Why won’t my child poop? Basics of Constipation

by Shari Burns, MD

Poop. It’s something we don’t like to talk about as children, but we can’t stop talking about it once we have children of our own. We all focus on bowel movements once we become parents – frequency, color, consistency, straining, discomfort, and gas. Constipation is one of the most common topics we discuss at routine well child care visits. And it is probably one of the more misunderstood topics as well.

Constipation, by definition, is not only having infrequent bowel movements, but it also includes passing hard stools. Painful stools. Stool size can vary from very large to small and pebble-like. The confusing part, though, is that stool can also be loose or liquidy, which often causes us to not consider constipation as a diagnosis. Constipation is also very common. It affects nearly 30% of children at some point.

The ability to stool requires a lot of coordination within the large intestine (also known as the colon). The muscles of the colon contract regularly, which leads to successful stool passage in most cases. However, as stools become harder, this contraction and ability to pass stools becomes more difficult. If there is large and hard stool in the colon, this can often lead to the passage of loose stool from around the hard stool, which then results in what many report as diarrhea. Stool can even leak in those patients that are potty trained, which can result in messy accidents. Making things worse is that children will try to hold stool once it becomes painful, which only leads to more difficulty passing stool.

Newborns typically stool many times per day, but this pattern can change within a few months. Some infants pass stool about once per week, and this is normal in most cases. We suggest that you talk to your child’s doctor with all concerns, but as long as the baby is eating well and appears comfortable, then this is not usually a major medical cause for concern. Stool frequency changes as children get older, and most potty trained children will stool once to twice daily. This stool should be soft and easy to pass.

The keys to normal stool include adequate water intake, adequate fiber intake, and adequate time to pass the stool. These factors are often neglected, especially as our toddlers get pickier about their eating and our children forget to drink enough water. Then there is the time issue – kids don’t want to take the time to poop. Maybe those adolescents and their cell phones will contribute to healthier bowel habits!

For best results, make sure your children are drinking plenty of water and eating a high-fiber diet. Encourage them to take the time to use the bathroom. It is often best to have them sit on the toilet after meals, as this is when we can be expect the muscles of the colon to help us most. They might need to use a foot rest to get the best position. Sitting on a toilet with your feet dangling in the air is a very UNNATURAL way to pass stool. Some straining can be normal, but passing stool should not be painful. And if there is blood present, you should talk to your child’s doctor.

There are many things we can try to help with passing stool, from diet changes to medications. The suggestions will vary with the age of the child, so there is no advice that fits all children, other than what is mentioned above. If you have questions, please schedule an ill appointment, or discuss them at your routine well child visits. As Pediatricians, we are very comfortable talking about poop!