Nondrug measures for constipation in children 1 year or older

Tabbers, 2014 National Institute for Health and Care Excellence (NICE), 2010 Hyams, 2016

For children with mild constipation, simple measures such as increasing fluid intake, and encouraging regular toileting may be sufficient. Some children have restrictive diets—take a detailed dietary history and encourage a balanced diet. There is no evidence that increasing fibre intake above normal requirements is beneficial.

Children should be encouraged to sit on the toilet 2 to 3 times daily (especially if they are soiling), whether or not they have an urge to pass a stool. The best times are immediately after meals (to use the ‘gastrocolic reflex’), or after school (in school aged children). When seated, knees should be above the level of the hips to reduce the rectal angle—a footstool may be helpful to enable this. In general, children should not sit on the toilet for longer than 10 minutes at a time. Distractions (eg reading, playing electronic games) should be discouraged because they prolong toileting. A diary is useful to document the child’s toileting behaviour, including sitting on the toilet, defecation and soiling.