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Printed at: 03:09:48 / 28-02-2021

Constipation in Infants and Children

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This Patient Information leaflet aims to explain what constipation is and the possible causes of constipation in young children. It gives advice on dietary management and how to prevent it.

What is constipation?
Constipation occurs when your child has difficulty passing a stool (poo, faeces) from the bowel because it is hard and painful. Constipation has been recognized as one of the most common infant digestive problems. Everyone’s bowel habits are different. Some children may go daily, others up to every 3 days. What is normal for one child may not be for another. What is important to remember is that no matter how often your child passes a stool, it should not hurt when they do.

Factors involved include:
1. Holding onto stools:
Sometimes children delay going to the toilet. This can be for various reasons, such as:
• A lack of time or privacy
• Being in a new environment with an unfamiliar toilet
• A change in their normal routine such as starting school
• A lack of exercise
• Emotional stress, anxiety or a family upset
• A behavioural issue

Waiting too long to go to the toilet can cause stool to build up in the bowel and as a result, it can become very hard, and sometimes very large. Children are often frightened to pass it as they know it will hurt.

2. Not enough fibre:
There are two types of fibre: Soluble and Insoluble.
• Soluble fibre helps draw and keep water in your large intestine making your stools softer and easier to pass. The best food sources are vegetables and fruit, beans and legumes, nuts and seeds and whole grains.
• Insoluble fibre adds bulk to our stools, which as a result helps the bowels to work properly and regularly and can help relieve constipation. Some food examples are nuts and seeds, potatoes, fruit with skin, many types of vegetables and whole grains.

3. Not enough fluid:
Drinking enough fluid each day helps to ensure the stools are soft and easy to pass through the bowel.
Prevention and treatment of constipation

1) Encourage plenty of drinks
• Try to give your child 6 to 8 small glasses of fluid a day. Your child will need to drink more fluids when increasing their fibre intake, as fibre absorbs fluid.
• Adequate fluids will also help laxative medicines work effectively
• If your child finds it difficult to drink lots of fluid, ice lollies, jelly and ice cream are a good way of increasing your child’s fluid intake but do remember these foods are high in sugar!
• Remember to not offer more than one pint of milk (approx. 570ml) each day as more than this can reduce your child’s appetite for other foods.

2) Include wholegrain breads and cereals in your diet:
• Wholegrain breakfast cereals such as wheat biscuits, shredded wheat, puffed wheat or porridge
• Wholegrain, wholemeal, seeded, high fibre bread, pittas, wraps, chapatis and crackers
• Wholemeal pasta and brown rice
• Wholemeal biscuits such as digestives, flapjacks, oatcakes, and fig rolls
• Raw bran is another good source of fibre but adding it to foods is NOT recommended for infants and toddlers. This is because bran can interfere with the absorption of important minerals, such as iron and zinc

3) Eat plenty of fruit and vegetables
• Try fruits such as bananas, apples, oranges and pears
• Choose vegetables such as carrots, broccoli, celery and jacket potato with skins on
• Include fresh, frozen and canned varieties
• Legumes and pulses such as peas, lentils, chickpeas and baked beans are good sources of fibre and they can also be added to stews, pasta sauces and casseroles
• Dried fruit can also be included such as raisins, apricots, apple, prunes, currants, or sultanas. However, they also contain high amounts of sugar, so keep sugary foods and drinks including fruit juices to mealtimes to keep your child’s teeth and gums healthy. Look after your child’s teeth by brushing them at least twice a day with a toothpaste containing fluoride.
• Aim for the recommended 5 portions a day. Below are some examples of a portion size:

4) Encourage a regular healthy meal pattern and toilet habit:
• A regular meal pattern, for example 3 meals and 2 snacks a day will also help the bowels to open
• Encourage your child to go to the toilet after a meal or at the same time every day to help
• ensure that their bowel is emptied
• Create a relaxed, private environment and allow your child plenty of time to sit on the toilet
• Your child will be encouraged to empty their bowel when they are using a potty or toilet if they can rest their feet flat on the floor or a step may be needed so that their knees are raised above their bottom.

5) Laxatives
• As diet is not the only cause of constipation, your doctor may need to prescribe a laxative for your child, to restore a normal bowel habit in which stools are soft and passed without discomfort
• Children may need to take the medication for several months, starting on a higher dose, sometimes referred to as a dis-impaction regime to empty the bowel of stool and then a reduced dose may be continued longer term to maintain a regular bowel pattern.
• Laxatives should be taken as per the advice from your child’s GP/Paediatrician and it can take a few days for them to have an effect. Stopping and starting them can reduce their effectiveness.

6) Exercise
Children and young people aged between 5 and 18, should aim for an average of at least 60 minutes of moderate intensity physical activity a day, spread across the week.
• Physical activity can help to relieve constipation by increasing bowel activity
• Encourage your child to get plenty of active play and take part in exercise to prevent the bowel from becoming sluggish

Remember your child may find it difficult, particularly if they are frightened or worried about emptying their bowels. Staying calm and relaxed is the best attitude to help your child deal with constipation. Use encouragement, reassurance and praise to help show your child that going to the toilet isn’t stressful. Treatment of constipation can sometimes take months to resolve, even with the use of prescribed laxatives. It is important to keep trying until your child’s constipation has been resolved and continue to follow the preventative steps to stop it from reoccurring.

Meal ideas to prevent and treat constipation

Breakfast Suggestions
• Bran flake cereal with sliced banana, dried fruit and milk
• Wheat biscuit cereal with chopped apple and milk
• Porridge with chopped apple and raisins
• Muesli cereal bar and two plums
• Wholemeal toast with peanut butter and some berries

Lunch Ideas
• Wholemeal roll/bread with tuna and sweetcorn
• Wholemeal pitta bread with hummus, tomato and cucumber
• Wholemeal muffin and a pear or orange
• Baked beans on wholemeal toast
• Jacket potato with vegetable chilli and salad
• Vegetable soup with wholemeal bread/roll
• Lentil dhal with wholemeal chapati

Main Meal Ideas
• Bean and vegetable casserole with wholemeal pitta bread
• Vegetable curry with brown rice
• Chilli con carne with wholemeal rice and salad
• Fish fingers, new potatoes and baked beans
• Stir fry chicken and vegetables with brown rice or noodles
• Meat and vegetable casserole with jacket potato
• Sausage casserole with mashed sweet potato and beans
• Fish, potato wedges and beans or peas
• Wholemeal pasta with vegetables
• Vegetable curry with brown rice

Snack Ideas
• Fresh fruit/vegetable sticks
• Wholemeal scone
• Oatcakes, muesli bar or malt loaf
• Wholemeal toast, bagel, muffin or chapatti
• Wholegrain or seeded crisp bread and cracker bread

The Bristol Stool Chart