Initial Treatment of Constipation in Children

Non-Pharmacological Interventions

Education and lifestyle modifications, including explaining the nature of constipation to parents and establishing realistic treatment expectations, should be the first step in managing constipation in young children, according to the American Urological Association 1
Increasing fluid intake to ensure adequate hydration is recommended for children with constipation, as suggested by the National Comprehensive Cancer Network 2, 1
Increasing dietary fiber is recommended if the child has adequate fluid intake, as suggested by the National Comprehensive Cancer Network 2, 1
Encouraging appropriate physical activity for the child's age is recommended, as suggested by the National Comprehensive Cancer Network 2
Establishing a regular toileting routine, including timed voiding/toileting with a reward system, is recommended, according to the American Urological Association 1
Ensuring proper toilet posture with buttock support, foot support, and comfortable hip abduction is recommended, according to the American Urological Association 1, 3
Addressing hygiene issues, including changing of wet clothing, skin care, and correct wiping technique, is recommended, according to the American Urological Association 1
Implementing a consistent toileting schedule, typically after meals to take advantage of the gastrocolic reflex, is recommended, according to the American Urological Association 1

The goal of maintenance treatment is to achieve one non-forced bowel movement every 1-2 days, as suggested by the National Comprehensive Cancer Network 2

Constipation management is typically long-term, and treatment may need to continue for months, according to the American Urological Association 1
Addressing concurrent issues, particularly behavioral issues around toileting, is recommended, according to the American Urological Association 1
Monitoring for treatment success, including acceptable outcomes such as adequate constipation symptom management, reduction of family distress, and improved quality of life, is recommended, as suggested by the National Comprehensive Cancer Network 2

Regular follow-up is essential to monitor progress and adjust treatment as needed, as suggested by the National Comprehensive Cancer Network 2
Reassessing for cause and severity of constipation if initial treatment is unsuccessful is recommended, as suggested by the National Comprehensive Cancer Network 2

Increase dietary fiber intake, particularly through whole fruits rather than juices, as fiber helps promote regular bowel movements, according to the American Academy of Pediatrics 4
Certain juices containing sorbitol, such as prune, pear, and apple juices, can help increase stool frequency and water content in constipated children, as recommended by the American Academy of Pediatrics 4, 5
Avoid excessive use of fruit juices as they lack fiber and can contribute to excessive calorie intake, as suggested by the American Academy of Pediatrics 4
Foods high in simple sugars, such as soft drinks and undiluted apple juice, should be avoided as they can worsen symptoms through osmotic effects, according to the Centers for Disease Control and Prevention 6

The American Academy of Pediatrics recommends treating constipation first in children with daytime wetting or urinary tract infections, as 66% had improvement in bladder emptying after treating constipation alone, with 89% resolution of daytime wetting and 63% resolution of nighttime wetting 7

Aggressive treatment of chronic constipation in infants is required to prevent serious complications, including rectal prolapse, hemorrhoids, and intestinal perforation. 8