Constipation relief for toddlers

Dear Alice,

I have a child who is two-years-old and has constipation problems. I need solutions for this.

Dear Reader,

Constipation is a relatively common childhood problem. Children become constipated for a number of reasons, including eating too little fiber, drinking too little liquid, taking in too much milk, or purposely trying to hold in their stool if they've had a painful experience while having a bowel movement or while they are in the process of learning to be potty-trained.

An good first step, though, is to make sure that you are correct in thinking that your child is constipated. Signs of constipation include:

  • Pain and difficulty passing stools
  • Small, dry, pellet-like stools
  • Infrequent stools (less than every couple of days)

The frequency issue is difficult to define, however. Not everyone has stools daily — so don't panic if your child is on a once-every-other-day schedule, unless you are also noticing other signs that point to constipation.

If you decide that your child is indeed constipated, here are some simple ways to address the issue:

Offer fluids, fluids, fluids
Plain water is definitely the best choice. Your child needs to have a cup of water available to sip on. When you get a drink for yourself, offer your child a drink. One way to tell if s/he is getting enough fluids is to look at the urine — it needs to be a very light shade of clear yellow. The darker the urine, the more likely they are not taking in enough water.

Similarly, do not wait till your child, or yourself for that matter, is thirsty. If someone is thirsty, they are already dehydrated, so offer it before. Just keep that bottled water or thermos handy.

Up the fruit 'n fiber
Add a bit more fiber into his or her food choices with whole grain breads, crackers, cereal, and lots of whole fruit (e.g., prunes, pears, plums). A healthy eating plan for a two-year-old includes (FYI: minimum serving size for toddlers is approximately one tablespoon per year of age or ¼ of an adult serving per year of age):

  • 4 servings of grains — one serving equals 2 tablespoons of cooked rice, pasta, or cereal, or ½ slice of bread
  • 2 servings of fruits — one serving equals 2 tablespoons of fresh or canned fruit, or fruit sauce
  • 2 servings of vegetables — one serving equals 2 tablespoons of cooked vegetables

Avoid offering your child bran, however — your two-year-old is too young for that fiber source.

Cut back on constipating foods
These may include rice, cooked carrots, bananas, cheese, and yogurt.

Get on the move
Your two-year-old needs a reasonable amount of exercise time and movement — running, jumping, time with playground equipment, etc. Being a couch tater tot will increase the tendency to be constipated.

Give just enough milk
Stick with no more than 2 to 3 six-ounce cups of milk a day. Exceeding this amount may encourage more constipation. It's thought that constipation due to dairy products may be a form of allergy to the protein in milk; the sugar component (lactose) and fat percentage doesn't seem to make a difference in constipation.

If your child is still constipated with 2 to 3 cups of milk a day, cut back to 1 to 2 cups daily. If they are still having trouble with constipation, try a different source of calcium, protein, and fat; you can try soy or rice milk, although soy can often be an allergy source in children, as well.

Schedule some potty time
Try popping your child on the potty for five to ten minutes after each meal — sit yourself down as well, and make yourself comfortable while you chat or read a book to your child. This designated potty time can allow your child a calm routine to look forward to, where s/he can learn to relax and let nature take its course.

Some guidelines of when to head straight to your health care provider include:

  • 1½ to 2 weeks have passed, and none of the simple fixes listed above is working.
  • Your child has gone three days or more without having a stool.
  • Your child is experiencing ongoing, unrelenting abdominal or rectal pain.
  • Your child passes blood in the stool.
  • Your child is occasionally leaking stool.
  • Your child is vomiting or has diarrhea.
  • Your child develops a fever.

Your health care provider may suggest using medication to help soften your child's stools. Do not use these products without consulting your provider first.

Hope these suggestions bring some relief for your two-year-old, and for you!

Last updated May 29, 2015
Originally published Dec 19, 2003

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