Children's legs hanging down from a chamber-potConstipation is really, very truly, no fun for anyone. No fun for baby or child, no fun for the parent who worries and watches and cleans the clogged toilet, and clearly nothing wonderful for the sister or brother who waits while a family supports a child in the room next door. In general, constipation is a frustrating, sometimes hugely embarrassing, and often a chronic problem for young children. In my experience, parents worry a lot about hard infant or toddler poop in the diaper (goal is always peanut butter consistency or softer) but it’s when constipation sneaks up on many families in school-aged children that BIG suffering ensues.

I can’t say this loud enough: if you’re worried about constipation in your child do consider seeing your pediatrician, nurse, family doc or physician assistant to make a long-term plan. Constipation DOES get better but do know it’s over weeks to months. When your child’s intestinal tubing is stretched out for weeks it takes weeks to re-configure sometimes — quick fixes won’t be long term solutions. More below on which remedies to use and how.

Constipation sneaks up because after children are toilet trained and wiping themselves (around age 4 or 5) many parents no longer gaze in the toilet bowl so gone are the days of tracking daily poops. Before you reach for OTC medications, consider what is normal and what is not normal when it comes to poop (below). I usually break this down for children (and parents) in visual terms. I talk about things you find outside:

In general, poop in the toilet can look like a pond, a snakea log, or a pebble. When it comes to poop, we’re always looking for snakes. It seems to me that framed this way, school age children can do a better job knowing if they’re constipated or not. We’re looking for  Snakes in the Lake, people! Frame it this way with your child and perhaps they will be more likely to get a glimpse of what they produce in the toilet? Or at least a report?

Lots of foods, hydration and OTC medicines can quickly change the game with constipation. Before I detail more specifics on constipation and highlight some remedies, I do want to call attention to some potential concerns of polyethylene glycol (PEG 3350). The medicine PEG 3350 is an odorless, tasteless laxative that can be easily diluted in juice or water. It’s a big polymer and can’t be absorbed by the intestine so it works by binding to water so that water ingested can’t leave the intestines, colon, and rectum. The great news is it doesn’t cause cramping or more pain and isn’t addictive. Used daily (often for days or weeks) the powder binds to water and disallows the colon to dehydrate the poop so it just doesn’t get hard. Therefore the poop that comes out is soft and often helps produce less painful pooping — and often it comes out more often! It’s commonly sold under both brand (Miralax) and various generic names. However, the Food and Drug Administration (FDA) has only approved its use in adults, not children. Currently, PEG 3350 is being studied as well as the bi-products of PEG 3350, specifically ethylene glycol (EG) and diethylene glycol (DEG), to determine whether it might be absorbed by children and whether use of the laxatives is linked to development of psychiatric or neurodevelopmental problems. The New York Times has done 2 stories on this topic: one in 2012 and one more recently in 2015, both worth a read if you are debating giving your child PEG3350. For children and families with severe constipation often the benefits of using it far outweigh the concerns.

What Is Constipation And Why?

Any child can be constipated, and it seems to run in families, but from the beginning it’s exceedingly rare to find constipation in breast-fed babies. That being said, some kids just come out more prone to constipation than others. It’s not just hard poop but rather a combination of hard poop and poop that doesn’t come out every day. The reason a typical child gets constipated is they lack good fiber in their diet, the poop sits in their colon longer than normal, and they hold the poop in because it hurts when it comes out. The vicious cycle of lacking fiber, having tummy pain, not wanting to poop, and poop getting dehydrated in the colon perpetuates and cycles and then constipation can set in.

  • For infants, constipation is hard, packed stools that come out less often than every other day. When poop comes out the poop can look like pebbles (or logs) in the diaper and even have a tiny bit of blood on the outside from an infant straining and tearing their skin when pushing it out. First line of defense is adding a bit of juice (1-2 oz pear or prune daily) to diet. If over 6 months, increase foods with high fiber (mango, pear, prune) & decrease constipating ones (rice, cereals, banana, carrot, potato).
  • In toddlers and preschoolers, constipation often occurs because of a more picky diet (normal!) that is deplete in fiber and water married with confusion or battles and pain around the time of stooling as children potty train. Some kids just start holding their poop in as they worry and/or learn to poop independently on the toilet. Constipation is defined as hard, painful or dry poops (logs/pebbles) that come less often than every 3 days. But if preschoolers are starting to hold their poop in during this time, it’s a good time to work diligently for a daily soft poop, increasing fruits/veggies/whole grains to ensure you don’t start the viscous cycle.
  • For school-aged children over age 4 constipation diagnosis requires 2 or more of the following symptoms (occurring at least once a week for two months)
    • At least one episode of fecal incontinence (leaking poop) per week.
    • History of retentive posturing or a child holding their poop in rather than going poop when they feel they need to.
    • History of painful or hard bowel movements.
    • Presence of a large fecal mass in the rectum (doctor would feel this on a quick rectal exam with their gloved-finger).
    • History of large-diameter stools that may obstruct the toilet.

KNOW THIS: constipation is a common reason to see the pediatrician (up to 1 in 20 visits are for constipation) so don’t be shy if you’re worried about your child’s poop. The longer you wait to do something about this, the harder the poop may get and potentially the longer it will take to correct your child’s habits.

constipation

OTC Remedies For Constipation In Children:

In general I would say that if you use an OTC medication for your child’s constipation for more than 2 times, I think it’s worth seeing the pediatrician. There are often tips we can provide and exam findings that can help guide how to support your child’s pooping habits and help make the process of constipation end faster. If a child has been constipated for months, know that it may take months to correct the problem. Using medications for constipation are not typically a one-time fix. With constipation the muscles in the rectum and colon can stretch out and will need regular poop flying through every day for weeks to months to enable them to return to normal size.

  • Stool softeners: Stool softeners are found as suppositories (ie glycerin), or liquids (ie lactulose). Softeners work to literally just loosen and soften the poop.
  • Enemas: Enemas are often needed for children who have poop stains in their underwear or poop accidents because there is a hard ball of stool in their rectum that poop is leaking around. The enema will break that ball up and help your children get rid of it. I would ALWAYS recommend seeing a pediatrician before using an enema to ensure it’s the right thing to do (it can be not only messy, but embarrassing and traumatizing for both children and parents who aren’t comfortable). Often a child will need a quick rectal exam first to ensure normal muscle tone and a good reason for using an enema in the first place (hard ball of stool in the rectum). There are FDA warnings about safety of some enemas (Sodium Phosphate) if used too frequently so review dose and type of enema with nurse or doctor you plan to use prior!
  • Fibery foods: Encourage your child to drink plenty of water and eat more high-fiber foods such as: prunes, apricots, plums, raisins, high-fiber vegetables (peas, beans, broccoli), and whole-grain cereals and bread products. At the same time, cut back on foods such as rice, bananas, and cereals or breads that are not high in fiber.
  • Poop Stop Before Bus Stop: Help your child set up a regular toilet routine. That means plan a poop stop before the bus stop!
  • Get Moving: Encourage your child to be physically active. Exercise along with a balanced diet provides the foundation for a healthy, active life but also can help with constipation…

5-13 know your OTCs

This post was written in partnership with KnowYourOTCs.org. In exchange for our ongoing partnership helping families understand how to use OTC (over-the-counter) meds safely they have made a contribution to Digital Health at Seattle Children’s for our work in innovation. I adore the OTC Safety tagline, “Treat yourself and your family with care all year long.” Follow @KnowYourOTCs # KnowYourOTCs for more info on health and wellness.