Toddler Constipation Treatment

  • Lucy BrandrietBSc Natural Sciences, University College London, London UK

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Constipation is a common problem that children experience at different stages of their childhood. Many times, we view it as something that will resolve with time as the child gets older.

However, this may lead us to a missed opportunity for early intervention, and cause complications, such as tummy aches, anal fissures, bleeding, haemorrhoids, stool withholding, and stool and urinary incontinence. The first line of defence is the prevention of constipation in the first place, through guidance about what to expect regarding diet, potty training, and toileting behaviours.

The treatment of toddler constipation depends on factors like the age of the child, symptoms and duration. It may encompass one or a combination of the following: education, dietary and behavioural changes, and drug therapy.1,2

In this article, we will focus on recent-onset constipation, i.e. shorter than 8 weeks in duration, rather than constipation of longer duration.


Constipation can be defined as a decreased frequency of bowel movements (≤ two times per week), and having painful, hard, or large stools.

In terms of cause, constipation can be divided into two organic, or functional constipation.

  • organic constipation refers to constipation caused by an underlying physical cause
  • functional constipation refers to constipation without a known physical cause. What usually causes it is the child voluntarily withholding stool to avoid painful defecation. In children, it is the most common cause of constipation. The majority of children with this type of constipation need long-term treatment and experience frequent relapses3,4

In terms of duration of symptoms constipation can either be recent-onset constipation, the focus of this article, or chronic constipation.

  • Recent-onset constipation: constipation is considered recent in onset if the child has been experiencing it for eight weeks or less. Short-term behavioural interventions or the administration of laxatives for a short period usually solves the issue
  • Chronic constipation: If the child has been experiencing the symptoms for more than 3 months (even if it includes multiple bouts of symptoms) then we consider it to be chronic. To treat the issue, the child will usually require long-term and more intensive behavioural support, and longer use of laxatives

Prevention and monitoring

Healthcare professionals should provide parents with appropriate and timely guidance about what to expect during a child’s developmental stages when constipation is most likely to happen. When this happens, parents can anticipate and even prevent constipation episodes from happening.

Additionally, even if they happen, then they can deal with them swiftly with temporary interventions, thus preventing possible complications. The parents should address any complaints indicating constipation and never ignore them.

Painful stools can lead children to withhold bowel movements which worsens constipation and can lead to stool impaction and incontinence. This succession can happen covertly, so the parents need to be on the lookout.5,6

Developmental stages where constipation is expected

When the parent introduces solid food or cow’s milk:

Parents should be watchful for signs of constipation when they transition an infant to a solid diet. This is because the transitional diet often lacks enough fibre and fluids.

To prevent or initially treat mild constipation, it can help to ensure that the infant consumes enough fluid and fibre. There is little evidence to prove that including an amount of fluid or fibre that exceeds the recommended amount would be effective in severe chronic constipation.7

Recommended daily fibre and fluid intake


Five grams of fibre per day is a reasonable target to aim for as a daily fibre intake for toddlers younger than two years of age.

This amount can easily be obtained from several servings of pureed fruits, vegetables and an infant cereal that contains fibre. Most fruits and vegetables provide around one gram of fibre per serving. Unlike multigrain, whole wheat, and barley cereals which provide 1-2 grams of fibre per serving, rice cereals provide a negligible amount.

Fluid intake

It is important that a child receives enough fluids. However, there is no need to exceed their maintenance fluid needs, unless the child is dehydrated.

We can calculate the minimum daily fluid requirements based on the child's weight, examples include:

  • 5 kg infant – 500 mL daily
  • 10 kg child – 1000 mL daily
  • 15 kg child – 1250 mL daily
  • 20 kg child – 1500 mL daily

Cow's milk

The transition to cow’s milk from breast milk or formula seems to trigger constipation in some toddlers. If the two events seem to coincide, the parents can try a cow milk-free diet for two weeks (A soy-based formula can be used during that time). If the constipation improves, the parent can continue this milk-free diet for 6-12 months, and then try cow’s milk again.

Anal fissures

Passing large stools, and vigorous wiping during diaper change can cause anal fissures, which cause painful defecation and can lead the toddler to try to retain stool and avoid defecation, which in turn can cause the symptoms to persist and become chronic.

Toilet training

When parents start to toilet-train their children, they need to be watchful for any signs of constipation. In this case, the parents can prevent and initially manage constipation if they do the following:

  • Implement toilet training in a relaxed child-oriented manner 
  • Put foot support for the child to use when they sit on the toilet (to relax the pelvic floor and for comfort)
  • Ensure adequate fluid and fibre intake 
  • Avoid excessive cow's milk intake


Parents should intervene promptly when a child develops signs and symptoms of constipation even if they only experience them short term (i.e., < 2 weeks), this is important to prevent the vicious cycle of stool withholding and worsening constipation. They should also put a follow-up plan in place to make sure the constipation resolves and the child develops a healthy stooling pattern. 

Recent-onset constipation

The first step is to educate the parents about what to expect, signs to watch out for, and how to respond to the first signs of constipation. They need instructions about age-appropriate toileting and dietary changes. Depending on the severity of the symptoms laxatives are sometimes used. For anal fissures, topical treatments can help.8 

Non-response or relapse

For toddlers and children who do not respond or who experience recurrence after the initial treatment, it is crucial to find out and appropriately address dietary problems and/or any precipitating factors that remain. Precipitating factors may include recurring painful defecation (e.g., because of an anal fissure, or hard stool), reluctance to use the toilet at school, under treatment and early stopping of laxatives, and not enough time to use the toilet at school or after meals.9

In this case, one or more of the following interventions may help during the time that precipitating events are being addressed.

Optimise dietary fibre intake

Children with recurring episodes of constipation need to undergo a dietary assessment to make sure of the recommended daily fibre intake (age plus 5-10 grams/day). If the fibre consumption is not enough, fibre supplements can help. Safe fibre supplements for children are available over the counter (e.g., psyllium, methylcellulose, or wheat dextrin).

However, it is important for the children who consume these supplements to consume (1000 to 2000 mL) plenty of water or other non-milk fluids per day, because these supplements work by absorbing water to provide bulk to the stool. Consequently, if a child consumes an inadequate amount of fluid, this can worsen the situation.


Children who experience recurring constipation episodes may also need a couple of doses of a laxative at the beginning of an episode to ease out the passage of hard stool and promote regular bowel movements. Parents can consider maintenance laxatives if the stools remain large or remain painful. Stopping laxatives too early can worsen retentive behaviour and facilitate chronic constipation or recurrence.


Children who have not passed stool for several days and are unable to have a bowel movement could have faecal impaction. These children may benefit from a higher dose of oral laxative for a short duration (up to one week), or a sodium phosphate enema (with the appropriate size and dose for the child's age) followed by an oral laxative. It is not recommended to repeat sodium phosphate enemas.


Follow-up is crucial to prevent vicious cycles of recurrent constipation. For children who experience a single episode of constipation, parents should be advised to call if the constipation does not go away quickly or if it comes back. If the constipation recurs, patients should schedule follow-up visits to assess if the constipation is adequately managed.

Although it is normal for a child not to have a daily bowel movement. It is advisable to intervene, soften and increase the stool frequency if hard or painful stools are present. Timely intervention may help to break the vicious cycle and prevent faecal retention, which may develop into chronic constipation. 


Constipation is common in toddlers, often occurring during transitions like starting solid foods or toilet training. Defined by infrequent, painful stools, it can be organic (physical cause) or functional (stool withholding). Prevention includes educating parents on proper diet (adequate fibre and fluids) and toilet training. Toddlers need around five grams of fibre daily and sufficient fluid intake based on weight.

Initial treatment involves dietary adjustments, education, and possibly laxatives or topical treatments for anal fissures. If symptoms persist or recur, re-evaluate diet, address precipitating factors, and consider fibre supplements or maintenance laxatives. For fecal impaction, higher doses of oral laxatives or a sodium phosphate enema may be used. Continuous monitoring and timely intervention are crucial to prevent chronic constipation and ensure healthy bowel habits. Parents should seek medical advice if constipation persists or recurs.


  1. Abi-Hanna A, Lake AM. Constipation and encopresis in childhood. Pediatr Rev. 1998 Jan;19(1):23–30; quiz 31.
  2. Tabbers MM, DiLorenzo C, Berger MY, Faure C, Langendam MW, Nurko S, et al. Evaluation and treatment of functional constipation in infants and children: evidence-based recommendations from ESPGHAN and NASPGHAN. J Pediatr Gastroenterol Nutr. 2014 Feb;58(2):258–74.
  3. Benninga MA, Faure C, Hyman PE, St James Roberts I, Schechter NL, Nurko S. Childhood functional gastrointestinal disorders: neonate/toddler. Gastroenterology. 2016 Feb 15;S0016-5085(16)00182-7.
  4. Hyams JS, Di Lorenzo C, Saps M, Shulman RJ, Staiano A, van Tilburg M. Functional disorders: children and adolescents. Gastroenterology. 2016 Feb 15;S0016-5085(16)00181-5.
  5. Di Lorenzo C. Pediatric anorectal disorders. Gastroenterol Clin North Am. 2001 Mar;30(1):269–87, ix.
  6. Abrahamian FP, Lloyd-Still JD. Chronic constipation in childhood: a longitudinal study of 186 patients. J Pediatr Gastroenterol Nutr. 1984 Jun;3(3):460–7.
  7. Iacono G, Cavataio F, Montalto G, Florena A, Tumminello M, Soresi M, et al. Intolerance of cow’s milk and chronic constipation in children. N Engl J Med. 1998 Oct 15;339(16):1100–4.
  8. Heyman MB, Abrams SA, SECTION ON GASTROENTEROLOGY, HEPATOLOGY, AND NUTRITION, COMMITTEE ON NUTRITION. Fruit juice in infants, children, and adolescents: current recommendations. Pediatrics. 2017 Jun;139(6):e20170967.
  9. Loening-Baucke V. Prevalence, symptoms and outcome of constipation in infants and toddlers. J Pediatr. 2005 Mar;146(3):359–63.

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This content is purely informational and isn’t medical guidance. It shouldn’t replace professional medical counsel. Always consult your physician regarding treatment risks and benefits. See our editorial standards for more details.

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MSc. Clinical Pharmacy, BCPS, Amman, Jordan

Khaled is a clinical pharmacist with extensive healthcare experience, having served in different roles in hospital and community sectors in different countries. He is board certified as a pharmacotherapy specialist by the American College of Clinical Pharmacy.

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