By Dr. Daniel Lustig and Lisa Philichi, ARNP

If your child is constipated, chances are it’s frustrating for both of you.

Constipation — difficulty passing stool or a longer-than-normal time between bowel movements — is common in children and can sometimes be a cause for concern.

What is normal?

The frequency and consistency of bowel movements in infants and children depend upon age and diet, and an individual child’s patterns can vary widely. Normal for an infant could mean a bowel movement every time they eat or only once a week. An older child may go three times a day or once every three days.

When is it constipation?

Your child may be constipated if he or she has had less frequent bowel movements — or difficulty passing stool — for more than two weeks.

It’s important to note that even children who go with normal frequency can still have symptoms of constipation. Small, hard or rocklike stools passed daily or very large, firm stools that clog the toilet once a week can both be signs of constipation.

Stool withholding — trying to keep from having a bowel movement — is also a clear indicator that your child is constipated. Infants may arch their back, tighten their buttocks and cry. Toddlers may rock back and forth while stiffening their buttocks and legs, arch their back and wriggle or fidget, squat, or get into other unusual positions. They may also hide in a corner or a special place.

Children withhold because they are afraid passing stool will hurt and it can be a difficult habit to break. Unfortunately, repeated withholding can make the problem worse. Young infants may appear constipated or in pain because they strain and get red-faced when they go. This is usually because the muscles used for defecating are still uncoordinated in infants less than 6 months old. A baby is unlikely to be constipated if he or she passes soft stools within a few minutes of straining.

How do I make it better?

Diet changes, illness, stress, toilet training, lack of exercise or unwillingness to stop playing for a bathroom break can all lead to constipation. The good news is most children with constipation do not have an underlying medical problem.

Treatments may include stool softening medications (oral or rectal) to make it easier for the child to go to the bathroom, dietary changes and behavior modification. Parents should put any toilet training activities on hold until after their child’s constipation has been resolved. In some cases, constipation can be a symptom of a more serious problem, such as hypothyroidism, Hirschsprung’s disease, celiac disease, spinal cord dysfunction or an adverse effect of some medications. So it’s a good idea to check with your pediatrician before starting any treatment.