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Identifying constipation

For the most part, constipation is easy to identify: A child is uncomfortable while unable to pass a stool, experiences minutes of straining and pain while attempting a bowel movement, or goes three or fewer times per week with hard, dry stool. Other side effects may include a distended belly or, in more serious cases, vomiting, fever or bloody stool—which Dr. Vrittamani says are good cues to call a doctor.

Although some children are more prone to constipation due to genetic causes, dietary or psychological factors can be the difference between relatively easy bowel movements or chronic struggles. A smaller number of constipation cases may be related to other causes, such as spinal abnormalities, Irritable Bowel Syndrome (IBS) or other conditions diagnosable by a physician.

But there are some misconceptions about constipation that can throw off parents. It's common for breastfed newborns, for example, to go days between stools and they may even appear to strain in order to have a bowel movement because of immature abdominal toning. The difference in these cases is that the babies don't experience the more tell-tale signs of constipation, such as belly distention, irritability or hard stools. (It is best to trust your own gut if you're concerned or call your family pediatrician!)

Dietary causes + cures for constipation

More typically, constipation challenges coincide with the introduction of solid foods—especially as highly starchy, processed or dairy-rich foods enter the baby's diet. Some culprits may even be surprising, such as apples, sweet potatoes and bananas. Rather than banish these foods from the home altogether, Dr. Vrittamani suggests "mixing and matching" at mealtime with foods that can help keep the digestive system moving along.

A few good examples she points to include…

• "P- fruits," such as prunes, plums, pears, peaches, papaya and pineapple
• Avocado
• Berries
• Lentils
• Flaxseed for babies over 8 months
• Brussels sprouts or broccoli
• Prune juice

If diversifying your child's diet isn't working or you're eager for a short-term solution, Dr. Vrittamani also suggests offering small amounts of a concentrated apple juice. Even in a small dose, the pectin naturally found in apple juice can help stimulate the digestive system—and the encouragement to drink extra fluid can help, too. In fact, limited fluid intake is a commonly overlooked cause that may contribute to constipation. But, thankfully, it is just as easily fixed by encouraging water consumption throughout the day. (A good reminder for us all!)

A few more remedies include…

• Moving baby's legs in a bicycle motion or encouraging older kids to play.
• Taking a baby's temperature rectally, which can loosen stools.
• Giving your baby a warm bath.
• For older children, drinking warm lemon water.
• Offering a probiotic supplement or food, such as yogurt.

If the constipation persists, a physician such as those at Stanford Children's Health would be able to offer advice on the proper course of treatment. Dr. Vrittamani says this should always be done before drastic, potentially dangerous steps are taken.

Specifically, she would advise against…

• Stimulating laxatives
• Milk of magnesia
• Changing a baby's formula preparation to include more water
• Switching to a low-iron formula
• Mineral oil for children under age 2

Common psychological triggers

Although dietary changes may benefit anyone struggling with constipation, the cause isn't always dietary in nature: Especially in situations like toilet training or going to school for the first time, a child may end up "holding it in" out of fear or anxiety. This can be avoided or minimized by reading a child's cues about how he or she is feeling before sending the child into uncomfortable new territory.

Looking at potty training, parents should look for readiness signs, such as vocalizations about wet diapers and an interest in using the potty that is encouraged with books and videos on the subject. "What is important is for us to realize that when parents do start toilet training they want to do it in a way that is non-threatening so the child is involved in it," says Dr. Vrittamani, adding parents should use "encouragement rather than punishment" and employ non-food rewards.

Like the rest of us, children are also beings of habit, so it can help to create a routine out of potty time. Dr. Vrittamani suggests encouraging a child to sit on a toilet after breakfast each day for no more than 10 minutes, but without distractions from books or videos.

For school-aged children, the same kinds of stress may contribute to constipation, which can be compounded by anxiety about cleaning themselves or having to tell a teacher when they need to go. "All of this becomes a self-esteem issue eventually," says Dr. Vrittamani, explaining parents should work with children before school on having bathroom confidence and independence.