Understanding constipation in children: why it matters and how to help
By Tabitha Poole, Continence Occupational Therapist, Continence Hub
Constipation is one of the most common — but often overlooked — health issues affecting children.
It’s far more than just an occasional tummy ache or skipped bowel movement.
For many kids, especially those who are neurodivergent or have hypermobility, constipation can cause daily pain, impact behaviour, disrupt sleep, and even affect emotional wellbeing.
At Continence Hub, constipation is the number one reason families reach out for help.
And once you understand how deeply it can affect a child’s life, it’s easy to see why getting support early can make all the difference.
Continence Hub supports children with toileting, constipation, bed wetting and all continence issues in Perth and online.
What exactly is constipation?
Constipation in children typically means:
- Passing stools less than every second day, or more than three times per day
- Hard, dry or painful bowel movements
- Straining during bowel movements
- Avoiding the toilet altogether
- Soiling or “accidents” due to overflow leakage (often appearing like loose stools)
Constipation can become a vicious cycle: painful poos make children fearful of going to the toilet, which leads them to hold on even longer, stretching the rectum and worsening the problem.
It’s important to know that constipation often develops gradually.
Many kids don’t even realise they are constipated until bigger symptoms (like wee or poo accidents, or chronic stomach pain) appear.
Signs your child may be constipated
Some clues to watch for include:
- Complaints of tummy pain, especially before or after meals
- Fidgeting, squatting, or “holding” behaviours (such as crossing legs, laying on tummy, sitting on heel)
- Changes in appetite
- Irritability or emotional outbursts
- Wetting accidents or increased urinary frequency
- Reluctance to use the toilet
- Hard, cracked stools or very large poos that block the toilet
- Poo accidents
- Vomiting
- Bloating
Sometimes, the symptoms aren’t obvious — especially in young children or those with communication difficulties.
They might not be able to explain their discomfort clearly, so behaviours like meltdowns, sleep disturbances, or food refusal can be mistaken for “bad behaviour” rather than a sign of physical distress.
Why constipation is even more common in neurodivergent and hypermobile kids
Children who are neurodivergent (e.g., autistic, ADHD, PDA profiles) or hypermobile face some extra challenges when it comes to continence and constipation.
Neurodivergent kids:
- Sensory sensitivities can make the toilet environment overwhelming (think bright lights, loud flushing, or strange smells)
- Interoception difficulties mean they may not recognise the internal signals that they need to poo
- Rigid routines or anxiety about unfamiliar places can make them avoid using the toilet when they need to
- Demand avoidance (especially in children with a PDA profile) can make toileting feel like a confrontation if not approached carefully
Hypermobile kids:
- Hypermobility affects the connective tissues throughout the body—including the digestive system
- Slow gut motility (the movement of food and waste through the intestines) is common, leading to delayed transit times and harder stools
- Weak core muscles and poor posture can make it physically harder to sit properly on the toilet and achieve effective bowel movements
Constipation in these groups is often chronic and complex, requiring a sensitive, individualised approach rather than a “one-size-fits-all” toilet training plan.
Why early help matters
Untreated constipation doesn’t just cause discomfort. It can lead to:
- Chronic abdominal pain
- Poor appetite and reduced growth
- Urinary tract infections
- Faecal incontinence (soiling accidents)
- Low self-esteem and anxiety
- School avoidance or difficulty participating in activities
More extreme consequences are rare, but possible. These could include:
- Bowel obstruction
- Stretched rectum leading to lack of sensation and long term continence
- Bowel perforation
- Sepsis and even death.
Early identification, thorough assessment, and a comprehensive, multidisciplinary management plan are essential for addressing these challenges and improving the well-being of affected children.
How the Continence Hub can help
At the Continence Hub, we specialise in working with children of all developmental profiles, including those who are neurodivergent or hypermobile.
Our approach is:
✔️ Body-positive (no shame or punishment)
✔️ Child-centred (tailored to developmental and sensory needs)
✔️ Family-friendly (strategies that work in real life)
We look at the whole picture, not just how often a child goes to the toilet.
Our constipation support plans often include:
- Education: Helping children understand their bodies in a way that’s developmentally appropriate
- Interoception work: Building awareness of internal body signals
- Toileting routines: Gentle, flexible routines based on individual patterns
- Environmental adaptations: Making the bathroom a more comfortable, sensory-friendly place
- Dietary support: General advice or referrals to specialist dietitians where needed
- Positioning: Using footstools, toilet seats, or potties to achieve optimal posture for bowel movements
- Medical collaboration: Working alongside GPs, gastroenterologists, or pelvic health physiotherapists if laxatives or medications and needed and we can also provide real-time ultrasound assessments at home.
Most importantly, we empower families with the knowledge and tools they need—not just for now, but for the future too.
A special note for parents: it’s not your fault
Many parents feel guilt or shame when their child struggles with constipation or toileting. Please know: it’s not your fault.
There are so many factors outside your control — genetics, gut health, neurobiology, sensory processing differences.
What matters most is recognising when your child needs support and reaching out for help.
And the good news? With the right support, things can and do get better.
We’ve seen children who were anxious, withdrawn, or physically unwell transform once constipation was managed — eating better, sleeping better, participating at school, and smiling more.
Ready to get help
You don’t need a referral to access support at Continence Hub.
📍 We offer online and in-person services across Perth and beyond.
🌐 Visit www.continencehub.com to learn more or complete a quick intake form.
📲 Follow us @continencehub for practical tips, myth-busting facts, and encouragement.
Every child deserves to feel comfortable and confident—and a healthy bowel is a big part of that story.
More Information
Constipation Fact Sheet – The Royal Children’s Hospital Melbourne
References
Coe, A., Ciricillo, J., Mansi, S., El‐Chammas, K., Santucci, N., Bali, N., Lu, P. L., Damrongmanee, A., Fei, L., Liu, C., Kaul, A., & Williams, K. C. (2023). Evaluation of Chronic Constipation in Children With Autism Spectrum Disorder. Journal of Pediatric Gastroenterology and Nutrition, 76(2), 154–159. https://doi.org/10.1097/MPG.0000000000003662
Wang, H., Liu, S., Xie, L., & Wang, J. (2023). Gut microbiota signature in children with autism spectrum disorder who suffered from chronic gastrointestinal symptoms. BMC Pediatrics, 23(1), 476–10. https://doi.org/10.1186/s12887-023-04292-8
Chogle, A., Wong, G., & Megerian, J. T. (2024). Constipation in Children with Autism: A Comprehensive Review. Current Treatment Options in Pediatrics, 10(4), 287–294. https://doi.org/10.1007/s40746-024-00304-6
Sood, V., Kaul, A., El‐Chammas, K. I., Mukkada, V. A., Sun, Q., Fei, L., & Santucci, N. R. (2024). High prevalence of gastrointestinal disorders in a large cohort of patients with joint hypermobility. Journal of Pediatric Gastroenterology and Nutrition, 79(1), 42–47. https://doi.org/10.1002/jpn3.12245
