Medically reviewed by Dr Deborah Lee, _Dr Fox Online Pharmac_y.
Seeing your little one in any sort of discomfort can be really distressing for the both of you. If toddler constipation is causing your child to feel poorly, you'll want to know how to relieve this uncomfortable feeling as soon as possible.
According to you the NHS: "Constipation is common in childhood, particularly when children are being potty trained at around 2 to 3 years old. If your child is constipated they may find it painful to poo, which may mean they do not want to try to poo. This can create a vicious circle; the more they hold back, the more constipated they get.", says the NHS.
NHS Data has also found a 60% rise in hospital diagnoses of constipation in primary schoolchildren in the past decade, with increases also seen in preschool and secondary age groups. But the figures have also shown that more than 44,000 children were admitted to hospital with constipation last year alone.
Constipation can leave children mentally scarred for life
Unless constipation is addressed early and effectively, some children can rapidly develop a “megarectum”. They lose the sensation that might give them the urge to defecate when necessary. This, combined with behavioural problems inherent in this presentation, can lead to overflow soiling and chronic faecal incontinence.
According to Dr. Deborah Lee_,_ Dr Fox Online Pharmacy, they say: "Constipation is common in toddlers and preschool children, and it may be a problem for children from 12 months of age and may be noted, for example, during potty training.
This is known as functional constipation, meaning the child is perfectly healthy, and constipation has a natural underlying cause, says Dr. Lee.
How to know if a toddler has constipation?
There’s a wide range of normal when it comes to how often a toddler should have a poo. However, when constipated, a toddler will be only doing two poos a week or less. They may seem to be in discomfort when they do it, and the poo is hard and lumpy.
An occasional hard poo is nothing to worry about. But if this happens regularly, it’s time to take note and do something about it, says Dr. Lee.
Symptoms of toddler constipation
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Only pooing twice a week or less
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Poo is hard and lumpy, very large hard stools, or like little pebbles
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The child may hop around on their tip toes and not want to sit down and try and have a poo
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They may have a bloated tummy
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They may have blood in the poo
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Sometimes constipation causes overflow diarrhoea
Causes
The vast majority of toddler constipation does not have a serious underlying medical cause.
Most commonly it is due to
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Not drinking enough fluids
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Not having enough fibre in the diet
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They just prefer to keep playing
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Embarrassment
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Feeling nervous or anxious
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They are not ready for toilet training
Medical reasons for constipation
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A side effect of medication – such as cough medicines, antihistamines, antacids, and anticonvulsants
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Diabetes
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Hypothyroidism (an underactive thyroid)
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Coeliac disease
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Hirschsprung’s disease (a congenital condition in which the nerves supplying the large bowel are missing)
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Spina bifida
Constipation and gut function
Constipation in young children has the same underlying causes as constipation in adults. Most often this is due to too little fibre in the diet and dehydration. However, in children, anxiety at home or at nursery/preschool can make them fearful of going to the toilet. This can cause emotional distress, embarrassment and psychological difficulties, says Dr. Lee.
Just like adults, food passes from the stomach into the intestines, and passes along due to the muscular action of muscles in the bowel wall – peristalsis. Fibre in partially digested food is vital for good gut function. It bulks out the intestinal contents, exerting pressure on the bowel wall which stimulates peristalsis. As the food passes along, water is absorbed from the gut into the bloodstream. If there is not enough fibre, the food passes along too slowly, allowing more time for water to be absorbed. As a result, the stool is harder, more difficult and painful to pass. Hence too little fibre is the major cause of constipation, adds Dr. Lee.
Factors linked to toddler constipation
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Dehydration – There must be enough water in the gastrointestinal system to avoid constipation. Parents may not realise that their child is dehydrated. Children are at higher risk of dehydration than adults. Often they may not recognise the symptoms of thirst. They can't help themselves to a glass of water, they have to ask. They may sweat more when playing outside. Because of their lower body weight, they have a proportionally larger surface area to lose water from, says Dr. Lee.
Studies show children are not drinking enough water. The UK Diet and National Survey of Children aged 1-18 reported that 25% of children are drinking less than one glass of water at mealtimes. In another study, only 6.1% of children regularly drank water at breakfast and only sipped water during the morning.
Living in poverty – 7.2 million people are now living in food poverty. 2.3 million have used a food bank including families and children. If given vegetables, many families cannot afford the energy costs of cooking them.
Cost of living crisis - 60% of families say they have bought less fruit and 44% less vegetables. It’s sad that the cheapest fruit and vegetables tend to contain the highest amounts of sugar. Whole grain foods tend to be more expensive than the white varieties.
Processed and ultra-processed foods (UPF) – A recent 2024 study revealed that 46.9% (almost half) of a toddler's diet consists of UPF. This rises to 59% for children aged 7. This is a major cause of constipation as UPF tends to be high in fat, sugar and salt.
High sugar drinks – The high sugar intake of children is alarming. 84% have at least one sugary snack a day. 45% of children regularly consume fizzy drinks. Energy drinks are not suitable for children and should not be consumed by children under age 16. High sugar intake is closely linked to constipation, says Dr. Lee.
Children going to school not toilet-trained - 1 in 4 UK children are going to school in reception class aged 4 and are not toilet-trained. Because of this, children face humiliation in the classroom and then try not to have to open their bowels at school. It’s understandably very upsetting and causes tummy pain and distress.
Treating toddler constipation
Parents need to be aware of their child's bowel habits – Look out for signs your child could be constipated -
On average, a child should have three softish poos per week. The parents need to take note of what is in the potty or the toilet. If they pass large, hard lumpy stools or little hard rabbity pellets, something is wrong. Constipation can also result in overflow diarrhoea.
Keep an eye on the child and see if they are straining to have a poo or if it seems uncomfortable.
Any bleeding during opening their bowels is a poor sign. Rarely, small children can get hemorrhoids (piles) and anal fissures. This should always be reported to your GP. Also, they may complain of tummy aches during the day, lose their appetite and may not want to eat at mealtimes, says Dr. Lee.
Rarely, in very severe constipation, the child may develop faecal impaction. The poo becomes a solid mass in the large bowel and the child is unable to pass any stool at all. This is associated with abdominal pain, nausea, vomiting, and faecal soiling.
How to improve toddler constipation
Ensure your child is having enough water - Start by making sure your child has a drink at mealtimes, preferably plain water. Babies can drink cooled boiled water between feeds. After 6 months, a baby can drink tap water.
Get a baby used to drinking water between meals at an early age. Offer water in a water bottle or a beaker regularly during the day – on waking up in the morning, after a nap, after a nappy change and before bed.
Make drinking water fun by letting them choose stickers to out on their bottle and letting them choose chopped up fruit to put it the bottle. You need your own water bottle to and should drink from it regularly as children love to copy adults.
Don’t give babies or small children fruit juice, squashes, fizzy or high sugar drinks. These not only cause tooth decay, but they also worsen constipation. Stick to plain old water! Milk is an alternative and this is good for hydration, says Dr. Lee.
Make sure your child is getting enough fibre - Make sure your toddler eats lots of fruit and vegetables. By the age of 1, a toddler can eat any fruit or vegetable so long as it has been appropriately chopped up or cooked to soften it a little. Fruit like apple, banana or strawberry can be chopped into small pieces. Apples and pears can be pureed (don’t add sugar).
You can encourage children to eat healthily. Sit facing your child when they eat and give them your full attention. You might like to eat the same yourself as they love to copy what adults do. Make mealtimes fun – no mobile phones at the table.
Fibre is present in many foods – lentils, chickpeas, beans, and whole grains. Get into the habit of adding these to soups, casseroles and stews. Whole grains are full of fibre so give them brown bread, rice and pasta rather than white alternatives. Choose high-fibre, low-sugar breakfast cereals.
Healthy snacks - Make sure your child has healthy snacks such as fruit, yoghurt, peanut butter, popcorn, savoury muffins or pancakes, for example.
Avoid processed and UPF as much as you can - Cook from scratch so you know what is in your child’s food. It is the hidden additives – preservatives, emulsifiers, flavourings, and colourants that need to be avoided, says Dr. Lee.
Cook with healthy unsaturated fats - such as olive, sunflower or avocado oil.
Don’t add salt to children’s food – This is dangerous and can cause many health issues including high blood pressure and increased risk of heart disease, as well as causing constipation.
Encourage your child to get plenty of exercise - After meals, let them play as physical activity stimulates bowel function.
A warm bath after dinner and before bed – This can help relax their tummy muscles and make pooing easier.
Start potty training - Potty training should start between 18 months and 2 years. A child should be toilet trained before they go to school.
Sit them on the potty, or on the toilet for 5 minutes after every meal and encourage them to go. After eating a meal there is a natural reflex – the gastrocolic reflex – which tells the body to open the bowels. Don’t overly stress about this, but it can help to try and set a pattern.
When they need a poo, you need to be calm and reassuring. They need to learn that having a poo is part of human life for us all and it's nothing to be ashamed about.
Keep a stool chart - You might like to keep a stool chart and praise them when they’ve done well, for example, the ERIC poo chart.
See your GP - If you are concerned about your child's bowel habits, take them to see their GP.
Laxatives are sometimes prescribed for children. These include -
Stimulant laxatives include senna, docusate and bisacodyl, which stimulate peristalsis.
Macrogol or lactulose are osmotic laxatives that work by drawing water into the large bowel and stimulating peristalsis ( the muscular contractions in the bowel wall)." advises Dr. Lee.
About the expert
Having worked for many years in the NHS, mostly as Lead Clinician within an integrated Community Sexual Health Service, Dr Deborah Lee now works as a health and medical writer, with an emphasis on women's health, including medical content for Dr Fox pharmacy. She has published several books and remains passionate about all aspects of medicine and sexual health. After completing her Medical Degree at University of Southampton Medical School in 1986, Dr Lee trained as a GP and after a number of years specialised in Sexual & Reproductive Health (S&RH).
Mummy to a little girl, Adejumoke Ilori is Commercial Content Writer for Mother&Baby. With a BA hon in Creative Writing, she has worked for digital platforms, where she has empowered women from the inside and out, by sharing real life stories based on relationships and loving yourself.