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Constipation (Pediatric)

What is constipation?

Constipation is a common problem characterized by infrequent bowel movements or hard, dry stools that may be accompanied by straining.


Various factors can lead to constipation in children. Among the most common are early toilet training, withholding, and changes in diet. Others causes include:

  • Changes in routine
  • Medications
  • Allergy to cow’s milk
  • Family history
  • Certain medications
  • Other medical conditions

Fortunately, most cases of constipation in children are temporary.

What are the symptoms of constipation?

  • Fewer than three bowel movements a week
  • Bowel movements that are hard, dry, large and difficult to pass
  • Painful bowel movement
  • Abdominal pain
  • Traces of liquid or clay-like stool in your child’s underwear — a sign that stool has backed up in the rectum

How is constipation diagnosed?

The first step is a complete medical history and physical exam.

Your child’s physician will place a gloved finger into your child’s anus to check for abnormalities or the presence of impacted stool. Stool found in the rectum may be tested for blood.

More extensive testing is usually reserved for certain cases of constipation. If necessary, these tests may include:

  • Abdominal X-ray
  • Anorectal manometry: a thin tube called a catheter is placed in the rectum to measure the coordination of the muscles and nerve signaling.
  • Barium enema X-ray
  • Rectal biopsy: a small sample of tissue is taken from the lining of the rectum to see if nerve cells are normal.
  • Transit study or marker study: your child will swallow a capsule containing markers that show up on X-rays taken over several days. The doctor will analyze the way the markers move through your child’s digestive tract.
  • Blood tests

How is constipation treated?

Often, simple changes in diet and routine help relieve constipation in children. The following regimen may be helpful:

  • A high-fiber diet
  • Adequate fluids
  • Adequate time for bowel movements
  • Parental reassurance and support

Depending on the circumstances, your child’s doctor may recommend fiber supplements, stool softeners, laxatives or rectal enemas.