- Can't pass a stool or pain when passing a stool
- Crying when passing a stool (bowel movement or BM) or
- Can't pass a stool after straining or pushing longer than 10 minutes or
- 3 or more days without passing a stool (exception: breastfed and over 1 month old)
- Caution: any belly pain from constipation comes and goes. Most often, it is mild. Use the Abdominal Pain (Stomach Pain) care guide if there is constant belly pain.
Causes of Constipation
- High Milk Diet. Milk and cheese are the only foods that in high amounts can cause constipation. It causes hard pale stools. This is why you want your child to eat a well-balanced diet.
- Low Fiber Diet. Fiber is found in vegetables, fruits and whole grains. Fiber keeps stools soft, bulky and easy to pass. A low fiber diet causes hard, small stools.
- Low Fluid Intake. This can also cause stools to be dry and harder to pass. It's rarely the only cause of constipation.
- Lack of Exercise. Exercise also keeps the bowel from slowing down. Not a cause in children unless they are confined to bed.
- Holding Back Stools Because of Pain. If passing a stool causes pain, many children will hold back the next one. This can happen with a Strep infection around the anus. It can also occur with a bad diaper rash or anal fissure (tear).
- Holding Back Stools Because of Power Struggles. This is the most common cause of recurrent constipation in children. Most often it's a battle around toilet training. If they are already trained, it may begin with the start of school. Reason: some children refuse to use public toilets. Some children postpone stools because they are too busy to sit down.
- Slow passage of food through the intestines. Most often, this type runs in families. Called slow transit time.
Stools: How Often is Normal?
- Normal Range: 3 per day to 1 every 2 days. Once children are on normal table foods, their stool pattern is like adults.
- Kids who go every 4 or 5 days almost always have pain with passage. They also have a lot of straining.
- Kids who go every 3 days often drift into longer times. Then, they also develop symptoms.
- Passing a stool should be free of pain.
- Any child with pain during stool passage or lots of straining needs treatment. At the very least, the child should be treated with changes in diet.
Imitators of Constipation: Normal Patterns and Stools
- Breastfed and Over 1 Month Old. Stools every 4-7 days that are soft, large and pain-free can be normal. Caution: before 1 month old, not stooling enough can mean not getting enough breast milk.
- Straining in Babies. Grunting or straining while pushing out a stool is normal in young babies. They are learning to relax their anus after 9 months of keeping it closed. It's also hard to pass stool lying on their back with no help from gravity. Babies also become red in the face and draw up their legs during straining. This is normal. Key: they continue to pass normal size stools every day. Just not every time they have some straining.
- Brief straining under 10 minutes can occur at times at any age.
- Large Stools. Size relates to the amount of food eaten. Large eaters have larger stools.
- Hard or Dry Stools. Also can be normal if passed easily without too much straining. Often, this relates to poor fiber intake. Some children even have small, dry rabbit-pellet-like stools.