Overview
Constipation means passing hard, painful stools that are delayed or infrequent, often with excessive straining. Normal stool frequency changes with age, so frequency alone does not indicate a problem. Functional constipation (no underlying medical cause) accounts for about 95% of cases in children.
Why this matters for your child
It's very common — and not your fault
Functional constipation is very common and is not caused by anything the parent did wrong. With the right plan, almost every child improves.
Treatment takes time
Treatment often takes months and sometimes years. Be patient — relapses are normal and do not mean treatment has failed.
Accidents are not behavioral
Fecal soiling (encopresis) is usually involuntary overflow from backed-up stool. It is not a behavioral problem and should not be punished.
When to see a doctor
Consider a specialist referral if:
- Constipation does not improve after adequate treatment
- There is concern for an underlying medical condition such as Hirschsprung disease, thyroid problems, celiac disease, or spinal abnormalities
How we evaluate this condition
History and physical exam
Constipation is diagnosed based on a thorough history and physical exam.
Testing is usually not needed
Routine lab tests, X-rays, or rectal exams are usually not needed unless there are warning signs.
Treatment & management options
Treatment has three main steps. See your pediatrician for weight-based and age-appropriate dosing and instructions specific to your child.
Step 1 — Cleanout phase (clearing backed-up stool)
This is typically accomplished in 3 days with two medications:
- Stool softener — polyethylene glycol (Miralax, Glycolax, or PEG)
- Stimulant laxative — senna or bisacodyl
Step 2 — Keeping stools soft (maintenance phase)
- PEG is the first-line maintenance treatment
- Other options include lactulose, milk of magnesia, senna, or mineral oil
- Continue maintenance therapy for several months, or as instructed by your doctor
Step 3 — Gradual medication weaning
- Slowly reduce the dose once your child has regular, comfortable bowel movements
- Relapses are common — restart treatment promptly if constipation returns
Diet and lifestyle tips
For infants
See your pediatrician for suggestions tailored to your baby's age and feeding.
Fiber, fruits, and vegetables
- Aim for 5 servings of fruits and vegetables daily
- A simple fiber goal: child's age in years + 5 = grams of fiber per day
Physical activity
Encourage regular physical activity, though it has not been proven to relieve constipation on its own.
Behavioral strategies
Build a toilet routine
- Encourage structured toilet time after meals (to take advantage of the body's natural gastrocolic reflex)
- Use a positive reward system for sitting on the toilet
- Make toilet time relaxed and pressure-free
- A foot stool can help younger children achieve proper positioning
- Avoid punishment for accidents or soiling — this is not the child's fault
Reassurance for parents
Regular follow-up with your child's doctor is important to adjust treatment as needed. We're in this with you for as long as it takes.
Ready to talk?
If your child is struggling with constipation, call us — we'll build a plan that fits your family.
This guide is for general education only. When in doubt, call us — we'd rather hear from you.