Constipation is a common childhood health issue, but we don’t talk about it much.

According to the children’s bowel and bladder charity ERIC, the condition impacts one in three kids (including babies).

For nurse and potty learning expert Rebecca Mottram, it’s a “significant health issue in the UK”, with many cases going unnoticed.

“Nine out of 10 cases that I treat in my consultancy practice involve children with constipation, and this is usually undiagnosed,” she tells HuffPost UK.

“This is often due to a lack of awareness about the signs of constipation in children, which parents and caregivers may misinterpret or overlook.”

What are the symptoms of constipation in kids?

The National Institute for Health and Care Excellence (NICE) identifies 12 key symptoms that may indicate constipation in children.

However, Mottram says in her consultancy work, she has observed up to 16 signs that could point towards constipation being the problem.

She says if your child has two or more of the below symptoms, they are likely to be constipated:

• Not having a poo every day/every other day. 
• Pooing more than three times a day (this can be a sign that the bowel is full and is overflowing, says the experts).
• Soiling in pants. “The poo might be hard or soft, or even liquid, which is fresh poo that has managed to get around a blockage of older, harder poo that is sitting in the bowel,” she explains. 
• Poos that are wider than your child’s wrist.
• Poos that look strange, e.g. like clay or dark in colour.
• Poos that may block the toilet.
• Tummy ache or a distended/swollen tummy.
• Really smelly poo/wind, or bad breath.
• Poor appetite or feeling sick.
• Irritability or upset, especially leading up to doing a poo, then happy and relaxed afterwards.
• Avoiding doing a poo/withholding.
• Fear or refusal of the toilet or potty.
• Day or night time wetting.
• Urinary tract infections.
• Tiredness and lack of energy.
• Disturbed sleep.

Meanwhile the NHS list the following signs:

• Doing fewer than three poos in a week;
• Large, hard poos;
• Small pellet poos;
• Experiencing straining or pain when pooing;
• Bleeding after a large hard poo;
• Having tummy ache or a poor appetite that gets better after a poo;
• Soiled pants.

Constipation is particularly common when children are being potty trained at around 2-3 years old, the health service says. 

Based on her observations over the past 10 years, Mottram suggests the widespread use of what she calls a “one-step method” – where children receive little preparation and are expected to potty train within just a few days – “is closely linked to an increased risk of poo withholding”.

Other common causes of constipation in children include low fibre intake, insufficient hydration, withholding behaviour at the start of potty training, lack of physical activity and reduced body awareness due to modern nappies, she said. 

Some children are also more likely to develop constipation if they’re on specialist medication or have neurodevelopmental differences.

If you think your child may be constipated, take them to a GP. The longer your child is constipated, the more difficult it can be for them to get back to normal – so early intervention is key.