saudigastro.com/patients/pediatric-constipation
Category
Common
Red flags
5
This article is educational and does not replace your doctor's advice. Seek urgent care for any red-flag symptoms.
What is it?
Constipation means passing hard, dry or painful stools, or going less often than is normal for your child. Some children also leak soft stool into their underwear (soiling, or "encopresis") because hard stool is stuck in the lower bowel and liquid stool slips around it. This is not deliberate, and children should never be punished for it. Constipation that has no underlying disease is called functional constipation, and it is the usual cause in children.
How common is it?
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.
Why does it happen?
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.
Symptoms
- Hard, dry, large or pellet-like stools
- Pain or crying when passing stool, or avoiding the toilet
- Fewer bowel movements than usual
- Belly pain or a hard, bloated tummy
- Streaks of fresh blood on the stool or tissue from a small tear (fissure)
- Soft stool stains in underwear (soiling)
- Poor appetite, irritability, or a child who stands stiffly or crosses legs to hold stool in
Red flags — seek urgent medical care
Constipation that began in the first weeks of life, or a newborn who passed the first stool (meconium) later than 48 hours after birth
May point to a condition such as Hirschsprung disease. Your child should be assessed promptly.
Green (bile) vomiting, a swollen hard belly, or severe belly pain
May indicate a bowel blockage. Go to the emergency department immediately.
Fever with bloody diarrhoea, or a very unwell, floppy child
Could be a serious infection of the bowel. A child needing urgent care should be seen immediately.
Weight loss, poor growth, or persistent blood in the stool
Suggests a cause other than simple constipation. See your doctor soon.
Weakness of the legs, a dimple or tuft of hair at the base of the spine, or new problems passing urine
May suggest a problem with the nerves of the lower back. Needs medical review.
How is it diagnosed?
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.
Outlook — what to expect
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.
Treatment
Habits & Lifestyle
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.
Diet
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.
Medications
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 & Surgery
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.
Living with the condition
- Keep a simple diary of stools, medicine and any soiling.
- Stay positive. Soiling is not your child's fault and improves as treatment works.
- Share the plan with caregivers and school staff so everyone is consistent.
In the Saudi context
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.
Questions to ask your doctor
Save this list or print it before your appointment — doctors appreciate prepared patients.
- 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?
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Status: Approved for publication by SGA; individual clinician review is ongoing · Published 24/04/2026
For general education only; it does not replace your doctor’s advice. Individual clinician review of this guide is ongoing. SGA clinician? Review this guide