Constipated baby or child? Here’s what causes constipation in children

Whether you’ve got a tiny baby, an energetic toddler or a school-age kid, child constipation can turn your happy little one into a miserable, uncomfortable shadow of themselves. One minute they’re playing contentedly, the next they’re crying, straining or complaining of a tummy ache, and you feel utterly helpless watching them struggle.

Then, like magic, once they’ve finally passed that stubborn poo, their whole personality switches back. They’re suddenly ravenous, chatty and full of beans again. It’s quite something to watch just how dramatically a blocked-up bowel can affect their mood, appetite and energy levels.

Here’s something that might surprise you. Nearly one in three children will struggle with constipation at some point during their early years, with around 40% showing symptoms before their first birthday. Paediatric wards have even had to open specialist constipation clinics to cope with the volume of kids affected.

We had a long, drawn-out ‘constipation with impaction’ journey with our son, with not many answers even from a private gastroenterologist (paraffin oil – yuck!) and a constipation psychologist (a gold star for going…really?!). We eventually cracked the code, and I really want to share some shortcuts with you to help you get there faster than we did all those years ago. Here is what I have learnt as a mum and from 30 years of clinical experience about how to get out of the awful constipation trap, without needing to rely on laxatives.

When does constipation typically strike?

I’ve noticed patterns over the years of when constipation tends to rear its ugly head. The first wave often happens during those early milk transitions when switching your baby from breastmilk to formula, or when you start introducing solid foods to your baby. Yes, some people say it’s fine for a baby not to poo very often, but in my experience, babies who go daily (ideally one to three dirty nappies) tend to be happier, more settled little souls.

If your baby’s tummy troubles last longer than a couple of weeks during the weaning process, it could be their way of telling you something isn’t quite right with their new diet. Baby rice and white flour products are particularly notorious for causing constipation, which is exactly why I steer parents away from these when a baby is being weaned onto food. However, even foods we think of as healthy, such as butternut squash, can constipate some babies. Keeping a food diary and noting bowel movement patterns can be really helpful here.

The second common time point is during potty training, usually between ages two and four years old. So many toddlers simply refuse to use the potty or loo for number twos. They’ll wait, legs crossed, until you pop a nappy back on them, then they scuttle off to their favourite corner for some privacy. If this sounds familiar, please don’t make a big fuss about it. The more stress we pile on, the deeper the pattern becomes. With time, and with soft and comfortable poos, most children will eventually feel safe and confident enough to use the potty or the loo.

Then there’s the school starter phase. Reception can be overwhelming, and some children feel too shy to ask to use the school loos. They hold it in all day, which makes the poo harder and more painful to pass later. This creates a vicious cycle where they associate pooing with pain and start avoiding it altogether.

Many children with constipation also continue to have bowel problems as teenagers and adults. Since only 60 per cent of constipated children are successfully treated with laxatives, many need to manage ongoing symptoms as adults, which is really not much fun! So it is good to find the root causes early on in life.

How do I know it is constipation?

Constipation can present in several different ways. It normally means only ‘going’ three or fewer times a week with hard and dry poos that are difficult to pass. Constipation-type stools can vary in shape and size. You might see rabbit-dropping-style pellets or conker-shaped balls, clumped-up sticky balls or even large, bulky ‘elephant-sized’ poos. In one bowel movement, you might even see some hard pellets first and then a big soft movement to follow.

After several days without a bowel movement or with very infrequent bowel movements, the bowel and large intestine can become congested with faecal matter, which can then form hard bulky lumps that are very difficult to pass, and they build up in the gut, a condition called impaction. When there is bowel impaction, you might see thin, pencil-thin-like stools that curl around like a snake in the bottom of the loo or flat ribbon-shaped poo. This is because any stool that is passed has to navigate around the sides of the impacted faecal matter.

With constipation and/or impaction, you might also notice tummy pain before or during a bowel movement, excessive bloating, strong-smelling wind, rushing urgency to get to the loo, visible straining, the feeling of not emptying completely, or even soiling and accidents (known as encopresis).

When constipation becomes chronic, it can seriously affect their appetite. Think about it, if your child’s intestines are packed with old poo, there’s simply no room for food. I hear from parents all the time that their “fussy eater” suddenly becomes ravenous after a proper bowel movement. The relief and the extra space in the intestines make all the difference.

We learned this the hard way with my eldest. Even though his tummy was soft and his poos weren’t rock hard, he was actually severely impacted. And YES, soft constipation is a real thing. The final wake-up call came when he started gagging and vomiting his food. We rushed him to A&E where an X-ray revealed a blockage the size of a small melon in his bowel. The poor little thing!

Clearing his bowel completely did take ages (and oh my gosh, so much came out of such a tiny belly – I still feel traumatised). The prescribed laxatives helped initially, but I knew they weren’t getting to the root of why this was happening. That’s when I put on my detective hat and developed strategies to support his long-term bowel health — work that has kept our clinic busy ever since.

Signs of Constipation

These can be standalone symptoms or found collectively together:

• Three or fewer bowel movements a week
• Hard, dry stools that are difficult to pass
• Small, pebble-like stools (rabbit droppings or conkers)
• A history of stool retention
• Wide-diameter stools (bulky elephant poos…)
• Slim-diameter stools (thin finger-thickness snake-like poos…)
• Abdominal pain & discomfort before or when passing a stool
• Excess bloating
• Strong-smelling gas or wind
• Urgency (rushing to the loo)
• Straining
• Incomplete stool evacuation
• Soiling and incontinence (encopresis)

Why do children get so bunged up?

There are many factors contributing to why a child might get constipated and here are some of the key reasons I have learned over the years that will give you a better understanding of why they are struggling so much to pass regular stools. I will first share the common dietary reasons, and then I will do a deep dive into the other reasons to explore, if they are already eating a brilliant diet.

Not enough of the right plants

It is a myth that eating 5 fruits and veggies a day is vital to prevent constipation. Sure, to some extent this is true and that these foods do contain some fibre, and will encourage a healthy gut microbiome. For both reasons they will help to some degree to help your child to ‘go’.

However, not all fruit and veg are created equal on the fibre front, and the plants to really focus on feeding your kids are kiwi fruit, papaya, apples, prunes, dates and figs, as well as flax seeds, peas, avocado, rye bread, black beans and lentils. Dark chocolate and cocoa or cacao are also high in fibre. These are the specific foods to focus on giving your child when they are prone to getting bunged up.

Too much dairy

Research from 2020 found that children who drink excessive amounts of milk and who eat lots of dairy products are more likely to get constipated. Once your child is over 12 months old, they only need about 2 cups of milk daily (or the equivalent in yoghurt or cheese). If they’re drinking more milk than that and also struggling with constipation, then swap the extra milk for water.

Magnesium matters

This mighty mineral is involved in 300 body functions and helps bowel muscles stay toned while encouraging proper bowel movements. You’ll find it in oily fish, nuts, seeds, green vegetables, pulses, buckwheat, cocoa, avocado and banana. Adding Epsom salts or magnesium flakes to bath water is wonderfully soothing, and your child absorbs the magnesium through their skin.

Which type of magnesium is best for the constipated child to take orally? Magnesium citrate loosens the bowels and magnesium oxide is a winner for very persistent and really difficult to budge situations.

Not enough water

Many children simply don’t drink enough water, and water is essential for keeping the bowel flowing and moving efficiently through the large intestine. Babies under 12 months need just half to one cup of water daily (best at mealtimes). For toddlers and young children, aim for one cup per year of age. This looks like two cups for a two-year-old, five cups for a five-year-old.

Mineral-rich water, such as San Pellegrino or specialist Magnesium waters, can help to hydrate the bowel. Some kids benefit from taking electrolytes for temporary constipation, which contain the right balance of sodium, potassium and magnesium.

Antibiotics

Babies exposed to antibiotics, whether they’ve taken them directly or mum has passed them on through her breast milk often struggle more with constipation. The antibiotics can disrupt their delicate gut microbiome, wiping out the beneficial bacteria. It can take weeks for the good bugs to repopulate, especially before solid foods are introduced. So, if you or your baby needs to take antibiotics, consider adding a friendly bacteria supplement for at least six weeks afterwards.

Mum’s microbiome

If mum’s gut bacteria took a hit during pregnancy or breastfeeding from antibiotics or reflux medications like omeprazole, she might not pass along a diverse enough microbiome to her baby. Highly processed “beige” foods made from white flour and refined sugar can also create an environment where stools become hard and dry.

What is the fix? Think cultured and fermented foods such as yoghurt and kefir, as well as plenty of fruit, vegetables, salads, nuts, seeds and pulses for both mum and baby (once they’re weaned). A quality Lactobacillus and Bifidobacterium-rich live bacteria supplement can also help top things up.

Missing prebiotics

Breast milk naturally contains prebiotics that feed her baby’s gut diversity, but the amount depends entirely on what mum eats and the state of her own microbiome. Most infant formulas include GOS (galacto-oligosaccharides), which mimic breast milk prebiotics and help feed gut bacteria. However, some formulas don’t contain GOS. The current GOS-free list includes Holle, Nannycare and certain specialist formulas, and hypoallergenic options like Nutramigen LGG and Neocate. There is a reason they leave it out, as it can cause gas in babies with highly sensitive tummies.

Once you start weaning, you can offer prebiotic-rich foods like bananas, apples, berries, barley, garlic, onions and leeks. My weaning cookbook I Can’t Believe It’s Baby Food has loads of recipes featuring these ingredients.

The gentlest prebiotic supplement I’ve found is partially hydrolysed guar gum (PHGG) and it’s suitable even for babies from 3 months and can be given to kids with SIBO or those following a low FODMAP diet. PHGG tends to cause less wind than lactulose, and it is tasteless and dairy-free.

Probiotic power

Two specific strains have shown real promise for childhood constipation: lactobacillus (found in live yoghurt, kefir and cultured foods), and bacillus coagulans. In one study of 141 children aged 4-12 with painful tummies and difficult poos, those taking bacillus coagulans for eight weeks saw significant improvements in abdominal pain, bloating, urgency, straining and soiling. You can find bacillus species in kimchi, water kefir, sauerkraut and some live yoghurts and milk kefirs.

Hypermobility and low muscle tone

Children who are hypermobile or have conditions like Ehlers-Danlos syndrome often struggle with gut motility. I always say if they’re bendy on the outside, they’re bendy on the inside too, and this can mean a gut that can get easily impacted with poo and gut transit can be very slow. This kind of child needs longer-term support from an experienced practitioner and may well include some magnesium, vitamin C and kinetic herbs. It is also important to encourage exercises to help build better core strength which in turn also tones the muscles in the intestinal wall.

Mast cell activation

We’re seeing more babies and children with multiple allergies and food sensitivities, also experiencing constipation. Histamine and allergic reactions can dehydrate the system and slow gut motility, leading to harder stools. Kids with mast cell activation as part of their picture, particularly benefit from 1 to 1 support from our NatureDoc clinical team and again we may look at magnesium and vitamin C to stabilise things.

Gut parasites and SIBO

Common microscopic and amoebic parasites like Dientamoeba fragilis and Blastocystis hominis can be picked up from siblings, nursery, school or travel. These pesky amoeba often come hand in hand with threadworm infections. They’re usually harmless but can contribute to constipation in some children, and they are well known for triggering IBS-C (the constipated type of irritable bowel syndrome).

Methane-dominant SIBO strains (these are bacteria that are inadvertently found in the small intestine) may also drive symptoms of constipation, and this type of child often easily gets bloated, and their tummy swells up like a balloon by the end of the day.

Both microscopic amoebic parasites and SIBO-producing strains of bacteria can be identified from a gut microbiome test through the NatureDoc team.

Round Up

If your child has been struggling with a sluggish bowel, this isn’t something you need to battle alone. The causes can be complex and the management can be tricky, especially when you’re dealing with a distressed child. Try the diet changes first plus maybe a prebiotic or probiotic to see if things flow more easily. If their constipation persists, magnesium can be a helpful next step.

If they are STILL bunged up after trying these things then consult with our NatureDoc baby and child gut health team who specialise in getting to the root cause of sore tummies and straining. We’d love to help your little one to find lasting relief and to break the cycle of feeling bunged up all the time

NB. This is an update from a blog originally published 25 April 2021

References

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