Your child may be constipated if one or more of the following are true:

• He or she has fewer than 3 bowel movements a week.
• The stools are hard, dry and unusually large.
• The stools are difficult to pass.

For some children, it is normal to pass stools as far apart as every few days. Whether your child is constipated or not depends on how often he or she normally passes stools and how easy this is to do. If stools are soft and easy to pass, less frequent stools are not a problem. If they are hard and difficult to pass, constipation is likely. If your child is having trouble with constipation for more than 2 weeks, it is called chronic constipation.

Constipation is likely to happen when your child doesn't drink enough water, milk or other fluids, or if your child doesn't eat a healthy diet that includes enough fiber. Fiber is found in foods such as cereals, grains, fruits and vegetables. If your child eats a diet high in fat and refined sugars (candy and desserts), he or she is probably not getting enough fiber, which may result in constipation.

Constipation may also begin when you change your baby from breast milk or baby formula to whole cow's milk, and when you switch from baby food to solid food. Sometimes constipation happens after your child has been sick or has taken certain medicines. You should not be concerned if your child becomes constipated for a short period of time. Constipation is common in children and usually goes away on its own.

Young children who have chronic constipation often ignore the urge to have a bowel movement. Your child may not want to interrupt play, or may be afraid or embarrassed to ask a teacher or use a public restroom. When a child avoids bowel movements, stool builds up in the lower bowel. The stool becomes larger and harder. Passage of the stool can be painful and makes children want to avoid having a bowel movement even more.

There are many things you can do to help your child:

• Diet. You can start by increasing the amount of fluid your child drinks each day. If your baby is eating cereal, you can try adding a little prune juice to it. If you have an older child, make sure they are drinking plenty of water. You can also give them prune juice, bran cereal, fruits and vegetables to increase the amount of fiber in his or her diet and help your child pass a stool. Decrease the amount of candy and refined sugar in your child's diet.
• Bowel habit training. Your child should be taught not to wait to have a bowel movement. To establish a regular bowel habit, ask your child to sit on the toilet for at least 10 minutes at about the same time each day, preferably after a meal. Make sure your child can place his or her feet firmly on the floor while sitting on the toilet. If this is not possible, put a footstool in front of the toilet. While your child is sitting on the toilet, you might let your child read a story book or listen to the radio.
• Medicine. Many laxatives are available to treat constipation in children. The choice of laxative depends on the age of your child and how serious the constipation is. Ask your family doctor to suggest a brand name and tell you how much to use.
• Start a reward program. Begin rewarding your child for just sitting on the toilet. For example, if your child sits on the toilet at the planned time, reward your child with a favorite activity. If your child has a bowel movement, give your child praise and a reward. Try not to use food as a reward. Young children may like to be awarded with stickers or stars on a chart. Older children may like to add up points for a larger reward, such as a trip to a movie theater or the park.

Take your child to see your family doctor if the constipation doesn't get better or if you think your child has chronic constipation. Constipation can sometimes be a sign of a more serious medical condition.

The pattern of your child's bowel movements may show that he or she has constipation. You can help the doctor by keeping a day-by-day list of your child's bowel movements. You should include:

• When your child sat on the toilet
• How long your child sat on the toilet
• What your child's stool looked like
• If your child has any soiling in his or her underwear

It also is important to note unusual changes in your child's stools or behavior. Some things to watch for include:

• Stools that are large in diameter
• Stools that are very hard
• Small amounts of bright red blood on the toilet tissue after your child has a bowel movement
• Stomach pain and bloating
• Loss of appetite
• Crying or screaming during bowel movements
• Avoiding the toilet or resisting toilet training

The doctor also will do a physical exam. This may include an exam of your child's rectum. The doctor also may order an X-ray of your child's abdomen. If constipation is very severe, an enema may be necessary to physically remove the stool from your child's bowels. An enema is a procedure where liquid is injected into the rectum. The enema helps loosen the stool and can ease severe constipation.