Constipation in children can be so tricky to catch and manage. Once kids are potty-trained, so much of what happens in the bathroom becomes a mystery. And kids are typically very quick in the bathroom, so they don’t always give the process much thought either. However, if your child isn’t having a good bowel movement every one to two days, constipation can sneak up and cause some painful symptoms.
Experts often say it takes just one painful bowel movement for a child to begin holding, which can subsequently lead to constipation. The following are tips to avoid constipation and home remedies to try if your child becomes constipated.
Let’s be honest, pooping can be a weird topic to discuss. However, it’s important to normalize it so kids don’t become embarrassed by it. If they’re embarrassed to poop, they may begin to hold, thus beginning the slide into constipation territory. When your child first starts to poop independently, I would try to avoid making comments about smells, size, shape, etc. If you normalize it, your child will follow your lead. And if you make it a normal topic of conversation, your child will hopefully feel comfortable approaching a caregiver should they start to have painful or infrequent bowel movements.
Encourage proper posture
Believe it or not, there are correct and incorrect ways to sit on the toilet. When sitting on the toilet, it’s important that:
- Feet are flat and supported
- Legs are separated
- Knees are at or above hip height
- Trunk is erect and leaned slightly forward
This is the optimal position for the pelvic floor to relax and allow for easy defecation.
If your child’s feet dangle and they can only reach the ground on their tip-toes, they’re unable to properly relax their pelvic floor muscles. In that case, it’s crucial to provide a step stool to support their feet so they can get into the proper toileting position.
Encourage proper breathing and “pushing”
Similar to the above, there are proper ways to breathe and push when trying to defecate. Ideally you should never need to push, as your bowel movements should be soft. Realistically, however, we all occasionally need to push. If you hear your child pushing or they complain of needing to push, make sure your child isn’t holding their breath to push.
When you close off your airway to push by holding your breath, your pelvic floor also closes, thus blocking the exit for defecation. Instead, encourage your child to take deep breaths and breathe out while using their belly muscles to push.
As pediatric physical therapists, we often have to teach our patients proper coordination for pushing techniques. We typically use animal noises or sounds such as “MOOO,” “SSSS,” or “SHHH” so it’s easier for kids to breathe while pushing. We encourage them to take a deep breath and then exhale while making one of those sounds and pushing down. It might sound silly, but it works wonders.
Remember to hydrate
As if we didn’t have enough cause to stay hydrated, avoiding constipation is yet another reason to offer little ones water often. The body pulls water from the intestines to stay hydrated, and dehydration leads to your body absorbing more water, thus contributing to more solid bowel movements. By staying hydrated, your body won’t take as much water from the intestines, making for softer bowel movements.
Include fiber-rich foods in their diet
Just as water is very important, it’s also crucial to encourage a high-fiber diet. Fiber helps provide bowel movements with bulk so they can move more easily along the digestive tract. Think whole grains, fruit, vegetables, nuts, etc. If your child isn’t fond of a particular food or ingredient, don’t push that one—instead, find something they’re willing to eat! You can also swap out white bread/pasta for whole grain bread/pasta or sneak some chia seeds into smoothies or yogurt.
The bowels respond to movement and activity. By activating the abdominals and deep breathing muscles, your bowels are also activated. Encouraging activity can promote bowel motility, so it’s important to keep your children active. Things like climbing, swimming, and bike riding can especially activate the abdominals, which in turn activates the bowels.
Discourage holding habits
As much as possible, try to discourage holding habits. If you see your child demonstrating holding behaviors such as crossing their legs, sitting on their heels, or doing potty dances, encourage your child to go to the bathroom. By holding, the pelvic floor muscles can become overactive and initiate a vicious cycle of stool withholding. When the pelvic floor muscles become overactive, it’s more difficult to void and your bowels store more stool, thus becoming more and more backed up.
Other ways to help your constipated child
If you feel your child is constipated, the following recommendations may be helpful:
- Number one, talk to your doctor. Medication may be helpful for your child.
- Try to encourage toilet sits after meals. After meals, your bowels begin to move and be more active, so sitting on the toilet 20-30 minutes after a meal may stimulate a bowel movement.
- Try a belly massage. Start at your child’s right hip, move up toward the ribs, across the belly, and then down toward the left hip. This pattern follows the movement of the large intestine and can help move stool along. You can drag your hand or make small circles along that pattern. Try for 5-10 minutes to see if it helps stimulate a bowel movement.
- Try a warm bath. Warm baths can help the muscles relax.
- And be sure to encourage more of the above: water, fiber, and activity.