If your child has hard stools that are painful to pass or they have to strain, they’re probably constipated.

This is a common problem especially amongst younger children and usually happens because they aren’t eating enough fibre or drinking enough fluid.

A change of diet should sort it out in a few days. However, some children resist opening their bowels because they don’t enjoy the sensation or have found it painful in the past.

This can lead to chronic constipation which may need to be treated with laxatives on prescription. Chronic constipation can also cause soiling which parents mistake for diarrhoea.

Eating foods with plenty of fibre and drinking plenty makes stools that are bulky, but soft and easy to pass out.

Food and fibre

Ask your practice nurse for a list of foods high in fibre if you are unsure which foods contain fibre. Some examples include: fruit, vegetables, cereals, wholemeal bread. A change to a high fibre diet is often ‘easier said then done’, as many children are fussy eaters. However, any change is better than none. Have you tried such things as:

• giving dried apricots or raisins for snacks.
• jacket potatoes filled with baked beans for tea.
• porridge or other high fibre cereals for breakfast.
• vegetable soups with bread.
• offering fruit with every meal.
• perhaps do not allow sweets until your child has eaten a piece of fruit.

Another tip for when children are reluctant to eat high fibre foods is to add powdered bran to yoghurt. The yoghurt will feel grainy, but powdered bran is tasteless.

Drink

Encourage children to drink plenty. However, some children get into the habit of only drinking squash, fizzy drinks or milk to quench their thirst. These may fill them up, and make them less likely to eat proper meals with food that contains plenty of fibre. So try and limit these kinds of drinks, and give water as the main drink. However, fruit juices that contain fructose or sorbitol have a laxative action (such as prune, pear, or apple juice). These may be useful from time to time if the stools become harder than usual and you suspect constipation may be developing.

Some other tips which may help

• Try and get children into a regular toilet habit. After breakfast, before school or nursery, is often best. Try and allow plenty of time so they don’t feel rushed.
• Some kind of reward system is sometimes useful in younger children prone to ‘holding on’ to stools. For example, a little treat after each successful toilet trip.

However, try not to make a fuss over the toilet issue. The aim is to be ‘matter of fact’ and relaxed about it.

Mild constipation in children and it’s treatment

Most bouts of constipation in children last just a few days. Many children strain to pass a large or hard stool now and then. It is of little concern, so long as a normal pattern soon returns. Treatment of mild and temporary constipation is the same as for preventing constipation. That is, a diet with plenty of fibre, lots to drink, and perhaps a fruit juice which contains fructose or sorbitol.