Lots of children suffer from constipation -- bowel movements that are hard or painful. Your child may become constipated because of toilet-training troubles or anxiety related to using the toilet. Or, he may not be getting enough fiber or liquids in his diet or may not be getting enough exercise.

This health decision guide will help you understand what causes constipation, how you can ease your child's discomfort, and when it is necessary to contact your pediatrician. Proceed through the questions -- unless you are instructed to seek medical help.

For questions about constipation in infants, please visit our Constipation in Infants Guide.

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Bowel habits vary from child to child. Some children have a bowel movement every day, others go every few days. Two to three days between bowel movements generally are not cause for concern, as long as your child is not having pain or vomiting.

Do any of these statements describe your child?

• He has not had a bowel movement for more than three days.

• He has hard, painful stools.

• He does not have stools very often and when he does, they are very large, sometimes clogging the toilet.

Yes, one or more of these statements describe my child.

No, this does not describe my child.

Your child is having stools every day or every other day. The stools are not hard, painful or extremely large. It does not sound like your child is constipated.

If you would like to learn more about our approach to constipation in children,

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Although it does not sound like your child fits the definition of constipation, you can choose different answers to see how the thinking and advice changes. You can go back at any time to change a response.

Is your child vomiting?

Yes, my child is vomiting.

No, my child is not vomiting.

You have said that your child has not had a bowel movement for several days, or has stools that are hard, painful, and/or large. It sounds as though your child is constipated.

Is your child vomiting?

Yes, my child is vomiting.

No, my child is not vomiting.

Your child is constipated, but not vomiting. When your child tries to pass a hard stool, he may have pain where the stool comes out. However, pain in his abdomen (belly) can be a sign of something more serious.

Is your child having abdominal pain?

Yes, my child is having abdominal pain.

No, my child is not having abdominal pain.

Your child is constipated, but does not have any abdominal pain or vomiting. That is reassuring.

Has your child been constipated for some time, or is this a recent problem?

He became constipated recently.

My child has been constipated for a while.

Your child's constipation is not a new problem.

Is your child toilet training?

No, my child is not toilet training.

Yes, my child is toilet training.

Children can become constipated when they are sick.

Has your child had a fever, vomiting and/or diarrhea lately?

Yes, my child has been sick recently.

No, my child has not been sick.

Your child has recently become constipated but has not been sick.

Has there been any blood in the stools or on the toilet paper when your child wipes himself?

Yes, there has been blood in the stool or on the toilet paper.

No, there has not been blood in the stool or on the toilet paper.

You have said that the constipation is a relatively new problem.

Is your child learning to use the toilet (toilet training)?

Yes, my child is toilet training.

No, my child is not toilet training.

Your child is not toilet training.

Do any of these statements describe your child?

• He has started a new school.

• He does not like to have a bowel movement away from home.

• He has just returned from vacation.

Yes, this describes my child.

No, this does not describe my child.

Your child has not started a new school and does not have any problems going to the bathroom away from home.

Do any of these statements describe your child's diet?

• He does not drink much water.

• He drinks more than three cups of milk each day.

• He does not eat many fruits or vegetables.

• He eats lots of white bread and white rice.

Yes, this describes my child's diet.

No, this does not describe my child's diet.

You say that your child is drinking lots of water and eating lots of fruits and vegetables. That is great. Make sure he gets lots of exercise, too.

Call your pediatrician if your child's symptoms get worse -- or do not improve -- in a few days.

Your child may be constipated because of his diet. Make sure that he eats more foods containing fiber and drinks more liquids. Call your pediatrician if your child's symptoms get worse -- or do not improve -- in a few days.

Some children are concerned about having a bowel movement away from home, for example, at school or while on vacation. They often are so concerned that they try not to have a movement and hold the stool inside. This can lead to large, hard stools in the rectum, setting up a cycle of constipation.

Children who are toilet training frequently are concerned about having bowel movements. They often are so concerned that they try not to have a movement and hold the stool inside. This can lead to large, hard stools in the rectum, setting up a cycle of constipation.

Call your pediatrician. Your child may have a tear or crack in the anus -- the place where the bowel movement comes out. This can make it painful for your child to push out a bowel movement, so he tries to keep the stool inside, worsening the constipation.

Your child may be constipated because he is dehydrated (suffering from a loss of fluids), or because he has been sweating or vomiting. Constipation also can happen after a child has diarrhea. Give your child lots of liquids to drink. If this does not cause him to have a bowel movement within the next 12 to 24 hours, call your pediatrician.

Call your pediatrician now. Constipation and abdominal pain can be a sign of a serious problem with the intestines.

Call your doctor now. Constipation and vomiting can be a sign of a serious problem with the intestines.