Constipation is very common in children, particularly around potty training, starting nursery or school, changes in routine and periods when a child has had a painful bowel movement and starts trying to avoid going again.
It does not always mean a child simply goes several days without a poo.
A constipated child may still pass something every day but produce:
- small hard pellets;
- very large stools;
- painful bowel movements;
- small amounts of runny stool in their underwear;
- stomach pain or poor appetite.
The NHS says constipation may be present when a child has fewer than three bowel movements in a week, produces large hard stools or small pellet-like poos, strains or experiences pain when going to the toilet.
One of the most confusing signs is soiling. Parents may assume runny poo means diarrhoea, when in fact liquid stool can leak around a large mass of hard poo that is stuck in the bowel.
Most childhood constipation can be treated successfully, but it is worth dealing with early. The longer painful constipation continues, the more likely a child is to start withholding stool and the harder the cycle can become to break.
This guide explains the common signs of constipation in children, why withholding happens, which treatments are commonly used and when symptoms need medical assessment.
How Can You Tell If a Child Is Constipated?
Parents often focus on how many days have passed since the last poo.
Frequency matters, but the appearance of the stool and the child's behaviour can be just as important.
Common signs include:
- fewer than three poos in a week;
- large, hard stools;
- small dry pellets that look like rabbit droppings;
- straining;
- crying or saying that pooing hurts;
- a little bright-red blood after passing a large hard stool;
- stomach ache that improves after a poo;
- poor appetite;
- avoiding the toilet;
- soiling underwear.
Some children develop very large bowel movements that can block the toilet.
Others pass tiny amounts frequently but never seem properly emptied.
A child may also behave strangely when they need to poo.
They might:
- cross their legs;
- stand on tiptoes;
- rock backwards and forwards;
- clench their bottom;
- hide behind furniture;
- refuse to sit on the toilet.
These behaviours can look as though the child is trying to push.
Often they are actually doing the opposite: trying very hard not to poo.
Why Do Children Become Constipated?
There is often no single cause.
A common pattern begins with one uncomfortable bowel movement.
The child remembers that it hurt and avoids going the next time they feel the urge.
When stool remains in the bowel for longer, more water is absorbed from it.
The stool becomes harder and larger.
Eventually, passing it hurts even more.
This creates a cycle:
painful poo → holding it in → harder poo → more pain → more withholding.
Other factors can contribute, including:
- not drinking enough;
- not eating enough fibre;
- changes in diet;
- potty training;
- pressure or anxiety around toileting;
- starting nursery or school;
- not wanting to use school toilets;
- changes in family routine;
- illness or reduced activity.
Some children simply ignore the urge because they are busy playing.
Others may be embarrassed about using an unfamiliar toilet or dislike the noise, smell or lack of privacy at school.
Constipation can occasionally be related to an underlying medical condition, which is why very early, severe or unusual symptoms deserve assessment.
What Is Overflow Soiling?
Overflow soiling is one of the most misunderstood consequences of constipation.
A child may have a large amount of hard stool sitting in the rectum.
Softer or liquid stool from further up the bowel then leaks around it and into the child's underwear.
This can look like diarrhoea.
Parents may even reduce laxatives because they think the medicine is causing loose stools, when the child may actually still be heavily constipated.
The NHS specifically advises parents to see a GP when a child regularly soils their underwear.
Most importantly, the child is usually not doing this deliberately.
When the rectum has been stretched by retained stool, normal awareness that poo is coming can become reduced.
Getting angry, punishing the child or repeatedly asking why they did not use the toilet can make the situation more stressful without fixing the underlying constipation.
Treatment often requires clearing the backed-up stool first and then keeping bowel movements soft for long enough for normal bowel habits to recover.
What Treatment Helps Childhood Constipation?
If you think your child is constipated, NHS guidance recommends contacting a GP rather than allowing the problem to continue for a long time.
Laxatives are frequently used in children who are eating solid food.
NICE recommends macrogol, also called polyethylene glycol or PEG, as the usual first-line medicine for childhood constipation and faecal impaction.
Macrogol works by keeping more water in the stool so that it becomes softer and easier to pass.
If there is a large build-up of hard poo, the child may first need a higher-dose treatment known as disimpaction.
After that, a lower maintenance dose may be continued to keep stools consistently soft.
Other laxatives may sometimes be added or substituted if macrogol is not effective or cannot be tolerated.
Parents should not guess at paediatric laxative doses from adult packaging.
The correct product and dose depend on:
- the child's age;
- the degree of constipation;
- whether faecal impaction is present;
- how the child responds.
A GP, pharmacist or other appropriate clinician can advise on the treatment plan.
NHS advice also makes clear that babies and children should generally use laxatives on medical advice rather than simply being given an adult over-the-counter product.
Why Treatment Can Take Months
This surprises many parents.
Once a child starts pooing again, it can seem logical to stop the laxative immediately.
But the bowel may need much longer to recover.
If constipation has stretched the rectum, the child may temporarily have reduced awareness of when stool is present.
Stopping treatment too quickly can allow another hard stool to form, restarting the cycle.
NICE recommends continuing maintenance laxatives for several weeks after a regular bowel habit is established, and treatment may need to continue for several months.
Children who are toilet training may need treatment until toilet habits are well established.
Laxatives should generally be reduced gradually rather than stopped abruptly.
Some children need longer treatment.
That does not automatically mean something serious is wrong.
Chronic constipation often takes patience because the goal is not merely to produce one large bowel movement.
The goal is to establish months of comfortable, predictable, pain-free pooing so that the child stops being afraid to go.
What Can Parents Do at Home?
Medicine is often only one part of treatment.
Children also need a relaxed environment in which normal toileting becomes routine again.
Use regular toilet sitting
A useful routine is to encourage the child to sit on the toilet for around five minutes after meals.
The bowel naturally becomes more active after eating, so this can take advantage of the gastrocolic reflex.
The aim is not to force the child to produce a poo every time.
Rewarding the behaviour of sitting and trying can work better than rewarding whether a bowel movement actually happens.
Make the position comfortable
A young child's feet should ideally be supported rather than dangling.
A footstool can help them feel secure and achieve a more useful position for bowel emptying.
Keep the approach positive
Avoid punishment, embarrassment or battles over the toilet.
NICE recommends non-punitive approaches such as regular scheduled toileting, bowel diaries, encouragement and reward systems.
Offer adequate fluids
Encourage regular drinking throughout the day.
Children who drink very little can produce harder stools.
Include fibre in an ordinary balanced diet
Useful foods include:
- fruit;
- vegetables;
- wholegrain cereals;
- wholemeal bread;
- beans and pulses.
However, NICE specifically advises against trying to treat established constipation with diet alone.
A child who already has a large painful mass of retained stool is unlikely to be cured simply by eating an extra apple.
Encourage activity
Normal daily physical activity supports bowel function and is part of NICE's recommended long-term approach.
Can Constipation Cause Bedwetting or Urinary Problems?
Yes.
The bladder and bowel sit close together in the pelvis.
A rectum full of retained stool can interfere with bladder function in some children.
Constipation can be associated with:
- daytime urinary urgency;
- frequent urination;
- wetting accidents;
- bedwetting;
- recurrent urinary symptoms.
The NHS lists constipation as one possible underlying cause of bedwetting.
This does not mean every child who wets the bed is constipated.
Bedwetting is extremely common for many other reasons, particularly in younger children.
But when bedwetting occurs alongside hard stools, infrequent bowel movements or soiling, treating the constipation may be an important part of the plan.
Our guide to bedwetting in children explains the other common causes and available treatments.
When Should You See a GP?
It is sensible to seek medical advice relatively early if you think your child has established constipation.
The NHS specifically recommends seeing a GP because the longer constipation continues, the more difficult it can become to restore a normal bowel pattern.
Arrange an assessment if:
- your child repeatedly passes painful hard stools;
- they have fewer than three bowel movements a week;
- they regularly soil their underwear;
- they are deliberately withholding stool;
- constipation keeps returning;
- there is repeated bleeding associated with hard stools;
- stomach pain or appetite problems persist;
- home measures have not helped.
A GP can usually diagnose childhood constipation from the history and examination.
Scans and blood tests are not routinely needed for straightforward idiopathic constipation.
NICE specifically advises against using abdominal ultrasound simply to diagnose ordinary childhood constipation.
If the symptoms are persistent, complicated or unusual, a child may be referred to paediatrics or a specialist bowel and bladder service.
If you are considering private assessment, our guide to private paediatrician consultation and test costs explains typical UK fees.
When Can Constipation Be More Serious?
Most childhood constipation is functional or idiopathic, meaning there is no serious underlying bowel disease.
However, some features need more urgent assessment.
Seek urgent medical advice if a constipated or soiling child has a swollen abdomen and is vomiting.
NHS advice recommends an urgent GP appointment or NHS 111 in a child who is soiling and also has abdominal swelling and vomiting.
Other concerning features include:
- significant weakness or numbness in both legs;
- severe or worsening abdominal swelling;
- persistent vomiting;
- poor growth or unexplained weight loss;
- constipation beginning in the first weeks of life;
- a newborn who passed their first meconium unusually late;
- ribbon-like stools from infancy;
- abnormalities around the anus or lower spine.
These features can occasionally suggest a condition such as Hirschsprung's disease, a neurological problem or another bowel disorder rather than ordinary functional constipation.
In babies, particularly newborns, constipation deserves a lower threshold for professional advice.
Do not repeatedly experiment with laxatives, suppositories or dietary remedies in a young baby without discussing the problem with a healthcare professional.
Frequently Asked Questions
How many days without poo means a child is constipated?
There is no exact number that applies to every child. The NHS suggests constipation may be present when a child has fewer than three bowel movements in a week, but stool hardness, pain, withholding and soiling also matter.
What does constipated poo look like?
It may be very large and hard or appear as small dry pellets resembling rabbit droppings.
Why does my child hide when they need to poo?
Some children hide, stiffen their legs or clench their bottom because they are trying to hold the stool in, often after previously experiencing a painful bowel movement.
Can a constipated child still poo every day?
Yes. A child can pass small amounts while still having a significant build-up of stool in the bowel.
Can constipation cause diarrhoea?
It can cause apparent diarrhoea through overflow soiling, where liquid stool leaks around retained hard poo.
Why is my child pooing their pants?
Constipation is a very common reason. A stretched rectum can reduce awareness that poo is coming, and softer stool may leak around impacted stool. Regular soiling should be discussed with a GP.
Is my child soiling deliberately?
Usually not. Overflow soiling from constipation is involuntary, and punishment can make the problem more stressful.
What laxative is commonly used for children?
NICE recommends macrogol, or polyethylene glycol 3350 with electrolytes, as the usual first-line treatment for both faecal impaction and maintenance treatment where appropriate.
Is macrogol safe for children?
Macrogol preparations are widely used in childhood constipation under appropriate medical guidance. The exact product and dose depend on age and the clinical situation.
Can I give my child an adult laxative?
Do not assume an adult preparation or dose is suitable. NHS guidance advises that laxatives for babies and children should be used on the advice of a GP or appropriate healthcare professional.
How long do children need laxatives?
Often much longer than parents expect. Treatment may continue for several months after bowel movements become regular, with doses gradually reduced rather than suddenly stopped.
Will a child become dependent on laxatives?
When prescribed appropriately for childhood constipation, the bigger problem is often stopping treatment too early and allowing painful constipation to return. Discuss dose reduction with the clinician managing the child.
Will more fibre cure constipation?
A balanced diet with appropriate fibre is helpful, but NICE does not recommend diet alone as first-line treatment for established idiopathic constipation.
Does drinking more water cure constipation?
Adequate fluid intake helps support normal stools, but a child with significant retained stool may still need laxative treatment.
Can constipation cause stomach pain?
Yes. Abdominal discomfort and reduced appetite are common, and the pain may improve after a bowel movement.
Can constipation cause blood in the poo?
A large hard stool can cause a small tear around the anus and a little bright-red bleeding. Recurrent, substantial or unexplained bleeding should be medically assessed.
Can constipation cause bedwetting?
Yes, constipation can contribute to bladder symptoms and is recognised by the NHS as one possible cause of bedwetting.
When is constipation an emergency?
Seek urgent medical help if constipation or soiling occurs with significant abdominal swelling and vomiting, severe illness or neurological symptoms such as weakness or numbness in both legs.
When should I take my child to the GP?
Seek advice if constipation is established, painful, recurrent or associated with soiling. Early treatment can help prevent the withholding cycle from becoming chronic.
