Constipation is common in childhood, particularly when children are being potty trained at around two to three years old. This advice is aimed at children after weaning (older than 6 months old).
Constipation
Advice for professionals
What are the symptoms of constipation in children?
These can be tricky to spot. Your child may be constipated if:
- They don't poo at least three times a week
- Their poo is often large, hard and difficult to push out
- Their poo looks like "rabbit droppings" or little pellets
If your child is potty trained, soiled pants can be another sign of constipation, because runny poo (diarrhoea) may leak out around the hard, constipated poo. This is called overflow soiling.
If your child is constipated, they may find it painful to poo. This can create a cycle: the more it hurts, the more they hold on to poo. The more constipated they get, the more it hurts, and so on. Even if pooing isn't painful, once your child is really constipated, they may try to avoid going to the toilet altogether.
Why do children get constipated?
Your child may be constipated because they:
- Hold onto stool due to fear of using toilets (smelly / lack of privacy etc)
- Aren't drinking enough
- Aren't eating enough high-fibre foods like fruit and veg
- Are having problems with potty (or toilet) training
- are worried or anxious about something, such as moving house, starting nursery or the arrival of a new baby.
Find out about other causes of constipation in children.
What should you do and when should you worry?
In general, children only need treatment for constipation if it is causing them pain or problems (such as soiling in school).
If your child is experiencing significant pain or regularly soiling their pants, despite being on treatment, you should take them back to see your GP. Some children need more intensive treatment of their constipation. Your GP may decide that a paediatrician needs to be involved in their care
Not all tummy pain is due to constipation - if your baby/child develops new severe tummy ache, please click here for advice about what to do
You need urgent help
Go to the nearest Hospital Emergency (A&E) Department or phone 999
What if your child’s constipation continues despite changing their diet?
If your child remains constipated despite the options listed above, take them to their GP who can decide if they need medicines. The treatment for constipation depends on your child’s age. The longer your child is constipated, the longer it can take to get back to normal, so do get help early from your GP
Laxatives often help children, alongside diet and lifestyle changes. Movicol is most commonly used as a stool softener, with stimulants such as senna added in if no improvement
For a significant blockage: disimpaction with Movicol is initially with 2 sachets a day for children under 5 years of age (with 60ml water per sachet) increasing by 2 sachets a day (max 8/day) until stools watery and clear/brown then halve dose then reduce by 1 sachet a week to a regular dose (maintenance) that helps keep the stools soft
Spacing out the doses through the day, and mixing squash or juice or keeping the dose cold in the fridge may help taste
It may take several months for the treatments to work, but keep trying until they do. Remember that laxative treatment may make your child's overflow soiling worse for a time
You need to contact a doctor or nurse today
Please ring your GP surgery or call NHS 111 - dial 111
Firstly, try to stay calm
Getting constipated and soiling their clothes isn't something your child is doing on purpose, so please be patient. You may both find the situation stressful, but staying positive and relaxed is the best attitude to help your child, and praising positive steps is important
Think about changes to your child’s diet
Make sure that children drink plenty of fluids and encourage them to eat fruit. Chop or purée it if it's easier for them to eat. The best fruits for constipation include apples, grapes, pears and strawberries
If your child is potty training, they may be feeling anxious or stressed about using the toilet. This can cause them to hold in poo and leads to constipation. Give your child plenty of time (5minutes) to use the toilet while they are still learning. Encourage them when they do use the toilet. Some parents find a reward chart works. Your health visitor can also provide advice and support
Self care
Continue providing your child’s care at home. If you are still concerned about your child, call NHS 111 – dial 111
This content has been developed by healthcare professionals from across the UK in collaboration with the RCPCH.
How to prevent your child getting constipated:
- Make sure your child has plenty to drink – offer breastfed babies who aren’t eating solids yet plenty of breastfeeds. Formula-fed babies can have extra drinks of water between their formula feeds. See more advice on drinks for babies and toddlers.
- Give your child a variety of foods, including plenty of fruit and vegetables, which are a good source of fibre. See what to feed young children.
- Encourage your child to be physically active. For more information, read the physical activity guidelines for children aged under five years.
- Get your child into a routine of regularly sitting on the potty or toilet, after meals or before bed (for 5 minutes), and praise them whether or not they poo. This is particularly important for potty-trained boys, who may forget about pooing once they are weeing standing up. Reward schemes appropriate for age are important; as is consistency and patience.
- Make sure your child can rest their feet flat on the floor or a step when they're using the potty or toilet, to get them in a good position for pooing. Take a look at the Children's Bowel & Bladder Charity's leaflet, Children’s Bowel Problems for a picture of this.
- Ask if they feel worried about using the potty or toilet – some children don't want to poo in certain situations, such as at nursery or school.
- Stay positive and reassuring, so that your child doesn't see going to the toilet as a stressful situation – you want your child to see pooing as a normal part of life, not something to be ashamed of.
For more information and support:
Click here to hear Dr Mark Tighe (consultant paediatrician) talking about managing constipation in children.
- NHS choices info on constipation in children
- ERIC’s guide to children’s bowel problems
- Contact the ERIC helpline on 0845 370 8008, Monday to Thursday 10am to 2pm, or email them a question ( helpline@eric.org.uk )
- NICE patient information:
There are many sensory issues associated with sleep including:
- Sensitivity to sound, touch, and visual stimuli which can be distracting and distressing and can affect the process of falling asleep.
- Interoception difficulties, particularly recognising when hungry, full or thirsty or when the person is tired.
- Some children are more sensitive to foods like sugar, caffeine and additives which keep people awake.
Look at the bedroom environment to see what may be affecting their ability to go to sleep and stay asleep. Do their pyjamas and bedclothes feel comfortable, are they too hot or cold? Is it too light or too dark, too noisy or too quiet? Perhaps it is too cluttered and stimulating. Think about your child’s diet. Are they eating too early or not having enough to eat? Are they eating food that can stimulate them close to bedtime. There can be added difficulties where children have restrictive diets but some simple adjustments of what is eaten and when can make a big difference.
Sticking to the same routine helps your child to know what to expect at bedtime and helps them feel secure. It also helps to support your child’s internal body clock and keep it on track. The age related sleep advice and information on this website can help with establishing routines. Some children will benefit from using picture timetables, timers or social stories to help them understand their bed-time routine. More information about visual supports can be found on these websites
Visual Resources | Autism West Midlands
Visual Supports | Autism Toolbox Autism Toolbox
Your child may be feeling overstimulated after a busy day and needs help to wind down, or their environment may be overstimulating with lots of toys, TVs and computers within reach. Avoiding TV and computers or hand-held devices an hour before bedtime can help your child to wind down. Activities that are good for the wind down period are jigsaws and colouring. Having a relaxing bath and milky drink can help some children, but for some children having a bath can over-excite them so they may need to have their bath earlier in the day.
Children who wake to use the toilet, wet the bed, or who wear nappies or pull-ups at night that need changing may have disturbed sleep. Eric, the children’s bowel and bladder charity are a good source of advice on this topic.
What might help
Keeping a sleep diary
A sleep diary can help you understand what may be causing difficulties with sleep. Fill it out every evening and record as much as you can. You can use it to spot patterns and make changes that may help.
The Sleep Charity have templates you can download; one for teenagers and one for younger children.
Seeking advice and help from sleep services
There are organisations that can help you if you are having difficulties with your child’s sleep. There are many national organisations, including those who specialise in sleep for SEND families, and there are also community-based services in Shropshire, Telford and Wrekin. Click the link at the bottom of page to visit our support services page.
Understanding sleep cycles
The circadian sleep cycle is a 24-hour cycle that helps govern essential bodily functions especially the sleep-wake cycle. It plays a vital role in a person’s ability to sleep in one consolidated block of time at night and to stay awake during the day. As the sun sets in the evening, the brain begins producing melatonin, a hormone that induces sleepiness. Core body temperature also drops.
As melatonin and tryptophan (an amino acid which helps produce melatonin) are naturally produced in the body, there are things you can do to help their production. Darkness helps to promote the production of melatonin which is why it is a good idea to put your child to sleep in a darkened room, and light emitting devices such as tablets and phones also can destroy Melatonin so should not be used for at least an hour before bed. New research shows that limiting exposure to screens and increasing physical activity levels during the day has a positive effect on children's overall physical, mental health and wellbeing, including sleep.
Setting a waking time consistently even in holiday times, called ‘anchoring’ the wake time, can help to reset the body clock over time. This should be accompanied with exposure to lots of light on waking to support circadian rhythm.
Melatonin and tryptophan occur naturally in some foods and drinks such as milky drinks and cereals which is why having a milky drink before bed can help settling to sleep. For more information visit Diet & Sleep - The Sleep Charity
Prescriptions of melatonin
Behavioural strategies and practical solutions are the best way to address sleep difficulties, but if they are having a significant impact on your child’s ability to function, a drug form of melatonin is sometimes prescribed for neurodivergent children. As the drug’s function is to re-set sleep and wake cycles, it works best combined with good sleep hygiene practices. It is important that is it taken under medical supervision and not purchased on-line so that it is closely monitored for dosage and side effects. It should be prescribed for the shortest period necessary as the long-term effects of the drug on children’s development are not yet known.
In Shropshire, Telford and Wrekin the Community Paediatric Service and the BeeU Service (CAMHS) can prescribe Melatonin for children and young people who meet ALL of the following criteria.
- the child/young person must be open to and being treated by the service due to a neurodevelopmental/mental health need (diagnosis not required)
- sleep issues are causing significant impact on the child/ young person, for example due to daytime sleeping or behavioural problems that are impacting daily functioning or educational attendance
- behavioural approaches have been tried and failed. These may have been offered by the service (where available) or by community sleep support services.
GPs are unable to prescribe Melatonin although they sometimes issue repeat prescriptions when prescribing has been started by a specialist (such as a paediatrician or child psychiatrist).
Further support
Click on the link below to visit a page with information about
- national websites and sleep organisations
- local community services in Shropshire, Telford and Wrekin.