My child keeps getting constipated. What helps besides food?

Children most often get constipated because they hold in their poo, and a hard, painful poo makes them want to hold on even more. Besides food, what helps is plenty to drink, active play every day, a regular time to sit on the toilet after meals or before bed, a footstool so their feet rest flat, praise or a reward for trying, and a calm, unhurried approach, especially during potty training. If it lasts more than 2 weeks, does not go away with these steps, or there is blood or constant tummy pain, see a doctor.

Many parents have already added fruit and vegetables and still find their child straining, crying on the toilet or going only every few days. This article draws on the UK's NHS and the US NIDDK to explain why constipation in children often comes back, what you can do at home apart from changing food, and when to see a doctor.

How can I tell if my child is constipated?

Signs the NHS lists

The NHS says your child may be constipated if:

• they have done fewer than 3 poos in the last week
• their poo is large and hard, or looks like rabbit droppings or little pellets
• they strain or are in pain when they poo
• there is some bleeding during or after a poo, because the poo is large and hard
• they have a poor appetite or a tummy ache that gets better after they poo

The NHS adds that in a child over 1 year old, soiled underwear can be another sign, because runny poo can leak out around hard poo.

Signs of holding it in

The NIDDK describes how children change position to avoid or delay a poo, for example standing on tiptoes and rocking back on their heels, clenching their buttocks or doing unusual, dance-like movements. If you see this, your child may be holding on rather than "not needing to go".

Why does my child's constipation keep coming back?

Holding it in creates a vicious circle

The NIDDK says children most often get constipated from holding in their poo. When poo stays in the bowel too long, the bowel absorbs too much fluid from it, so it becomes hard, dry and difficult to pass. The NHS explains that if pooing hurts, a child may not want to try, which creates a vicious circle: the more they hold back, the more constipated they get.

Common causes the NHS and NIDDK list

The NHS notes that constipation is common in childhood, particularly during potty training at around 2 to 3 years old.

Apart from food, how can parents build good toilet habits?

Sit after meals or before bed

The NHS suggests getting your child into a routine of regularly sitting on the potty or toilet after meals or before bed, and the NIDDK suggests asking a potty-trained child to use the toilet after meals. In a busy morning, that may mean getting up a little earlier so breakfast is not followed by a rush out of the door.

Use a footstool

The NHS advises making sure your child can rest their feet flat on the floor or on a step while on the potty or toilet, so they are in a good position to poo. On an adult toilet, a small stool or a child's toilet seat helps their feet reach and makes them feel steadier.

Praise trying, not only results

The NHS advises praising your child whether or not they poo. The NIDDK suggests a reward system when your child uses the toilet regularly.

Ask about toilets away from home

The NHS suggests asking whether your child feels worried about using the potty or toilet, as some children do not want to poo in certain places, such as at nursery or school. You could also talk to the teacher about toilet breaks, or make time for the toilet at home before and after school. The NHS also notes that boys who wee standing up may forget about pooing, so a regular sitting time matters for them too.

My child is constipated during potty training. What should I do?

Slow down and keep it calm

The NHS lists feeling pressured or being regularly interrupted during potty training as a possible cause of constipation. The NIDDK suggests taking a break from potty training until the constipation stops. The NHS advises staying calm and reassuring, so that your child sees pooing as a normal part of life, not something to be ashamed of.

Accidents are not on purpose

The NHS says that a constipated child soiling their clothes is not doing it on purpose, so there is no reason to get cross. It notes that staying calm and relaxed is the best attitude, and that a health visitor or doctor can offer tips.

How much should my child drink and move?

Plenty to drink, especially in hot weather

The NHS advises making sure your child has plenty to drink. The NIDDK says to ask your child's doctor how much liquid they should have each day, based on their size, health, activity level and the climate where you live. In Thailand's heat, offer water regularly through the day, at school and after play, not only at meals. For babies, the NHS says formula-fed babies can have extra drinks of water between feeds, which must be cooled boiled water for babies under 6 months, and breastfed babies who are not yet eating solids can be offered plenty of breastfeeds.

Active play every day

The NHS advises encouraging your child to be physically active. The NHS activity guidelines give these amounts:

Running in the playground, cycling, dancing, ball games and walking to school all count. The NHS also advises breaking up long periods of sitting, such as screen time or long car journeys.

Food still matters

The NHS suggests a variety of foods with plenty of fruit and vegetables, and the NIDDK gives examples such as apples with the skin on, oranges, pears, carrots, broccoli, green peas, beans, lentils and oatmeal. Keep these as part of normal family meals alongside the habits above.

For constipation in general, including causes and self-care, see What causes constipation, and how can I look after myself?

When should I take my child to see a doctor?

Signs to see a doctor

See a doctor straight away if

The NIDDK advises taking your child to a doctor right away if they are constipated and have:

• bleeding from the bottom
• blood in their poo
• a swollen tummy or bloating
• constant tummy pain
• vomiting
• weight loss

The NHS explains that the longer a child is constipated, the harder it can be to get back to normal, which is why getting help early matters. A health visitor or doctor can also offer tips. Do not give your child any medicine for constipation unless a doctor tells you to, and talk to the doctor before stopping or changing any medicine your child already takes.