Childhood constipation

Diet matters for preventing constipation, but for established constipation, dietary changes alone are often not enough. That's an important distinction. If a child is already impacted, adding more fruit and fibre isn't going to shift the impaction - you need medical treatment first, then dietary changes to maintain things afterward.

The dietary factors that matter — fluid intake, fibre from food, and meal regularity — are well established but need to be tailored to the individual child. What's often overhyped: 'constipation foods' lists circulating online, fibre supplements as a first-line approach for children, and probiotics (the evidence for probiotics in childhood constipation is weak). A consultation identifies what's actually going on with your child's diet and builds a realistic plan around it.

Many parents are understandably reluctant to give their child laxatives. There's a common worry that the bowel will become 'dependent' or 'lazy'. The evidence doesn't support this concern for the standard first-line laxatives used in children, which have a good safety profile even with long-term use. Your GP prescribes and manages laxative treatment.

For established constipation, a medical treatment phase is often needed before dietary strategies become effective. The timeline can be longer than most families expect — months rather than weeks. This is why working with both your GP for the medical piece and a dietitian for the dietary and behavioural piece tends to produce the best results.

Adequate treatment duration matters. Stopping too early can allow the cycle to restart, which is why working with a professional to plan the timeline can help. If your GP has prescribed laxatives for your child, please use them as directed rather than reducing or stopping prematurely.

Diet and laxatives are part of the picture, but the behavioural piece matters just as much. Toileting routines — timing, positioning, and creating a relaxed environment — are evidence-based strategies that can make a real difference. Many children also develop toileting anxiety alongside constipation, especially if previous bowel movements have been painful. Addressing this gently and consistently is part of the recovery.

The specific routine, how to manage anxiety around it, and how to coordinate with school if school toileting avoidance is a factor are all things I cover in detail in a consultation, tailored to your child and family.

School toilets are a particular issue. Many children won't use school toilets because they're unpleasant, lack privacy, or they're embarrassed. This means they're holding for the entire school day, which perpetuates the problem. It's worth speaking to the school about access and privacy if this is contributing.