Code brown: A Guide to Managing Constipation in Children

Constipation in kids, sitting on toilet trying to use bowels

By Grace Larson

When my son was 5 years old, he developed a fear of going to the toilet, he would only go if we accompanied him and so sometimes this led to him ‘holding-on’ to his number twos. We had just moved to a new house, so big changes had happened and the bathroom was a little dated, and maybe to his 5 year old brain a little scary. It wasn’t long before this progressed into some issues with constipation. Constipation is a common issue among children, affecting approximately 30% of school aged children. Children who are constipated experience difficulty passing hard stools and/or have infrequent bowel movements (less than 3 per week). In this blog we are going to take a look at some of the reasons children become constipated and what we can do about it. I will also reveal what I did to give my son the confidence to go into the toilet independently again and resolve his constipation in the process


There are a variety of different cause of constipation which may include;

  • Bowel habits, such as ignoring the urge to poo, are common among children who may be too engrossed in play to visit the toilet. This delay can result in harder and larger stools. Establishing a regular toilet routine, ideally three times a day, can facilitate consistent and uninterrupted visits to the toilet.
  • Holding-on behaviour may develop after a child experiences pain or fear during a bowel movement, such as when they have anal fissures. This behaviour exacerbates the problem by further hardening the stool and making subsequent bowel movements more painful.
  • Changes in the toilet environment, such as encountering new or unpleasant school facilities or being instructed to delay using the toilet, especially during school hours, can contribute to constipation.
  • Following an acute illness such as gastroenteritis 
  • Some children naturally have slower gut movement (also referred to as gut motility or gastric dysmotility), contributing to constipation.
  • Dietary factors play a significant role, with a diet high in processed foods and lacking fresh fruits and vegetables increasing the risk of constipation. Excessive consumption of cow’s milk can also lead to constipation in some children. Constipation can also occur after starting solids in babies or changing from breast milk to formula or cows milk
  • Certain diseases, although rare, can cause constipation in children. These include conditions like the absence of normal nerve endings in parts of the bowel, spinal cord defects, thyroid deficiencies, and specific metabolic disorders. While uncommon, it’s essential for your doctor to evaluate your child for these conditions if constipation persists.


Physical signs of constipation may include increased bloating in your child’s abdomen, with palpable hard lumps of stool when gently pressing on their stomach.You only need to worry about the firmness or frequency of your child’s poo if it seems to be causing a problem. There are a few other symptoms and complications that can evolve as a result of constipation that you should be aware of, including:

  • Intermittent stomach cramps, characterised by pain that comes and goes.
  • Decreased appetite in your child compared to their usual eating habits.
  • Irritable behaviour, which may be a result of discomfort and frustration.
  • Anal fissures, small tears in the skin around the anus, causing pain and sometimes bleeding during bowel movements, often due to straining to pass large, hard stools.
  • Further exacerbation of holding-on behaviour, such as squatting, crossing legs, or refusing to sit on the toilet, as a response to discomfort during bowel movements.
  • Physical signs of constipation may include increased bloating in your child’s abdomen, with palpable hard lumps of stool when gently pressing on their stomach.
  • In the long term, untreated constipation can lead to a condition called “encopresis” or “faecal incontinence,” where your child may involuntarily soil themselves, either by passing stool or experiencing large smears in their pants. This occurs when the rectum becomes chronically distended from retained poo, diminishing the child’s sensation of needing to use the toilet. As a result, poo may leak into their underwear without them being aware of it.

Stool chart, describing poo types of children with constipation

Image source:

Fortunately, there are numerous strategies and lifestyle changes that can help alleviate and prevent constipation in kids. 

  1. Encourage regular toilet use by getting them to sit on the toilet after meals, preferably after breakfast, lunch, and dinner, regardless of the urge to poo. Set a timer for three to five minutes to ensure adequate time spent on the toilet. * A paediatric nurse tip – give them an engaging book to look at or play a podcast for them to listen to so they don’t get bored 
  2. Encourage your child to respond to their body’s signals for number two’s.
  3. Ensure proper toilet equipment, such as a seat adapter and footstool, for comfortable and effective use.
  4. Address any fears your child may have about using the toilet, such as fear of falling in, by providing support and safety measures like footstools or rails.
  5. Assess if your child has concerns about using public toilets and explore solutions to alleviate their worries.
  6. Increasing fibre intake can aid in managing constipation. Incorporate fibre-rich foods such as fruits with peel, prune juice, vegetables, and less processed cereals. Psyllium husk fibre is a natural fibre supplement that helps soften the poo and is a mild laxative. It can be mixed into your child’s food.
  7. Limit cow’s milk intake to 500 ml per day for children over 18 months old and avoid sugary drinks before meals to stimulate appetite.
  8. For Babies: Introduce more fruits and vegetables into your baby’s diet and consider offering prune juice or changing formula if constipation persists.

Image source: Link here

Ensure proper toilet equipment: Sit your child on the toilet with feet and legs apart. Your child should lean forward with a straight back. You can use a footstool to support your child’s feet. 

When to Seek Medical Attention:

  • Consult a healthcare professional if your baby is under 12 months old and showing signs of constipation.
  • For older children, seek medical advice if dietary changes fail to relieve constipation or if your child experiences significant pain or rectal bleeding.
  • Your doctor may recommend laxatives for chronic constipation, in addition to promoting healthy bowel habits. You can obtain laxatives over the counter – but it is not recommended to start these on children without medical advice


For my son, we decided to replace the toilet seat cover with a fun decorative toilet seat that he picked out himself. He chose the most outrageous frog themed green toilet seat, but it worked a treat! As soon as we had replaced the old toilet seat with the new one, he felt confident to return to taking himself to the toilet when he felt the need to go!