Child toilet training

What is constipation?

Constipation is an abnormal pattern of bowel movements that causes a person to pass stools less often than usual. The stools may be difficult to pass or harder than usual. Constipation makes passing stools uncomfortable. In more extreme cases, there may be soiling (encopresis). 

Everyone has a different bowel pattern. A normal frequency of stools can vary from several times a day to once every few days. If your child's pattern has slowed down, they may be constipated.

Constipation can occur over days, weeks or months or it can occur during a change in routine such as toilet training, starting school, having a new sibling, going on holiday or having a change in diet.

Often stools may appear normal, but they build up in the bowels over time. This build-up may cause stomach cramps and pain, but the symptoms of constipation may go unrecognized for a long time. For children who have been constipated for a long time, retraining the bowel and returning it to normal can take many months or sometimes even years.

What causes constipation?

In most children, constipation is caused by issues with bowel routines or diet. Some common causes of constipation are:

  • not drinking enough fluids
  • not having enough fibre from whole grains or cereals, fruits and vegetables
  • eating too much junk food or other foods that promote constipation
  • withholding stools to avoid painful bowel movements if there are small tears (fissures) at the bowel opening (anus)
  • genetics - some children inherit a tendency toward constipation from their parents
  • poor bowel routines, problems with toilet training and sometimes refusing to spend time on the toilet.

Some children may have a fear of public bathrooms. Other children simply prefer to keep playing rather than go to the bathroom when they feel the urge to have a bowel movement. Instead, they 'hold back', causing a build-up of stool.

Other less common causes of constipation are:

  • illnesses that cause vomiting, diarrhea or fever and lead to a loss of body fluids and dehydration
  • some medicines such as morphine
  • underactive thyroid gland (hypothyroidism)
  • Hirschsprung's disease, a disease of the bowel that is usually diagnosed in the first few weeks of life
  • infant botulism, which can occur if a child less than one year of age has affected honey (even if the honey is pasteurized).

How to care for your child with constipation

In some children, constipation can be relieved by making diet and lifestyle changes. Once constipation starts, it can last a long time. Treatment for constipation​ is long-term and requires patience, co-operation and commitment from family members and from the school.

Diet in children less than 1 year old

Babies under two months old generally do not have constipation. Talk to your child's doctor before you make any changes to your baby's milk or formula or give any medicine to treat constipation.

If your baby is under four months old, you may consider giving 1 ounce (30 ml) of apple, pear or prune juice once or twice a day.

Once your baby is more than four months old, try giving high-fibre, strained foods. These include apricots, beans, cereals, peaches, pears, peas, plums or prunes.

Diet in children over 1 year old

Give your child plenty of fluids, especially water.

Make sure that your child eats fruits and vegetables every day. Canada's Food Guide recommends that children have four to six servings of fruits and vegetables a day. Some good examples are apples, apricots, beans, blueberries, brocolli, cabbage, cauliflower, dates, figs, lettuce, peas, pears, prunes and raisins. Avoid any foods that could cause choking in younger children.

Take steps to increase the amount of fibre in your child's diet. As a general rule your child should have their age plus 5 grams of fibre a day. So if they are four years old, for example, they should have 9 grams of fibre a day. 

Have your child eat bran every day. It is high in fibre and is a natural stool softener. There are many sources of bran to choose from. Try bran cereals, bran muffins, whole wheat or multigrain bread, graham crackers or oatmeal. If your child is over four years of age, popcorn is another great fibre source.

Some foods are known to cause constipation. You may wish to limit them in your child's diet. Examples include low-fibre foods such as white rice or bread and junk food such as chips and pop. Filling up on too much dairy so you don't eat fibre-rich foods may also contribute to the problem. Diet changes are most successful when the entire family follows these healthy choices.

Toilet training

Two or three times a day, right after meals, have your child spend at least five minutes on the toilet or the potty. Even if there is no bowel movement, you are helping to set a pattern. You might find it helpful to use a calendar to reinforce the schedule.

Your child should be comfortable, with the knees up. A foot rest can prevent your child's legs from hanging down. It will also keep the knees bent, which helps bowel movements pass more easily.

If you are having problems with toilet training and your child is holding back stool, you may need to delay the toilet training until the constipation is successfully treated.


If a change in diet does not relieve your child's constipation, talk to your child's doctor.

Some children with constipation will not respond to diet and toilet routine changes alone and will need medication.

The most effective medications for constipation are stool softeners. These work by drawing water into the bowel to 'flush' out the stool. They include lactulose, sorbitol or, most commonly, polyethylene glycol (PEG 3350). Polyethylene glycol is safe for children and can be used long-term. Many brands are available without a prescription and it is tasteless when fully dissolved in a drink.

For children who are severely constipated, higher doses of medicines are often needed at first to clean out backed-up stool and provide relief from the pain linked to constipation. You can then adjust the dose to enable the child to empty their bowels every day.

Avoid using suppositories or enemas when possible. If you do need to use them, only do so under the direction of your doctor.

Do not be afraid to give your child long-term medication under your doctor's supervision to help treat their constipation. Routine emptying of the bowel is important for overall bowel health.

Goals of treating constipation

  • Complete initial cleanout of backed-up stool
  • Daily emptying of the bowel
  • Regular toilet routines
  • Long-term bowel maintenance
  • Long-term diet and fluid habit changes for the entire family

When to see your child's doctor

See your child's doctor if your child:

  • is generally affected by poor bowel movements
  • has blood in the stool
  • has a fever
  • is urinating (peeing) often or finds urinating painful
  • has a hard time passing a bowel movement after four days
  • loses some bowel control or starts to soil underwear.

Take your child to the nearest Emergency Department if:

  • your child is having a lot of pain
  • your child is vomiting (throwing up) repeatedly or vomiting dark green
  • your child's abdomen (belly) becomes swollen.

Key points

  • Constipation means bowel movements that are less frequent than usual, painful or hard to pass.
  • Constipation can be caused by inadequate fibre in the diet, poor bowel routines, fissures in the anus, medicines, genetics or not drinking enough fluids.
  • Family bowel patterns may play an important role.
  • Changes in your child's diet may stop constipation.
  • Your child's doctor may also suggest giving medicine such as stool softeners to clear the bowel.
  • See your doctor if your child has blood in their stool, loses control over bowel movements or has a fever.​​

Beth Gamulka, MD, and SickKids Constipation Working Group​