Constipation Clues: Signs, Solutions, and Soothing Tips
Constipation is a common issue in childhood, often influenced by toilet training, behavior, picky eating habits, and developmental stages. At some point, most parents find themselves navigating this challenge with their child so it’s something we, as pediatricians, spend a lot of time talking about.
Signs
According to the Rome IV Criteria, the clinical guidelines used to diagnose constipation in children, constipation looks different for infants and toddlers (4 years old or younger) and children over 4 years old. The following table shows the symptoms to look out for.
Rome IV Criteria for Constipation
“I’ve noticed my child having more accidents this week, like pooping in the bed, he’s potty trained, and this is unlike him. I’m worried something is wrong. What do you think?”
Be prepared to answer questions about how long the accidents or changes in behavior have been occurring, and remember, your doctor and MPF are here for you!
If it has been an ongoing problem, bringing some notes about timeline, what makes it better or worse or any patterns can be helpful for your care team to review with you.
Soothing Tips
Warm Baths – Help relax tummy muscles and encourage pooping
Distraction on the Toilet – Reading books, listening to music while sitting
Normalize Poop Talk – Reassure kids that everyone poops and it’s nothing to fear
Avoid Punishment – Accidents are not their fault; shaming worsens withholding
Massage & Movement – Gentle belly rubs, stretching, or core-strengthening exercises
Comfort Objects – Allow a favorite toy during toilet time
Be Patient – It can take weeks or months to fully resolve
It’s important to talk solutions over with your pediatrician, ask questions about which solutions they’ve seen work that might help, and if symptoms continue it might be time to start medication.
TLDR
Functional constipation is common in kids and usually not caused by illness. Look for signs like infrequent or painful poops, stool withholding, or toilet clogging. Treatment starts with regular toilet routines, healthy fiber intake, and if needed and recommended by your pediatrician, gentle stool softeners like Miralax. Keep it positive and patient. Don’t punish, and try warm baths, footstools, or books to make bathroom time easier.
References
Allen P, Setya A, Lawrence VN. Pediatric Functional Constipation. [Updated 2024 Jan 11]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK537037/
Mulhem, E., Khondoker, F., & Kandiah, S. (2022). Constipation in children and adolescents: Evaluation and treatment. American Family Physician, 105(5), 469–478.
Rajindrajith S, Devanarayana NM, Benninga MA. Childhood constipation: Current status, challenges, and future perspectives. World J Clin Pediatr. 2022 Sep 9;11(5):385-404. doi: 10.5409/wjcp.v11.i5.385. PMID: 36185096; PMCID: PMC9516492.
Santucci, N. R., Chogle, A., Leiby, A., Mascarenhas, M., Borlack, R. E., Lee, A., Perez, M., Russell, A., & Yeh, A. M. (2021). Non-pharmacologic approach to pediatric constipation. Complementary Therapies in Medicine, 59, 102711. https://doi.org/10.1016/j.ctim.2021.102711
de Geus, A., Koppen, I.J.N., Flint, R.B. et al. An Update of Pharmacological Management in Children with Functional Constipation. Pediatr Drugs 25, 343–358 (2023). https://doi.org/10.1007/s40272-023-00563-0