler constipation: Understand the signs, and how your doctor can help

Toddlers are, by nature, temperamental and finicky. Their moods and wants can change on a dime.

Even going to the bathroom can present a challenge at times. Some toddlers have a set bathroom schedule with regular bowel movements. On the other hand, some can go two and three, to multiple days without any bowel movements.

It’s common for parents to become stressed when they see their child has not been using the bathroom for 2 to 3 days. However, the good news is that constipation is not a serious disease and can be easily treated with diet, or solving the child’s urge to hold it in. As such, it is not something that should worry you all that much.

Let’s discuss how you can find out if a divergence in bathroom routine is normal for your child, or if they are constipated. Instead of discussing the medical management of constipation, let’s outline ways with which it can be treated using a fibre-rich diet and making lifestyle changes.

Prevalence of Constipation in Kids

Young children are often seen having constipation, a normal occurrence at this age. The condition is marked by an inability or difficulty in passing stool. In most cases, this happens due to hardened stool, a condition that can arise due to multiple reasons like dehydration, medications, a medical problem, or  poor diet. 

3 to 5% of general paediatrician cases involve constipation issues, with the rate going up to 30% for paediatric gastroenterologists. This shows us that the issue is quite common.

How to know if your toddler is constipated, the symptoms

Toddlers may not be able to communicate effectively that they are constipated. As such, it falls on you to observe their bowel movements and look for signs that may indicate a case of constipation. These may include cramps in the belly, abdomen swelling or bloating, sickness, bloody stools, as well as hard, dry and lumpy, large stools. 

A constipated toddler poops less than twice a week. If you see them standing or dancing on tiptoes or other abnormal postures, it may indicate they’re trying to avoid going to the bathroom by holding it in.

Toddlers often try to hold it in by crossing their legs, clenching their buttocks, twisting their body or making unusual faces, as they fear pain.

What Causes Toddler Constipation?

Slow stool movements in the intestines can cause stool to become dry and hard, leading to complications associated with constipation. Many reasons can lead to, or cause constipation in children.

Withholding

Children involved in playing sometimes hold their stoolsstool in as they are not ready to pause their activity. Oftentimes, constipation is painful, which is why children avoid it. Other children may not feel comfortable using public toilets, so they’ll hold it in until they return home.

Pooping while constipated can be a painful experience for some children. They may start holding it in to avoid going through the same pain again.

Toilet training issues

Children can often turn rebellious when you try to force things upon them. They might not like early toilet training and can voluntarily decide to avoid the need to poop. If this habit is developed, it can be challenging to overcome. 

Changes in diet

Children often suffer from constipation when they move from an all-liquid diet to solid foods. Their diet should encompass sufficient fibre-rich fruits, vegetables, and fluids to avoid constipation.

Changes in routine

Children don’t always handle changes in their routines well. Thus, weather, stress, and travel can easily affect their bowel movements. It’s common for a child to experience constipation on their first day of school.

Medications

Constipation is also a result of certain medications. Some formulas in medications are not suitable for young children and cause constipation. 

Cow’s milk allergy

Oftentimes, consuming various dairy products like cheese and cow’s milk can disrupt bowel movements, which may lead to constipation. 

Familial link

Some aspects in the environment and genetics also affect bowel movements. This is why children with a family history of constipation also suffer from the same issue. 

Medical conditions

In very rare cases, constipation is a sign of a metabolic or digestive system problem, anatomic malformation, or any other inherent condition. This is where a specialist can help.

How can I prevent constipation in my toddler?

Constipation can be treated at home. The only matter of concern in this regard is the texture and frequency of the stool. It is important to keep their bowel movements in check.

Healthy bowel habits

Children who are toilet trained but feel constipated should sit on the toilet, even if they don’t feel like defecating. A good way to go about this is using a schedule and sitting on the toilet after breakfast, lunch, and dinner. Use a timer and have them sit for 3 to 5 minutes, even if they’ve gone to the bathroom beforehand.

You can even encourage your child by giving them rewards and stickers when they use the toilet. It can certainly help in this situation as children are attracted to positive reinforcement.

 Children must be taught the advantages of passing stool and responding to the body’s need to relieve itself. Make their toilet experience comfortable by using age-appropriate equipment. They will need their own little toilet, as well as a footstool for balance.

Keep all the things away that might trigger their anxiety while using a toilet. Children are sometimes scared that they might fall in the toilet. Having support or a railing nearby can be handy in this situation. Try to make this a joyful experience by showing them their favourite toy while they are on the toilet.

Take a follow-up of their bowel habits from school, as you will not know about it unless it is communicated.

A healthy diet

Diet is more of an issue for adults than it is for children. However, try making some adjustments in their diet and see how things work out. If your baby is already on solid foods, increasing the intake of fruits and vegetables helps treat constipation.

Consider the following options to add more fibre to their diet.

Some fruits have a lot of fibre in their peel. Give fruits twice a day with peels such as raisins, plums, prunes, apricots, and peaches. Prune juice is effective for constipation as it is a light, natural laxative. Mix it with any other juice for a better taste, like cranberry, apple, or apricot. It can also be used to make ice lollies which children will love. Serve vegetables thrice a day. 

Only give cereals that are not overly processed, such as shredded wheat, bran cereals, whole grain cereals or oatmeal. Cereals like corn flakes, rice bubbles and white bread must be avoided as these can cause constipation. Give them wholemeal bread and reduce cow’s milk to a maximum of 500 ml per day in children who are over 18 months old. Avoiding sweet drinks before meals helps with the appetite.

Give them 3 tablespoons of stewed apricots or prunes thrice a week, or prune juice, all of which also help with constipation. If a baby is on formula milk, try changing their formula, as it can also be one of the causes of constipation.

When to see a doctor for toddler constipation

While constipation is not something to be scared of in children, it can get serious if it lasts for more than 2 weeks. Consult a paediatrician if you observe that it is not getting any better and is causing vomiting, fever, bloody stools, weight loss, swelling in the abdomen, and anal fissures.

Some medical tests might be prescribed by your paediatrician if the case is serious, such as:

Abdominal x-ray

It is usually taken to observe any blockage. It is one of the common X-rays used in constipation.

Barium enema x-ray

In this X-ray, a dye is applied to the bowels to identify problems in the rectum, the colon or the small intestine. It is rarely used.

Rectal biopsy

It is a procedure to remove a small piece of tissue from the rectum for examination. There is hardly a need to perform rectal biopsies in this situation.

Constipation can occasionally occur due to multiple reasons, but it can usually be treated with adjustments in diet and lifestyle. 

When is toddler constipation an emergency?

It is an emergency if it occurs with a combination of intense chronic abdominal pain.

It is often normal to have some level of abdominal pain in constipation as it can occur due to an urge to have a bowel movement or flatulence. 

However, acute abdominal pain that becomes persistent can be serious and requires medical attention. It can be due to pancreatitis, appendicitis, intestinal obstruction, mesenteric ischemia or gastric perforation. 

Constipation and vomiting

Vomiting during constipation happens due to faecal impaction. It results from severe constipation when the stool gets blocked in the large intestine (colon) and is difficult to release. It requires immediate medical attention as it could have serious, life-threatening complications. 

Constipation and stomach bloating

If the bloating in the stomach is painful, it might indicate an obstruction of the bowel and requires immediate treatment. Stomach bloating is also experienced in gastroparesis, small intestinal bacterial growth (SIBO), and irritable bowel syndrome (IBS).

Constipation and blood in the stool

If you observe some drops of blood on the toilet paper, it might be due to scratching in the rectal area or haemorrhoids and is completely normal. However, immediately take medical help if there are more than a few drops of blood on toilet paper and if there is blood in the stool or if the stool is black and delayed. 

What is the prognosis (outlook) for toddler constipation?

The good news is constipation in toddlers is treatable with a few lifestyle changes. However, do not hesitate to see a doctor if it becomes persistent and painful. The longer the issue continues, the more firm and dry the poop becomes. This can make passing stools painful and your child will hold it in to avoid the pain.