Constipation in Children

A painful or frightening bowel movement can make a child hold back stool. The stool then becomes larger and harder, which hurts more, and a cycle begins. Common triggers include low fibre and fluid intake, avoiding school or public toilets, rushing in the morning, and a change in routine. Rarely, constipation is caused by a medical condition, which is why the red flags below matter.

Constipation is one of the most common reasons children are brought to doctors, and a frequent reason for referral to paediatric gastroenterologists. It often starts at times of change, such as starting solid foods, toilet training, or starting school.

During Ramadan, older children who fast may drink less and become more constipated. Offer fibre-rich foods and plenty of fluids between iftar and suhoor, and ask your doctor how to time any laxative. Children who are not yet expected to fast should not be encouraged to do so.

Most children are diagnosed from the story and a physical examination, including checking growth and the area around the anus. A rectal examination or X-ray is not usually needed. The doctor will look for red flags. Blood tests or other investigations are used only if the story or examination suggests another cause.

Routine and a calm, positive approach are as important as medicine.

• Encourage your child to sit on the toilet for a few minutes after meals, once or twice a day, when the bowel is naturally most active.

• Use a footstool so the knees are higher than the hips and feet are supported.

• Praise effort and use a reward chart for sitting, not for results. Never scold or punish accidents.

• Encourage daily active play and movement.

• Make school toilets less stressful by talking with the teacher and letting your child go whenever needed.

A balanced diet helps, although diet changes alone rarely cure established constipation.

• Offer fruit, vegetables, wholegrain bread and cereals, pulses and other fibre-rich foods at each meal.

• Offer regular drinks of water through the day. Do not force large amounts.

• Dates, prunes and similar fruits are traditional and may help some children, if suitable for the child's age.

• Limit the amount of cow's milk, cheese and processed snacks if they replace other foods. Do not stop milk completely without advice.

• Do not add bran or herbal laxatives or give home remedies to infants without asking a doctor.

Laxatives are the main treatment for established constipation. They are safe when used as the doctor directs, and they do not cause "laziness" of the bowel.

• Your doctor may first clear out the hard stool built up in the bowel, then prescribe a daily maintenance laxative to keep stools soft.

• Treatment often continues for weeks to months after the child seems well. Stopping early is a common reason for relapse.

• Do not give enemas, suppositories or adult laxatives to a child unless a doctor has prescribed them.

• The doctor chooses the medicine and the dose for your child's age and weight and will reduce it slowly when the time is right.

Procedures are rarely needed.

• In a small number of children who do not respond to proper treatment, tests such as an X-ray, bowel transit study, or anorectal tests may be done.

• A hospital stay to clear stool is sometimes needed when home treatment fails or the child is in a lot of pain.

• Referral to a paediatric gastroenterologist is advised if there are red flags or no improvement with treatment.

With a clear plan, most children get better, but it often takes months of treatment, and treatment should not be stopped too early. Relapses are common, especially if medicine is stopped suddenly. Regular follow-up helps prevent the cycle from returning.

• Does my child have simple functional constipation or something else?

• Which laxative is best, and how long should my child take it?

• How do we manage soiling accidents and toilet routines?

• When should we reduce or stop the medicine?

• Does my child need any tests or a specialist visit?

This guide comes from the Saudi Gastroenterology Association (SGA) patient library, prepared by the Approved for publication by SGA; individual clinician review is ongoing. Last reviewed: 2026-04-24. It is for education and does not replace your doctor's advice.