What to Do When Your Kid Won't Poop

It happens all the time: a parent comes into my office with a kid who’s has been complaining of low level belly pain for months. In some cases, the child has even ended up in the emergency room. I often see teenagers with this problem too, and I recently saw a school-aged child whose parents just happened to be physicians. Regardless of the circumstances, it’s always the adults in the room who look like they’re the ones in real pain, worried and frustrated by their child’s mysterious stomachache.

This issue usually can be chalked up to a common problem: constipation.

Constipation is the most common cause of abdominal pain in kids, and research shows it affects up to 30 percent of children worldwide and accounts for about 3 to 5 percent of all visits to the pediatrician. Luckily, constipation in kids is largely preventable, treatable, and easy to manage. By recognizing the signs and knowing how to act, you can keep your kid happy, healthy, and free of bellyaches.

Constipation refers to infrequent bowel movements or difficulty passing stools for several weeks or more. You’ll know your kid has it if they:

• Have fewer than three bowel movements per week.
• Have hard, dry bowel movements that are difficult to pass.
• Have abdominal pain, nausea, or pain while passing stools.
• Have blood on the surface of their stool.
• Have liquid stool in their underwear or have liquid stool leaking around the stool mass. This can mean stool is backed up in the rectum.

There are a lot of reasons kids get constipated, but some people are just more prone to getting backed up, thanks to a family tendency toward “slow transit.” This means waste doesn’t move through the large intestine as quickly as it should.

Many of the other causes of constipation are environmental:

• Too many processed foods like Goldfish crackers and white pastas (peak constipation season is between Halloween and New Year’s, thanks to all those candies and treats)
• Not enough water, fruits, vegetables, or fiber
• Not enough time to poop because of a rushed schedule
• Sudden changes in routine, like travel
• Anxiety

While constipation alone is unpleasant and uncomfortable, it’s generally manageable. But left untreated, it can lead to more serious problems like obstructed urine flow or stretching of the rectum, which can impair the ability to have a voluntary bowel movement. That’s why it’s important to get a handle on constipation quickly before it gets out of hand.

Setting up the right conditions can be important too. Have your child sit on the toilet for five to 10 minutes about 30 minutes after a meal, when bowel movements are most likely to occur. Propping their feet up on a stool or a device like the Squatty Potty can also help put them in prime pooping position. Kids can be scared of the toilet, so spend time with in the bathroom, either reading a story or just talking to help them relax.

There’s no single right way to treat constipation, and different kids respond differently to treatments and therapies. But dietary changes can make a big difference:

• Become a fiber detective! There’s an easy way to figure out how many grams your child needs: just take their age and add seven. So if you have a four-year-old, make sure they’re getting at least 11 grams of fiber a day. Try to strive for whole foods whenever possible (i.e. steel cut oats instead of Cheerios). I often refer patients to this helpful fiber guide. Some options: 
  • Beans (13-19 grams per cup)
  • Avocado (11 grams per serving)
  • Oat bran (12 grams per ounce)
  • Prunes (8 grams per cup)
• Increase fruits and veggies: Aim for five to seven servings every day. Avocados and artichokes are especially high in fiber (11 grams and 10 grams, respectively), and prunes, raspberries, and blackberries all have 8 grams each.
• Amp up water intake: Here’s a handy hydration guide based on age:
  • <2 years old: 30-35 oz.
  • 2-5 years old: 40-50 oz.
  • 6-12 years old: 50-60 oz.
  • Teens: 60-70 oz.
• Include more sorbitol-rich foods. Sorbitol is a natural sugar that’s not digested and can help with intestinal transit. Dried plums, peaches, apples, pears, and apricots are good sources, but also high in calories and can cause cavities, so use in moderation.

If dietary and lifestyle changes aren’t enough, you may want to consider a laxative treatment to help clear stool from the bowel. You can do this with a few different products including MiraLAX, magnesium citrate, or senna in the form of Ex-Lax chocolate squares. The dosing instructions on these supplement labels are usually considered starting doses — typically, you may need more to successfully treat constipation. Talk to their pediatrician about how much to use.

These supplements can also be helpful in maintaining regularity if your child is prone to constipation. One to two capfuls of MiraLax a day, or one to three squares of Ex-Lax chocolates, depending on age, can help keep things moving.

If none of these therapies work, or you’re concerned about your child’s chronic constipation, make an appointment with a pediatrician or family provider today. One Medical offers pediatric services to members in seven metro areas and growing including New York, San Francisco Bay Area, Chicago, Portland, Orange County, Los Angeles, Phoenix.