Understanding your child's bowel movements

Children's bowel movements, like adults', differ from person to person. There is a perception that children should poo every day. But this is far from the truth.

Some babies will need to be changed up to eight times a day, some only after feeds. It is even the case that some adolescents may only need to poo once or twice a week, so it can be hard for parents to truly understand what is normal.

Babies
The bowel movements for babies depend on whether they are breast-fed. Many breast-fed babies will poo a mustard stool up to eight times a day. This is normal, but - the presence of any blood or mucous needs review as this might reflect a food allergy. Bottle-fed babies tend to poo less often as milk calcium salts tend to constipate the stools.

Pre-school children
In infancy, many children tend to fear using the potty or toilet - and this can result in them clenching their buttocks or gripping the walls and surfaces grimacing in distress. Parents may interpret this as "struggling" to poo - this is far from the truth, since this is "faecal retentive behaviour" - a desperate attempt by the pre-school child to hold onto their poo - panicking that passing it might hurt.
 
Older children and adolescents
In older children and adolescents, some children may only need to poo a couple of times a week. This is not constipation unless the stools are massive and hard. Soiling, however, is frequently a consequence of significant impaction of stool in a full rectum leading to leaking and seepage. This is treatable but needs clearing out with laxative therapy - then continence swiftly will return.
 
Stool frequency
Stool frequency will also be affected by diet. Naturally, diets high in fibre will lead to bulky soft stools. Milk may harden stools. Many simple therapies are available to help children poo. There are softeners which are harmless like lactulose, or stimulant medicines - particularly good in those who ignore the desire to poo or hold on for example Senokot or Movicol. Such therapies are safe in children but may be necessary for months.
 
Abdominal pain
Abdominal pain in children and adolescents is not caused by constipation - they may be constipated but this should not be the cause of their regular or daily tummy pains. These children should see their doctors, but treating their alleged constipation may not improve their pain. The doctor will explore other causes. These might include food driven intolerances, or gut inflammation, especially if they are unwell or losing weight.
 
Seeking advice
Take your child to the doctor if:

• they have diarrhoea for more than one week;
• you see blood in their diarrhoea;
• they lose weight or have a fall in appetite;
• they soil and leak stool into their pants;
• regularly complain of pain without another cause being apparent.

Gut Week is organised by the national medical research charity Core - the working name for the Digestive Disorders Foundation , The Gut Trust, St Mark's Hospital, Harrow and Yakult.