Healthy Bowel Habits for Children

Regular bowel movements are important to your child's health. Bowel habits — how often, how much, and so on — will vary from child to child; some children go more than once a day, while others may skip a day or two. The most common problems with bowel movements are constipation and diarrhoea.

You can encourage healthy bowel habits by

• Eating healthy foods — whole grains, fruits and vegetables — and drinking more water each day. Children should have no more than 120 ml of 100% fruit juice per day.
• Staying active throughout the day, which helps keep bowels working well.
• Teaching your child not to hold a bowel movement.
• Explaining that regular bowel movements are normal and important for good health.
• Not using negative words like "dirty" or "stinky," which can make your child feel self-conscious about going to the toilet.

When should I call my doctor?

• Has diarrhoea and is younger than 6 months of age.
• Is often constipated.
• Has bloody or black stool.
• Is toilet-trained but starts to lose bowel control and has accidents.
• Has diarrhoea and a fever above 38.5°C (101.5°F).
• Shows signs of dehydration (increased thirst, no tears, urinating less, dry skin/mouth/tongue, faster heartbeat).
• Is not gaining weight.

What causes constipation?

Constipation happens when bowel movements are passed less often than usual, and/or are hard and dry and difficult or painful to pass, and/or seem unusually large. It can cause stomach pain and bright red blood on the surface of a hard stool. A constipated child may seem to be straining to go — in fact, he's often holding it in because it hurts to go.

Common causes include a low-fibre diet lacking whole grains, fruits and vegetables; too much milk, juice or dairy (which fills a child up so she eats less of the foods that help bowels work well); fear of using the toilet, sometimes from a crack or tear around the anus that makes it painful; not enough physical activity; and some medications.

What can I do if my child is constipated?

• Get your child into a regular daily toilet routine — don't rush toilet learning, since children can worry and hold back if they feel pressured.
• Offer high-fibre foods such as whole grain breads, fruits (apples, bananas, berries, prunes), vegetables and legumes (split peas, soy, lentils).
• Give milk and dairy in age-appropriate amounts — after 12 months, no more than 3 portions of milk products per day (1 portion = 1 cup/8 oz milk, ¾ cup/175 g yoghurt, or 50 g/1½ oz cheese); children between 2 and 8 years need only 2 portions a day.
• Give your child a firm support for his feet, like a small stool, when passing a bowel movement — it makes it easier to push.

Acute diarrhoea

Acute diarrhoea means more bowel movements, with stool that's less formed and more watery than usual, and usually lasts less than 14 days. It's usually caused by a virus — the most common cause is rotavirus, which spreads easily from person to person, especially among children who haven't learned to use the toilet. You can help prevent rotavirus diarrhoea by having your infant vaccinated, and reduce the spread of germs by washing your hands and your child's hands carefully after every nappy change, after using the toilet, and before preparing or eating food.

Children with diarrhoea can lose fluids quickly — keep offering food and drink. An oral rehydration solution (ORS), an exact mixture of water, salts and sugar, can help keep your child well hydrated when diarrhoea is serious.

Chronic diarrhoea and toddler's diarrhoea

Chronic diarrhoea lasts more than 14 days and has many possible causes, including coeliac disease. One fairly common cause in young children is toddler's diarrhoea — usually starting between 6 and 30 months and resolving by around age 5. Children with toddler's diarrhoea may have 2 to 6 watery stools a day but otherwise seem well and gain weight normally. The exact cause isn't known, but it may relate to food moving more quickly through the colon, too many sweetened drinks (juice, sports drinks), or too little fibre or fat in the diet.

If your toddler has frequent loose, watery stools, stop offering juice and give water instead (juice sugar can worsen diarrhoea), and offer more fibre through whole grain cereals, fruits and vegetables. If it continues, talk to your doctor at your next regular visit.