Everyone poops, as the saying goes. Well, except for when sometimes, they don’t. For children who may prefer processed foods, or are learning their bodies’ natural gotta-go signals and cues, pooping regularly can be a real challenge.

Dr. Amari Howard sees this problem every day at Novant Health’s Wilmington Pediatric Specialty Division. As a pediatric gastroenterologist, Howard specializes in dealing with issues that occur all the way from the mouth to the other end of the digestive tract. These may include vomiting, belly pain, and/or other common woes that kids call a tummy ache. Most of the time, Howard said, the culprit is trouble pooping, otherwise known as constipation.

How do I know if my child is constipated?

By definition, constipation occurs when a child poops fewer than two times in one week, or experiences hard, painful bowel movements or even accidents. A study in the Journal of Pediatrics reports that 18% of toddlers and 14% of adolescents aged 4 to 18 regularly suffer from constipation. Howard said the number climbs as high as 40% in infants and children.

“Constipation is one of the most common things we see in pediatrics,” Howard said. “Pooping is not supposed to be very difficult. There shouldn’t be any straining. Kiddos that are in the bathroom for a very long time, 10 minutes or more, saying that they’re working on trying to poop, or if they’re excessively gassy, if they’re having any vomiting. These are the main symptoms.”

When constipation becomes severe, meaning a child has not had a bowel movement for several days, it can cause decreased appetite, bloating, nausea, reflux or diarrhea. If a child struggles with passing hard stools, he or she may develop small tears in the skin of the anus called anal fissures. These can be uncomfortable and cause small blood streaks on the toilet paper while wiping. A child may also leave streaks of stool in their underpants while passing gas, a result of incompletely passed or impacted stool in the bowels

A mom holds her infant and talks on the phone while her toddler son sits in the foreground.

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What causes constipation in children?

While constipation is sometimes caused by an underlying illness, like celiac disease or thyroid issues, most cases of constipation in children are referred to as functional constipation. This means that there is no underlying medical disease responsible for the symptom and it may be caused by diet or physical withholding.

“A big component is diet,” Howard said. “Toddlers eat a lot of french fries and chicken nuggets and are often not getting the fruits and vegetables they need in the quantities we need them to.”

Some reasons children may become constipated are:

  • A limited diet can cause hard poops, which then hurt to pass. A child may try to prevent going to the bathroom to avoid this physical discomfort. The same may occur with diaper rash. If it hurts to poop, kids might try not to do it. The problem then perpetuates itself as poop then becomes compacted and harder to pass.
  • Toddlers between ages 2-5 are learning to assert their independence. They may see holding back as a way of taking control of their body autonomy.
  • Sometimes kids don’t want to stop having fun to take a bathroom break. Older children may try to withhold going to the bathroom at school or in public restrooms.
  • Babies and young children are learning how to coordinate the muscles that are necessary to pass poop. Infants, Howard pointed out, must pass poop lying down, which can make it challenging to engage the pelvic floor muscles.

What can I do if my child is constipated?

Howard said the first step to remedying constipation is to make a few healthy changes.

“There are lifestyle things that we encourage parents to do,” Howard said. “Things like hydration, fiber, getting your fruits and vegetables in, being a little more active.”

Howard said she typically recommends the normal daily recommended amount of fiber for children, meaning you don’t need to go overboard on high-fiber foods or supplements when your child is constipated.

“Same with water and exercise. Just try to do the normal, recommended amount,” she said.

For children ages 2-3 years, 1 cup of fruit and 1 cup of vegetables is the amount recommended by the Centers for Disease Control and Prevention. For kids from ages 4-8, this increases to 1.5 cups each of fruits and veggies daily, and kids ages 9-13 should stay at 1.5 cups of fruit a day while increasing veggies to 2 cups each day.

To keep kids properly hydrated, parents should pass on sports drinks and reach for plain water instead. The exact amount of water a child needs depends on their age and weight, but here are some good guidelines: On a regular day, a toddler needs 16-32 ounces; a child 4-8 years old needs 36-60 ounces; and children 9 and older need 64 ounces or more.

Daily physical activity has myriad benefits for kids and helping to ease constipation is just one of them. During exercise, blood flow increases to the body’s muscles, including the intestinal muscles. When blood flow to the muscles of the digestive tract is optimal, elimination is optimal.

When these things aren’t enough, prescription medications are an option. “We have a lot of different medications under our belt,” Howard said.

Stool softeners may be helpful for when it’s difficult to pass large, hard poops. A stimulant medication may be helpful to assist the colon muscles with contracting, which helps things to move more effectively. Howard emphasized that in most cases, a child only needs medication temporarily, and it’s only in rare cases that he or she would need medication long term.

Howard said it’s important for parents to know that constipation is common and treatable. Kids who come to see her with tummy woes find a compassionate and caring supporter. Howard loves working with kids every day and finds talking about the GI system fascinating.

“This is definitely for me,” she said. “It’s fun talking about poop every single day, honestly.”

Pediatric specialty care in your neighborhood

Novant Health is committed to increasing access to pediatric specialty care in Wilmington, and welcomed several new children’s specialists to their team in 2022 to serve the coastal community. This commitment is part of Novant Health’s expanded partnership with University of North Carolina Health, and it allows parents to seek care for their children closer to home, with less travel and shorter wait times.

New and expanded services at Novant Health Nunnelee Pediatric Multispecialty Care - Autumn Hall and Novant Health Betty H. Cameron Women’s & Children’s Hospital include:

  • Pediatric neurology
  • Pediatric endocrinology
  • Pediatric neurosurgery
  • Pediatric cardiology
  • Pediatric gastroenterology
  • Pediatric hematology