Constipation in children: what helps, and when should we get help?

Why it happens

Constipation often starts when a child has hard poo for a while and it hurts, so they avoid going (1177). Holding back makes the next poo bigger and more painful, a vicious circle (1177, NHS). Common reasons a child holds back (1177):

• School toilets: children like a safe, familiar place. They may avoid pooing if the door cannot be locked, the toilet is dirty or they do not get any peace.
• Too busy: a child can be so caught up in playing that they ignore the urge.
• Changes: starting school, or after an illness when they drank less than they needed.
• Food, drink and movement: too little fibre, too much binding food, too little to drink, or sitting still a lot.
• Worry and stress can also be a cause (1177, NHS).

Sometimes constipation is a sign of a disease such as coeliac disease, cow's milk protein allergy or an underactive thyroid, but usually there is no such cause (1177). Lactose intolerance does not cause constipation. Do not change your child's diet on your own if you suspect a food allergy: contact your health centre instead (1177).

It can affect peeing and underwear too

• Bladder: hard poo can press on the bladder, so the child needs to pee more often or wets themselves. Some children get repeated urinary tract infections (1177). Read more in our bedwetting guide.
• Leaks: loose poo can leak past a hard lump in the bowel. It is easy to think it is diarrhoea (1177). It is not your child's fault, so there is no reason to get cross. Staying calm and relaxed helps most (NHS).

What helps at home

• Fibre: wholegrain bread, cereals, oats and pasta, root vegetables, vegetables, fruit and berries. Fruits that can help are prunes, apricots, raisins, figs, pears and kiwi (1177).
• Water: make sure there is water when your child is thirsty, and choose water over sweet drinks. Peeing regularly is a good sign they drink enough. More fibre without enough to drink can make things worse (1177).
• Less binding food: cut down if your child eats a lot of white flour foods such as pasta, white bread and pancakes, white rice or bananas (1177).
• Move: moving the body helps the bowel work. Children aged 6 and older are advised to be active for at least an hour a day in total (1177). See our guide to movement.
• Toilet time after meals: the urge to poo often comes after a meal. Encourage your child to try after breakfast, lunch and dinner, but do not nag (1177). Praise them whether or not they poo (NHS).
• Do not hold it in: it is important to go when the urge comes (1177).
• Feet on a stool: pooing is easier with the feet supported, so use a footstool on the toilet (1177, NHS).
• Sore bottom: a soothing ointment can help with cracks, and there are pain-relieving ointments to use just before pooing. Ask a pharmacist (1177).
• Never try to solve constipation by putting something, such as a thermometer, into your child's bottom. It can cause injury (1177).

At school

Talk to the staff if your child finds it hard to poo at school, and try to find solutions together, for example a quieter toilet. Ask your child first whether it is OK for you to talk to the staff, and let them join in if they want to (1177). Ask your child if they feel worried about using the toilet at school (NHS).

Medicine and treatment

There are over-the-counter medicines for constipation. Which one suits depends on your child's age, so ask your health centre or a pharmacy (1177). If home advice does not help, a doctor can prescribe a softening medicine, usually a powder mixed with water (1177).

• Keep going long enough: your child should use it until they have had no problems for at least a month, sometimes longer, and then reduce the dose slowly over a few weeks. For many children it takes several months, and some need it for a year or more (1177).
• Do not stop too early: even when the poo is soft, your child may remember how much it hurt and hold back again. Using softening medicine for a long time is not harmful (1177).
• Get help early: the longer constipation goes on, the harder it can be to get back to normal. Treatment may make leaks worse before they get better (NHS).