Bowel patterns in children can vary, as they do in adults. Your child may have different bowel habits than other children, so learning their normal pattern is important. Most children have 1-2 soft but formed bowel movements daily, however some children may go a few days between bowel movements and still be healthy as long as they are without discomfort or pain and the stool appearance and consistency is normal.
When constipation is present children will have stools that are hard, dry, and sometimes difficult or painful to pass. Often the stooling pattern will be less frequent than their previously normal habit. If addressed early and treated appropriately constipation is usually temporary. However, chronic untreated constipation can lead to further complications and difficulty with treatment.
There are a variety of causes of constipation, including:
1. Diet – Changes in your child’s diet, most commonly not enough clear liquids or fiber intake, can lead to constipation.
2. Illness – Changes in appetite and solid food intake while sick can throw off your child’s bowel habits. Sometimes the illness itself can lead to decreased gut motility (ileus). Even some of the medications used to treat illnesses can also cause constipation.
3. Withholding – Young children (2-5 years old) often deal with issues of control and independence, including their bathroom habits. They often don’t want to take a break from playing. Sometimes constipation itself will lead to worsening symptoms due to fear of passing a hard and painful stool. Older children may withhold if they are away from home (school, camp, etc) as they are uncomfortable with public bathroom use.
4. Routine changes – Traveling, weather changes, stress, and other life changes can have an impact on bowel function.
For some children, untreated constipation can worsen until their colon and/or rectum stretches and they develop a fecal impaction (hard stool stuck in the rectal vault). When this happens they will often only have liquid diarrhea-like stools (only able to evacuate liquid stool around the hard impaction). This is called encopresis and needs to be treated aggressively by the pediatrician in order to improve.
Because all children have slightly different bowel habits, it is important to be familiar with your child’s normal bowel patterns, especially as they become older and use the toilet independently.
Make note of the usual size and appearance of the stool. Ask your child how often they have a bowel movement and if they experience any pain or discomfort or inability to go when they feel the urge to go.
The following images can be helpful to discuss stool appearance with children, or even with your pediatrician:
Normal stool is usually type 3 or 4 with stable frequency and no associated pain or discomfort.
There are proven natural remedies through diet intake that can alleviate constipation (we wrote about it here) in many children, but sometimes more aggressive treatment may be needed. Be sure to talk with your child's pediatrician if you are worried about your child being constipated.