Constipation occurs when a child does not go to the toilet to defecate regularly resulting in difficult or painful bowel opening (pooping).

The peak incidence of constipation is between 2-4 years of age when parents start to toilet train their children.  Around half the kids experience constipation at least once during childhood!

The frequency of defecation depends on the child’s age; beginning with around 4 times a day during neonatal and infant period but gradually decreasing to twice daily during early years of age and once daily by the age of 4 years when children are able to achieve anal sphincter control.

Symptoms of constipation

• difficulty or pain in defecation
• hard dry stools (see stool chart below)
• irregular bowel movements
• abdominal pain or distention (bloated)
• bleeding when it causes an anal tear or fissure
• pain during defecation causes the child to withhold the stool even more thereby setting up a vicious cycle of stool retention

Contributory factors to constipation

• Low fibre diet (not enough fruits and vegetables)
• Insufficient fluid intake (see below)
• Poor quality diet (too much junk food)
• Being overweight
• Sedentary lifestyle (not enough exercise)
• Psychological factors (such as stress or anxiety)
• Family history
• Organic bowel disorder

Prevention

Prevention is the best option and you can follow the following principles:

• Increase fluid intake
• Increase dietary fibre and avoid fatty, sugary or starchy foods
• Increase sorbitol in the diet (apple, prune or pear juice)
• Encourage your child to exercise (avoid being sedentary)
• Develop a regular meal schedule
• Get the child to have regular bathroom breaks

Recommended fluid intake (including fluid in food and drinks)

The table below is just a guide and more may be required if the child is active and sweats a lot.

Age	Boy	Girl
0 to 6 months	700 ml	700 ml
7 to 12 months	800 ml	800 ml
1 to 3 years	1300 ml	1300 ml
4 to 8 years	1700 ml	1700 ml
9 to 13 years	2400 ml	2100 ml
14 to 18 years	3300 ml	2300 ml

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