A step-by-step guide for parents with practical tools and encouragement
Written by Anna Katherine Black, PhD
Licensed Clinical Psychologist
GI Psychology
Constipation is one of the most common gastrointestinal (GI) concerns in children. While it’s usually not caused by a serious medical issue, constipation can be painful and distressing—for both children and parents. Kids may start withholding bowel movements to avoid discomfort, which only worsens the cycle.
The good news: parents can use a combination of medical guidance, behavioral therapy strategies, and positive reinforcement to help kids build healthier habits and reduce constipation-related stress.
What Constipation Looks Like in Kids
Constipation means fewer than three bowel movements per week, or stools that are hard, painful, or difficult to pass (American College of Gastroenterology, 2023).
Children may:
- Avoid the toilet (withholding)
- Complain of stomach pain or bloating
- Have painful or infrequent stools
- Experience stool accidents or soiling
When these patterns continue, kids can develop anxiety about toileting. That’s why parents’ role in providing structure, encouragement, and calm support is so important.
Push Practice: Teaching Kids How to “Go” Comfortably
Some children need to be taught how to position their bodies and coordinate muscles during a bowel movement. A short push practice routine can make a big difference.
1. Position matters
- Make sure feet are on the ground and knees are above hips (a small stool can help).
- Sit up straight, then lean forward a little bit.
2. Relax muscles
- Take a deep breath in and relax your bottom.
- Squeezing and then relaxing can help muscles release.
3. Time to push
- Take a deep breath in, then let it out.
- Push your belly button down toward your bottom—you may feel belly muscles tighten.
- Push for 3–5 seconds, then relax.
- Use fun tools like blowing bubbles, a balloon, or a kazoo to encourage gentle pushing.
- Try to complete 5 pushes before ending toilet time.
This structured approach reduces strain and helps kids feel more confident about using the bathroom
Behavior Strategies That Work
Praise
Children thrive on positive reinforcement. Praise should be immediate and specific to the behavior you want to see more of.
Examples:
- “You sat on the toilet when the alarm went off. Great job!”
- “I saw that you took your medicine before bed. Nice work!”
- “I’m proud of you for listening to your body and going to the bathroom.”
Commands
Kids respond best to clear, direct, and positive commands instead of vague questions or negative comments.
Effective:
- “Please sit on the toilet for 6 minutes.”
- “Take this medication before bed.”
Less effective:
- “Can you try to poop before we leave?”
- “Would you like to take your medicine now?”
Rewards
Reward systems can keep kids motivated and reduce power struggles. Rewards should be immediate, meaningful, and reserved for toileting behaviors.
Sample point system:
- 1 point = sitting on the toilet
- 2 points = sitting and pushing
- 3 points = sitting, pushing, and producing a bowel movement
- 2 points = taking medication
Points can be traded for daily or weekly rewards, such as extra playtime, small prizes, or family activities.
Toilet Sit Steps: Building Routine
To make toileting a habit, try this structured approach:
- Ensure your child’s attention (eye contact, gentle touch).
- Give a clear directive with an incentive: “When you sit on the toilet for 6 minutes, you will earn a sticker.”
- Provide praise and reward if your child complies.
- If not, remind them calmly: “If you do not sit now, you will not earn the sticker.”
- Do not repeat the instruction or argue—avoid reinforcing resistance.
- Ignore tantrums or complaints calmly.
- Wait until the next scheduled sit to try again.
These steps help children understand boundaries while keeping the focus on positive behavior.
When to Call the Doctor
Contact your child’s pediatrician or gastroenterologist if constipation:
- Lasts more than 2 weeks
- Causes severe abdominal pain or vomiting
- Is linked to weight loss or poor growth
- Includes blood in the stool
Medical evaluation ensures nothing serious is missed and provides additional treatment options.
Takeaway: You and Your Child Can Do This
Constipation in kids is common and treatable. With push practice, praise, clear commands, rewards, and structured routines, children can regain confidence and comfort. You don’t have to face this alone—licensed clinicians trained in GI-focused behavioral therapy can help.
GI Psychology is offering a Constipation & Encopresis Workshop for Parents—a 4-week, virtual program designed to support families of children experiencing constipation, with or without encopresis. This group provides practical strategies, education, and a supportive space to connect with other families facing similar challenges. Enroll today!
- Printable resources and educational support
- Schedule a consultation with our team to see how GI Psychology can support your child and family
- Reach out directly: admin@gipsychology.com
References
American College of Gastroenterology. (2023). Pediatric Constipation. https://gi.org
American Psychological Association. (2020). Evidence-based practice in psychology. https://apa.org
Crohn’s & Colitis Foundation. (2023). Constipation in children with IBD. https://www.crohnscolitisfoundation.org
Keefer, L., & Palsson, O. (2008). A randomized trial of hypnosis and CBT for IBS in children. Journal of Pediatric Gastroenterology & Nutrition, 47(1), 45–52.
Rome Foundation. (2021). Childhood functional GI disorders. https://theromefoundation.org
Szigethy, E. (2015). Cognitive-behavioral therapy for children with functional GI disorders: A randomized controlled trial. Clinical Gastroenterology and Hepatology, 13(12), 2044–2051.
Navidi, A. (2025). Psychological treatments for IBD [Conference presentation]. Crohn’s & Colitis Foundation, Washington, DC.