Constipation

Constipation is difficulty in passing poo or not opening bowels (does not do a poo) often enough. Poo problems in childhood are really common – constipation alone affects a third of all children. Constipation usually develops around the time of potty training at around 2-3 years of age. It can develop for a number of reasons and not usually because there is anything wrong with your child.

Constipation can be distressing for both you and your child and although it is natural to be worried, it is not usually serious and does not mean that they will get bowel problems later in life. There are many effective treatment options available to make your child feel better particularly if treated early

See more information on symptoms, why they get it and how to prevent constipation in the drop-down boxes below

Your child may be constipated if:

they have not done a poo at least 3 times in the last week
their poo is large and hard
their poo looks like "rabbit droppings" or little pellets
they are straining or in pain when they poo
they have some bleeding during or after having a poo, because their poo is large and hard
they have a poor appetite or stomach pain that improves after they poo

If your child is over 1 year old, soiled pants can be another sign of constipation, as runny poo (diarrhoea) may leak out around the hard, constipated poo. This is called overflow soiling.

As well as less frequent, hard stools can cause tummy pains, poor appetite, feeling off colour, behavioural changes such as being more irritable or unhappy, and feeling sick etc.

Your child may be constipated because they are:

not eating enough high-fibre foods like fruit and veg
not drinking enough fluids
feeling pressured or being regularly interrupted while potty (or toilet) training
feeling worried or anxious about something – such as moving house, the arrival of a new baby, or starting nursery or school

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.

Make sure your child has plenty to drink - encourage your child to drink 6-8 glasses of water squash or sugar free juices. Drinking more water based drinks increase the water content of the poos and make them softer and easier to pass
Give your child a variety of foods - including plenty of fruit and vegetables, which are a good source of fibre.
Encourage your child to be physically active
Get your child into a routine of regularly sitting on the potty or toilet - after meals or before bed, and praise them whether or not they poo. This is particularly important for potty-trained boys, who may forget about pooing once they are weeing standing up
Make sure your child can rest their feet flat on the floor or a step when they're using the potty or toilet - to get them in a good position for pooing
Ask if they feel worried about using the potty or toilet – some children do not want to poo in certain situations, such as at nursery or school
Stay calm and reassuring - so that your child does not see going to the toilet as a stressful situation – you want your child to see pooing as a normal part of life, not something to be ashamed of

If you'd like advice about taking the stress out of going to the toilet for your child, speak to a health visitor.

If you think your child may be constipated, and you have tried the above strategies, take your child to your GP or other health professionals for further advice. The treatment for constipation depends on your child's age.

The longer your child is constipated, the more difficult it can be for them to get back to normal, so make sure you get help early.

Your childs doctor or nurse may prescribe medicines called laxatives to clear out any poo which has built up inside your bowel and also help your child’s bowel to work normally. Most commonly prescribed laxatives are macrogols (like Movicol, Cosmocol, Laxido etc) which pull the fluid into the bowels keeping the stool soft. With the macrogols, the medication is prepared by mixing it with water or juice, click the link for information on how to prepare macrogol

Sometimes, children may need other types of laxatives which encourage the bowels to pass the stools out (stimulant laxatives) in addition to above treatment.

Dosages for your medications will be provided by your healthcare professionals

It may take several months for the treatments to work, but keep trying until they do. Remember that laxative treatment may make your child's overflow soiling worse before it gets better.

Once your child's constipation has been dealt with, it's important to stop it coming back. Your GP may advise that your child keeps taking laxatives for a while to make sure their poo stays soft enough to push out regularly.

When to see your GP or seek professional help

If your child’s constipation is ongoing despite increasing fluid, fibre in diet and other simple strategies- your child may need medication to help with the constipation
If your child is experiencing significant pain or regularly soiling in the pants, despite being on treatment – you should take them back to see your GP

Seek urgent professional help

If your baby/child develops a new onset severe tummy ache, vomiting or other additional symptoms
If your child losing weight, tired or lacking energy
If your child has blood in stools (occasional blood in stool with straining can happen)
If your child has swelling or fullness of the tummy associated with vomiting

More information and support:

ERIC, The Children's Bowel & Bladder Charity, is a UK charity for families affected by bedwetting, daytime wetting, constipation and soiling. ERIC has a freephone helpline on 0808 169 9949 (Monday to Thursday, 10am to 2pm), or you can email the service via a webform at www.eric.org.uk/helpline.

The UK charity Bladder & Bowel UK has produced a range of booklets and leaflets covering bladder and bowel problems in children.

Where should you seek help?

If it is non-urgent, speak to your local pharmacist or health visitor.
If your child has any of the above features, urgently see your GP. For an urgent out-of-hours GP appointment, call NHS 111.
You should only call 999 or go to your nearest A&E department in critical or life threatening situations.

Pharmacists are experts in many aspects of healthcare and can offer advice on a wide range of long-term conditions and common illnesses such as coughs, colds and stomach upsets. You don’t need an appointment and many have private consultation areas, so they are a good first port of call. Your pharmacist will say if you need further medical attention.

Sound advice

Visit a pharmacy if your child is ill, but does not need to see a GP.
Remember that if your child's condition gets worse, you should seek further medical advice immediately.
Help your child to understand - watch this video with them about going to the pharmacy.

For information on common childhood illnesses go to What is wrong with my child?

Health visitors are nurses or midwives who are passionate about promoting healthy lifestyles and preventing illness through the delivery of the Healthy Child Programme. They work with you through your pregnancy up until your child is ready to start school.

Health Visitors can also make referrals for you to other health professionals for example hearing or vision concerns or to the Community Paediatricians or to the child and adolescent mental health services.

Contact them by phoning your Health Visitor Team or local Children’s Centre.

Sound advice

Health visitors also provide advice, support and guidance in caring for your child, including:

Breastfeeding, weaning and healthy eating
Exercise, hygiene and safety
Your child’s growth and development
Emotional health and wellbeing, including postnatal depression
Safety in the home
Stopping smoking
Contraception and sexual health
Sleep and behaviour management (including temper tantrums!)
Toilet training
Minor illnesses

For more information watch the video: What does a health visitor do?

Midwives provide advice, care and support for women and their babies during pregnancy, labour and the early postnatal period. They provide health education and parenting advice until care is transferred to a health visitor. This usually happens when your baby is about 2 weeks old.

Sound Advice

A midwife is an expert in normal pregnancy and birth.

GPs assess, treat and manage a whole range of health problems. They also provide health education, give vaccinations and carry out simple surgical procedures. Your GP will arrange a referral to a hospital specialist should you need it.

Sound advice

You have a choice of service:

Doctors/GPs can treat many illnesses that do not warrant a visit to A&E.
Help your child to understand – watch this video with them about visiting the GP or going to a walk in centre

For information on common childhood illnesses go to What is wrong with my child?

If you’re not sure which NHS service you need, call 111. An adviser will ask you questions to assess your symptoms and then give you the advice you need, or direct you straightaway to the best service for you in your area.

Sound advice

Use NHS 111 if you are unsure what to do next, have any questions about a condition or treatment or require information about local health services.

For information on common childhood illnesses go to What is wrong with my child?

A&E departments provide vital care for life-threatening emergencies, such as loss of consciousness, suspected heart attacks, breathing difficulties, or severe bleeding that cannot be stopped. If you’re not sure it’s an emergency, call 111 for advice.

Sound advice

Many visits to A&E and calls to 999 could be resolved by any other NHS services.
If your child's condition is not critical, choose another service to get them the best possible treatment.
Help your child to understand – watch this video with them about going to A&E or riding in an ambulance

School nurses care for children and young people, aged 5-19, and their families, to ensure their health needs are supported within their school and community. They work closely with education staff and other agencies to support parents, carers and the children and young people, with physical and/or emotional health needs.

Contacting the School Nurse

Primary and secondary schools have an allocated school nurse – telephone your child’s school to ask for the contact details of your named school nurse.

There is also a specialist nurse who works with families who choose to educate their children at home.

Sound Advice

Before your child starts school your health visitor will meet with the school nursing team to transfer their care to the school nursing service. The school nursing team consists of a school nursing lead, specialist public health practitioners and school health staff nurses.

They all have a role in preventing disease and promoting health and wellbeing, by:-

encouraging healthier lifestyles
offering immunisations
giving information, advice and support to children, young people and their families
supporting children with complex health needs

Each member of the team has links with many other professionals who also work with children including community paediatricians, child and adolescent mental health teams, health visitors and speech and language therapists. The school health nursing service also forms part of the multi-agency services for children, young people and families where there are child protection or safeguarding issues.