How to Manage Constipation in Young Children

Constipation in Young Children: Causes and Care — A TCM Perspective
Constipation is a common health concern in young children, particularly when transitioning to new foods or weaning. Symptoms may include difficulty passing stools, hard or infrequent bowel movements, discomfort, fussiness, and reduced appetite. Left unaddressed, childhood constipation may negatively affect development and long-term health.

Causes of Constipation in Young Children
1. Functional Constipation (~90–95%)
Diet changes: Switching from breastfeeding to formula, starting solids too early, or consuming low-fiber foods.
Insufficient fluid intake: Low water consumption often leads to harder stools and difficulty in passing them.
Stooling avoidance: Fear of painful bowel movements or unfamiliarity with sitting on the toilet contributes to retention.

2. Organic Causes (~5–10%)
Less common but clinically important, including:
Hirschsprung’s disease
Hypothyroidism
Electrolyte imbalances
Spinal cord injuries or pelvic muscle dysfunction
Signs That a Child May Be Constipated
Bowel movements fewer than three times per week
Large, hard stools or stools mixed with blood
Straining, crying, or prolonged effort during bowel movements
Abdominal bloating or discomfort
Poor appetite or lethargy

Managing Constipation in Young Children
Adjust the Diet
Increase fiber-rich foods like pumpkin, bananas, and prunes. Avoid constipating foods such as cheese and many processed snacks.
Ensure Adequate Fluid Intake
Encourage sufficient water intake, especially for children who are eating solid foods or formula.
Stimulate Bowel Movement with Abdominal Massage
Gently massage the abdomen following the path of the intestines to encourage motility.
Encourage Physical Activity
Activities like crawling, walking, or playful movement aid intestinal function.
Establish Regular Toilet Routines
Create a habit, such as sitting on the toilet after meals, to help the child’s body recognize appropriate timing for bowel movement.

TCM Insights on Constipation in Children
In Traditional Chinese Medicine, constipation is viewed not just as a digestive issue but as a sign of imbalance in Qi, blood, yin-yang, and function of the spleen, stomach, and large intestine. According to Huangdi Neijing:

“Water and food blend in the stomach, becoming residue that travels down to the large intestine.”
“The large intestine’s function is to transmit and transform waste into elimination.”
If the spleen and stomach properly digest and absorb nutrients, the remaining waste will be carried into the large intestine and smoothly excreted.

TCM Patterns & Symptoms Related to Childhood Constipation
Spleen-Stomach Deficiency (脾胃虚弱)
Weak digestion results in stagnant food in the intestines.
Symptoms: Poor appetite, bloating, weakness, yellowish complexion, large tongue with teeth marks.

Accumulated Heat in the Large Intestine (大肠积热)
Caused by spicy, oily foods, sweet treats, or heat exposure.
Symptoms: Hard stools, dry mouth, thirst, flushed cheeks, red tongue with yellow coating.
Yin Deficiency and Dehydration (阴虚津亏)
Results from lack of bodily fluids, causing dry and hard stools.
Symptoms: Dry, pellet-like stools, dry skin, thirst, red tongue with little or no coating.

Qi Stagnation (气滞)
Triggered by stress, emotional blockage, or poor Qi movement.
Symptoms: Abdominal bloating, incomplete bowel evacuation, irritability, purple-colored tongue.

TCM Tuina Techniques for Alleviating Constipation in Children

Clear the Large Intestine Meridian (清大肠经)
Method: Gently stroke from the corner of the thumb web toward the tip of the index finger using the thumb or index finger for 3–5 minutes.
Benefits: Clears heat, expels waste, and stimulates bowel movement.

Tummy Massage (摩腹)
Method: Use the palm to make clockwise circular motions on the abdomen for 5–10 minutes.
Benefits: Enhances intestinal motility and eases bowel passage.

Back Pinch Along the Spine (捏脊)
Method: Pinch along both sides of the spine from the coccyx to the base of the neck using thumb and index finger, repeating around 7 times.
Benefits: Strengthens spleen and stomach function and supports digestion.

References:
Di Lorenzo et al. (2017). Pediatric functional constipation: Mechanisms, diagnosis, and treatment. Gastroenterology, 152(7), 1338–1349.
Wang et al. (2023). Pediatric functional constipation. In StatPearls. StatPearls Publishing.
Shen & Lu (2022). The effectiveness and safety of pediatric tuina therapy for functional constipation in children: A multicenter randomized controlled trial. Trials, 23(1), 743.

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Article by:

甘迪玛 中医师 
TCM. Dr. Kanthima Wutthi (Gan Di Ma)