Constipation in children is one of the most frequent reasons for pediatric consultations: a child may be in pain, hold it in for fear of discomfort, and enter a vicious cycle (harder stools → pain → retention → constipation). The good news: in most cases, simple measures and a structured strategy can provide rapid relief and, above all, prevent recurrence . In this guide, you will learn to recognize true constipation, take effective action at home, and identify situations where you should consult a doctor without delay.

Constipation in children: how to recognize it (without making a mistake)

Typical signs

A constipated child isn't simply a child who "doesn't go every day." The most helpful signs:

• Hard stools (of the “ball” or “plug” type, very large)
• Pain or crying during bowel movements, grimacing, avoidance
• Infrequent bowel movements (variable depending on age, but mainly associated with hard/painful stools)
• Traces of red blood (often linked to an anal fissure )
• Bloating , discomfort, loss of appetite
• Leakage of stool into the underwear (encopresis): often a sign of retention with "overflow" around a fecal impaction

Normal bowel movement frequency: what really matters

• Some children can have bowel movements every day or every other day without any problem.
• The key criterion: consistency + pain + retention , more than the number.

Functional constipation vs. medical cause

• Very often: functional constipation (habits, diet, retention, stress, cleanliness).
• Less commonly: organic cause (to be considered especially if there are warning signs — see section “when to consult”).

The most common causes of constipation in children

The vicious cycle of “pain → retention”

After a painful bowel movement, the child may hold it in (retention postures: stiffening, crossing legs, hiding). The colon reabsorbs the water: the stools become harder → increased pain.

Low-fiber diet + insufficient hydration

• Too many refined starches, ultra-processed products, not enough fruits/vegetables.
• Insufficient drinks, especially at school.

Changes in routine

• Starting nursery/school, travel, stress, moving house.
• Refusal to go to the toilet outside the house.

Toilet training

“At-risk” period: pressure, fear, unsuitable toilets (without a step stool), lack of time.

What to do right away at home (48–72 hour action plan)

1) Unlocking without robbing: smart toilet routine

Objective: to reactivate the natural reflex, without power struggles.

1. After meals (ideally breakfast + dinner), offer 5–10 minutes to use the toilet.
2. Position : feet firmly placed on a footstool (squatting position = best angle).
3. Zero pressure : we offer suggestions, encouragement, and praise for the effort (not the result).
4. Timer + calm distraction : book, story, breathing exercises.

Tip : The best time is 10–20 minutes after a meal (gastro-colic reflex).

2) Hydration: the often underestimated lever

• Aim for regular intakes throughout the day (water bottle at school).
• Water is the foundation. Juices are no substitute for structured hydration.

3) “Effective” (and well-tolerated) fibers: what to give

Favor, according to age and tolerance:

• Pear , prune , kiwi , peach, apricot (rather than unripe banana)
• Vegetables rich in fiber: peas, broccoli, courgette, carrots (depending on tolerance)
• Whole grains (progressive), oat flakes
• Legumes (introduce gradually, beware of bloating)

Common mistake : increasing fiber without increasing water → can worsen.

4) What can worsen (limit to a few days)

• Excess rice, overcooked carrots, white bread, biscuits, fast food
• Too much cheese/dairy products in some children (variable)
• Unripe banana (for some)

Treatments: what really works (and what to avoid)

Osmotic laxatives (often recommended): logic and safety

In pediatric practice, an osmotic laxative (often based on macrogol/PEG ) is frequently used because it softens stools by retaining water in the intestine, which helps to break the pain-retention cycle.

Key points (to be confirmed with a healthcare professional):

• The goal is not to "go to the toilet today", but to make stools soft and painless for several days/weeks.
• The duration can sometimes be several weeks to “recondition” the transit, especially in cases of retention/fear.

Suppositories and enemas: rather occasional, not a long-term strategy

• They can help temporarily , but do not treat the cause (retention + hard stools).
• Reserved for specific situations and according to medical advice , especially in young children.

What you should avoid

• Multiplying contradictory “remedies” (fibers + constipating agents + random treatments).
• Forcing the child, punishing, humiliating: increases retention.
• Self-medicating over a long period without monitoring.

Constipation in children: when to consult a doctor (and warning signs)

Consult quickly if…

• Severe pain, vomiting, very distended abdomen
• Abundant blood, fever, general malaise
• Weight loss, marked fatigue
• Constipation from the very first weeks of life, or persistent problems despite appropriate measures
• Suspected fecal (blockage) or repeated fecal incontinence (encopresis)

Common case: anal fissure

If the child is in severe pain and there is bright red blood on the toilet paper, an anal fissure the stools must and the pain avoided, otherwise retention will occur.

Preventing relapse: the “anti-return” strategy (over 4 weeks)

Toilet routine (non-negotiable, but no pressure)

• 2 "transit hygiene" passes after meals, systematic step stool.
• Positive reinforcement (motivation chart about effort, not about the saddle).

Nutrition: simple and measurable goals

• 1–2 “transition” fruits/day ( pear / kiwi / prune depending on tolerance)
• Vegetables at every meal (even small portions)
• Fiber progression over 7–10 days + water

Physical activity

Moving helps digestion: walking, cycling, active games (daily goal).

FAQ 

Childhood constipation: what to do quickly?

Establish a toilet routine after meals with a step stool, increase hydration, offer foods rich in fiber ( pear , kiwi , prune ) and consult if there is significant pain, vomiting, distended abdomen or abundant blood.

How many days without a bowel movement is worrying for a child?

It's not just the number of days: it's mainly hard stools + pain + retention . Consult a doctor quickly if the child is in pain, vomiting, has a very bloated stomach, or if constipation persists despite appropriate measures.

What foods are best for relieving constipation in children?

Pears , kiwis , prunes , fiber-rich vegetables, oatmeal and whole grains (gradually), with sufficient hydration.

Is macrogol (PEG) dangerous for children?

Macrogol (PEG) is commonly used in pediatrics to soften stools, but the dosage and duration must be adapted to the child: ask your doctor or pharmacist for advice, especially if there are significant symptoms or chronic constipation.

My child is holding it in and refuses to go to the toilet: what should I do?

Avoid any pressure, establish a 5–10 minute bowel movement after meals, use a step stool, maintain a stable routine, and offer encouragement for the effort. The goal is to make bowel movements painless (sometimes with medical assistance) to reduce fear.

Conclusion

Childhood constipation is effectively treated by combining relief of hard stools , an appropriate toileting routine , hydration , and prevention of retention . If the pain is significant, if warning signs appear, or if the situation persists despite consistent measures, consult a doctor: medical guidance often allows for a lasting solution.