Chronic Constipation in Kids: Why It Keeps Coming Back, and What I Do About It

By Dr. Nelli Gluzman, DO, double board-certified in Pediatrics & Lifestyle Medicine. Last reviewed October 2026.

This article is about children ages 1 and up. If your child is younger, please call your pediatrician. If your child is vomiting green fluid, go to the emergency room now. If your child has a very swollen belly, a swollen belly with repeated vomiting, severe belly pain, or looks very sick, stop reading and call your child’s doctor now. If you cannot reach the doctor, go to the emergency room. The full list is further down. If your child takes a laxative or stool softener, please do not stop it or change the dose on your own because of anything you read here.

Quick answer for busy parents

Chronic constipation in children usually keeps coming back because of a cycle of pain and holding, not because of anything a parent did. Pediatric guidelines treat it with a daily stool softener (PEG 3350, sold as Miralax) at a dose set by your child’s doctor. Treatment lasts at least two months, along with calmer toilet and food habits, and then the dose comes down slowly. At Blossom Pediatrics, I start with that standard treatment and use a 90-minute first visit to look for why the constipation started and what keeps it going.

Key takeaways

• About 1 in 10 children has functional constipation, the everyday kind with no disease behind it. That kind accounts for about 95 of every 100 cases.
• Constipation runs on a cycle. A painful stool leads to holding, and holding makes the next stool harder. In a toilet-trained child, poop accidents are usually overflow, which means soft stool leaking around hard stool.
• Pediatric guidelines put PEG 3350 first. It is the medicine in Miralax. It is given for at least two months, then the dose comes down slowly, and children do not become dependent on it.
• Once a child gets a normal amount of fiber and water, adding more has not been shown to help.
• Green vomit means the emergency room now. A very swollen belly, severe pain, new leg weakness or a child who looks very sick means calling your child’s doctor right away. The full list is below.

Hi Moms and Dads,

In my practice, I see many families whose kids have been dealing with constipation for months, sometimes years. They’ve tried changing the diet, stool softeners and every tip they could find, and the problem keeps coming back. Others wonder whether their child will ever be comfortable without Miralax.

I practice both conventional and integrative pediatrics, which means I use standard medical treatment and I also look at food, sleep, digestion and daily life. I treat what is happening right now, and I ask why it is happening and what we can do to help keep it from coming back.

Why does my child’s constipation keep coming back?

Constipation in children usually keeps coming back because it runs on a cycle of pain and holding. A child has a painful bowel movement. The next time the urge comes, they remember the pain and hold it in. The longer stool sits, the more water the body pulls out of it, so it gets harder and hurts more to pass.

About 1 in 10 children has functional constipation, which is the kind with no disease behind it. It often starts around toilet training or the start of school.

Holding does not always look like holding. A child may cross their legs, stiffen or hide in a corner, and parents often mistake that for straining. Before long, one uncomfortable bowel movement can become a pattern of holding, painful stools, belly aches and sometimes accidents.

This is not stubbornness. It is often a child trying to avoid pain. And you did not cause it.

Breaking that cycle comes first. Then I want to understand what contributed to the problem, what is keeping it going, and what this child needs to get better.

Why is my child having poop accidents?

In a toilet-trained child with chronic constipation, poop accidents are usually overflow. Soft stool leaks around hard stool that is stuck at the end of the bowel, and many children do not realize it is happening. Doctors call this overflow soiling, or encopresis. Accidents while a child is still learning to use the toilet are expected, and they are a different thing.

If your child is having accidents, I want you to know that they are often not on purpose. It is not laziness or defiance, and punishing does not help.

Understanding what is happening in the body changes how we handle it. Instead of pressuring a child or repeating the reminders, we treat the constipation and help the child feel safe again. Accidents can have other causes too, so they deserve a visit with your child’s doctor.

Is Miralax safe for kids, and how long will my child need it?

PEG 3350, the medicine in Miralax, is the treatment pediatric guidelines recommend first for constipation in children. In the 32 trials reviewed for the 2026 international guideline, no serious side effects from PEG 3350 were reported. The American Academy of Pediatrics says children do not become dependent on it. Guidelines call for at least two months of treatment. Then your child’s doctor lowers the dose slowly, which is called a taper.

Let me be clear: I am not against medication, and I don’t believe children should have to live with pain while we search for the perfect root-cause explanation. When a child is backed up, uncomfortable, holding it in or having accidents, treating the constipation comes first.

PEG 3350 is what the box calls an osmotic laxative, which means it holds water in the stool to keep it soft. Many families call it a stool softener, and so do I in this article. The box is written for ages 17 and up, so in children the dose and the length of treatment come from your child’s doctor. This is routine in pediatrics.

• Daily stool softener: at least two months.
• Before the medicine is stopped: constipation symptoms gone for at least a month.
• Coming off the medicine: the dose is lowered gradually.
• A child who is toilet training: stays on the medicine until training is achieved.

These steps come from the 2014 guideline of the European and North American societies for pediatric gastroenterology. Your child’s doctor decides each one.

This takes time. Among children referred to specialists, about half have recovered and are off laxatives after 6 to 12 months. Some children need the medicine for years, and that is not a failure. Constipation often comes back, too. In one long-term study of children over 5 at a specialist center, about half of those who got better had it return at least once. A good plan says what to do if that happens.

Some parents have read about mood or behavior changes. The 2026 guideline says there is no evidence that PEG 3350 harms the nervous system, and that the concern comes from individual reports. That is reassuring, though it is not proof that there is no risk. A 2022 review says PEG 3350 appears safe for long-term use in children. If you are worried, talk with your child’s doctor before you change anything.

Please do not stop the medicine or lower the dose on your own. The box says to stop and ask a doctor about bleeding from the bottom, about nausea, bloating, cramping or belly pain that is getting worse, and about diarrhea. If you see any of these, call your child’s doctor before the next dose. The list below says when it is urgent.

How does a holistic pediatrician treat constipation differently?

As a holistic pediatrician, I treat constipation in children with the same treatment pediatric guidelines recommend. What I add is time. At Blossom Pediatrics, the first visit is a 90-minute Foundation Consultation and follow-ups are 60 minutes. That leaves room for your child’s whole story: food, toilet habits, school, sleep and any other symptoms.

So what is missing in a standard visit? In my experience, it is time and follow-through. A standard pediatric visit has to cover the history, the exam, the warning signs and safe treatment. There isn’t always enough time to go through meals, routines, bathroom habits and sleep, or to follow up over several months. That is about the clock, not about what your pediatrician knows.

At Blossom Pediatrics, I do not replace evidence-based treatment with supplements, restrictive diets or unnecessary testing. I start with evidence-based care, personalized to your child, and then look at the whole child for anything else worth addressing.

I work alongside your child’s own pediatrician. By telemedicine I cannot examine your child, so the hands-on exam stays with your child’s pediatrician.

1. I take the time to understand your child’s story

One of my first questions is not simply how often your child poops. It’s when the problem started. Did it begin after one very painful bowel movement? During toilet training? After an illness, a move or a new school?

I also ask about school. Does your child feel comfortable asking the teacher? Are they so busy playing that they ignore the urge to go? I talk about this in my video on constipation in school-age children.

And yes, we talk about poop. A lot. Your child gets a turn to talk, too, in a way that suits their age. My goal is to take the shame, pressure and fear out of the conversation.

2. I look at the whole child

I want to understand what your child eats, how they sleep and how their digestion works. I may also ask about:

• How varied the diet is, and how much milk and cheese your child has
• Bloating, belly pain and picky eating
• Eczema or other skin concerns
• Sleep, bed-wetting and trouble concentrating

These questions help me see the whole picture. They do not mean that every symptom is caused by constipation, or that one hidden issue connects them all.

Testing should have a purpose. Most children with constipation need no blood work. Guidelines save testing for celiac disease and thyroid problems for children who have warning signs, or whose constipation does not respond to treatment. Celiac disease is an immune reaction to gluten.

For selected children, I sometimes go further. I may test the stool and the microbiome, which means the bacteria and other microbes that live in the gut, or test for food allergies and sensitivities. None of these tests is part of guideline care for constipation, and the research behind them is limited, including for microbiome testing. Using them is my clinical judgment. I use them only when your child’s story points that way and the result is likely to change what we do next.

3. We build a plan in layers

There is no single plan that works for every child. Generally, the plan has several layers, and treating the constipation starts right away.

• Clear what is backed up. If your child is backed up, we may start with a clean-out, which is a short course of the medicine at a higher dose set for your child. Please do not try a clean-out without your child’s doctor. Soiling and belly pain can get worse at first, so I explain what to expect, and which signs mean calling your pediatrician or going to the emergency room.
• Keep stools soft. A child who has learned that pooping hurts needs time to trust their body again. We keep a daily stool softener going long enough to break the cycle of pain and fear.
• Work on the daily habits. For a child who is toilet trained, that means a few relaxed minutes on the toilet after meals, a footstool under the feet, and praise for sitting and trying. Never force a child to sit on the potty.
• Look at food and whatever else is contributing. Our pediatric nutritionist and health coach looks for small changes your family can live with.

More fiber is not automatically better, so food goes alongside the treatment.

My goal is to address the root cause of constipation, and sometimes there is more than one. When your child’s story points that way, I sometimes use the testing I described above to help me choose a short list of kid-friendly supplements. This is my clinical judgment, not guideline care, and a supplement never replaces the treatment above. I want you to leave with a plan you can actually follow, not a cabinet full of supplements or a list of food rules that makes family life more stressful.

4. You have a team behind the plan

Between visits you can message me through our patient portal. Messages are for questions that can wait. For anything urgent, call your child’s primary pediatrician or go to the emergency room. Our nutritionist helps with meals, and our care coordinator handles scheduling, paperwork and referrals.

You should know what you are doing, why you are doing it, what improvement should look like, and when we will check in again.

My goal is to help your child have comfortable, regular bowel movements and, when the time is right, to slowly lower the medicine under medical supervision. I cannot promise that every child will be able to stop treatment completely, but I can promise that we will approach the question thoughtfully and individually.

When should I call the doctor about my child’s constipation?

Go to the emergency room now if a constipated child vomits green fluid. Call the doctor right away for a very swollen belly, severe belly pain, new leg weakness or a child who looks very sick. Call the same day for blood in the stool, fever or weight loss. For anything urgent, that means your child’s primary pediatrician or the emergency room. Blossom Pediatrics is not an urgent care service.

A few signs can mean this is more than constipation.

Go to the emergency room now if your child vomits green fluid.

Call your child’s doctor right away if your child:

• has a very swollen belly, or a swollen belly with repeated vomiting
• has severe belly pain, or belly or bottom pain that lasts more than an hour. In a toddler, this can be crying that does not stop
• has new leg weakness or trouble walking, or has stopped walking
• looks very sick

If you cannot reach the doctor, go to the emergency room. If you think it is an emergency, call 911.

Call the same day for:

• blood in the stool, or bleeding from the bottom
• fever
• weight loss or poor growth
• ribbon-thin stools
• constipation that began in the first weeks of life, or a first stool more than 48 hours after birth

These warning signs need a doctor’s exam before any constipation treatment at home. Until the doctor tells you what to do, do not start a laxative or stool softener. Do not raise the dose of one your child already takes. Do not give any medicine through the bottom, which means an enema or a suppository. If your child already takes a laxative or stool softener, get the doctor’s answer before you give the next dose.

Who is holistic constipation care for?

Holistic constipation care may be particularly helpful when a child’s constipation keeps coming back or has lasted a long time. These are the families I see most often:

• Constipation that keeps coming back. Things improve, treatment stops, and the same pattern starts again.
• A long time on stool softeners. You want to understand the plan and how to tell when your child may be ready to taper.
• Painful bowel movements or accidents. Your child is holding it in, afraid to go, or losing confidence.
• Constipation alongside other concerns. Picky eating, bloating, eczema or sleep trouble come with it.

I see families in person in New York City, Hoboken, NJ, Aventura, FL and Delray Beach, FL, and by telemedicine for eligible families. You can read more about constipation care at Blossom Pediatrics.

Where would I start if this were my child?

If my own child had constipation that kept coming back, I would start by taking the pressure off.

If your child has any of the warning signs above, follow that section now. If your child is in pain, is holding it in or refusing to go, or is having accidents, do not wait. Call your child’s doctor.

Otherwise, I would want to know how often my child goes, whether it hurts, whether they are holding it in, and whether there have been any accidents. I would also want a pediatrician to look at the situation, especially if the constipation is persistent, painful or getting in the way of daily life.

You can start a simple log tonight: when your child goes, what the stool looks like, any pain and any accidents. Bring it to the visit.

Most importantly, I would want my child to know that they are not in trouble. Their body is not doing something wrong on purpose, and we are going to work together to help them feel better.

Frequently asked questions

Ready for a plan that looks at your whole child?

Constipation is treatable, and it takes months of steady work. There is a Japanese phrase I love, kotsu-kotsu: steadily, one small step at a time.

If this sounds like your family, come talk to us. Your first visit is a 90-minute Foundation Consultation with me.

Schedule Your First Visit

Not ready yet? Start with a 15-minute Discovery Call, or call our care coordinator, Richie, at (201) 632-3060. If your child needs care now, start with your own pediatrician.

With love,

Dr. Nelli Gluzman

About the author

Dr. Nelli Gluzman, DO, is a pediatrician and the founder and medical director of Blossom Pediatrics. She is a Diplomate of the American Osteopathic Board of Pediatrics and of the American Board of Lifestyle Medicine, and has practiced pediatrics for more than 15 years. Blossom Pediatrics is a holistic and integrative pediatric practice with offices in New York City, Hoboken, New Jersey, and Aventura and Delray Beach, Florida. It also offers telemedicine visits for eligible families. Meet Dr. Gluzman.

This article is general education, not medical advice for your individual child. I’m a doctor, but not necessarily your child’s doctor. This article does not replace an exam by your child’s own doctor. It is not written for babies under 1, or for a child with kidney disease or another medical condition. Never start, stop or change any medicine, laxative or supplement without speaking with your child’s physician. In an emergency, call 911.

Sources

1. Koppen IJN, et al. Prevalence of functional defecation disorders in children: a systematic review and meta-analysis. The Journal of Pediatrics. 2018.
2. Mulhem E, et al. Constipation in children and adolescents: evaluation and treatment. American Family Physician. 2022.
3. Gordon M, et al. ESPGHAN/NASPGHAN guidelines for treatment of functional constipation in children aged 0 to 18 years. Journal of Pediatric Gastroenterology and Nutrition. 2026.
4. Tabbers MM, et al. Evaluation and treatment of functional constipation in infants and children: evidence-based recommendations from ESPGHAN and NASPGHAN. Journal of Pediatric Gastroenterology and Nutrition. 2014.
5. National Institute for Health and Care Excellence. Constipation in children and young people: diagnosis and management (CG99).
6. American Academy of Pediatrics. Constipation in Children. HealthyChildren. org. Updated July 2024.
7. American Academy of Pediatrics. Encopresis (Fecal Soiling) in Children. HealthyChildren. org. Updated April 2026.
8. American Academy of Pediatrics. Symptom checker: Constipation. HealthyChildren. org.
9. U. S. Food and Drug Administration. MiraLAX (polyethylene glycol 3350) Drug Facts label. 2023.
10. Pijpers MAM, et al. Functional constipation in children: a systematic review on prognosis and predictive factors. Journal of Pediatric Gastroenterology and Nutrition. 2010.
11. van Ginkel R, et al. Childhood constipation: longitudinal follow-up beyond puberty. Gastroenterology. 2003.
12. Porcari S, et al. International consensus statement on microbiome testing in clinical practice. The Lancet Gastroenterology & Hepatology. 2025.