Constipation in Infants and Children
Provided by: uptodate.com, Written by: AuthorGeorge D Ferry, MD
Constipation is a common problem in children of all ages, but children with disabilities are at greater risk of having constipation. A child with constipation may have bowel movements less frequently than normal, hard bowel movements, or large, difficult, and painful bowel movements.
Most children with constipation do not have an underlying medical problem causing their symptoms. Constipation generally resolves with changes in diet, behavior, or sometimes with medicine. You can try some of these treatments at home. If home treatment is not helpful, talk to your child’s healthcare provider.
Normal Versus Abnormal Bowel Habits
The “normal” amount of time between bowel movements in an infant or child depends upon their age and what they eat. The look of the bowel movement can also vary.
Normal Bowel Habits
- During the first week of life, infants pass approximately four soft or liquid bowel movements per day (generally more in breast- compared with bottle-fed infants). (See “Patient information: Deciding to breastfeed”.)
- During the first three months of life, breastfed infants have about three soft bowel movements per day. Some breastfed infants have a bowel movement after each feeding, whereas others have only one bowel movement per week. Infants who breastfeed are rarely constipated. (See “Patient information: Common breastfeeding problems”.)
- Most formula-fed infants have two to three bowel movements per day, although this depends on which formula is given; some soy and cow’s milk-based formulas cause harder bowel movements, while other formulas (eg, Alimentum Advance®, Pregestimil®, GoodStart®, and Nutramigen LIPIL®) can cause looser bowel movements.
- By two years of age, a child typically has one to two formed bowel movements per day.
- By four years of age, a child usually has one or two formed bowel movements per day.
Abnormal Bowel Habits
- An infant who is constipated typically has bowel movements that look hard or pellet-like. The infant may cry while trying to move his or her bowels. The infant may have bowel movements less frequently than before. Fewer could mean that the infant has a bowel movement every one to two days rather than their previous normal of three to four per day.
- You may be worried that your infant is constipated if your child looks like he or she is straining. Because infants have weak abdominal muscles, they often strain during a bowel movement, causing their face to appear red. The infant is unlikely to be constipated if he or she passes a soft bowel movement within a few minutes of straining.
- If your child has fewer bowel movements than usual or complains of pain during a bowel movement, he or she may be constipated. For example, a child who normally has one to two bowel movements every day may be constipated if he or she has not had a bowel movement in two days.
- A child who normally has a bowel movement every two days is not constipated, as long as the bowel movement is reasonably soft and is not difficult or painful to pass.
- Many children with constipation develop unusual habits when they feel the urge to have a bowel movement.
- Infants may arch their back, tighten their buttocks, and cry.
- Toddlers may rock back and forth while stiffening their buttocks and legs, arch their back, stand on their tiptoes, and wriggle or fidget, or they may squat or get into other unusual positions.
- Children may hide in a corner or some other special place while doing this “dance”.
Although these movements may look like the child is trying to have a bowel movement, the child is actually trying NOT to have a bowel movement because they are frightened of the toilet or worry that having the bowel movement will be painful.