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How to Manage Constipation in Children with Autism

MAY 3, 2023

If you are the parent of a child with autism, you know how difficult it can be to tell what is causing challenging behaviour. Though social, psychological and environmental factors can be triggers, you might be surprised to learn that behaviour can also be caused by physical discomforts like constipation. If this is the source of your child’s distress, relieving this discomfort can help your family get back on track. Some families experiencing challenging behaviours with a suspected medical trigger may also benefit from our Urgent Response Services.

Constipation in autism

Children who experience constipation have infrequent and uncomfortable bowel movements. This usually happens because stool remains in the colon for too long. Most children experience constipation at some point, but it is more common in children with autism. Reasons for this include:

  • Food sensitivities: If your child with autism is a picky eater, they may not eat many fruits or vegetables. This means they are getting less fibre in their diet, which can contribute to constipation.
  • Physical inactivity: Children with autism often enjoy screen-based activities like watching videos or playing computer games. A lack of exercise is often associated with constipation since physical activity helps regulate the GI system.
  • Medication: Many children with autism take medication for mental health or behavioural issues. Constipation is a common side effect. Constipation can also be a side effect of over-the-counter medications like Benadryl.

How to recognize signs of constipation in children with autism

It’s often difficult to recognize when constipation is the source of your child’s discomfort, particularly if they are toilet trained, struggle to find the words to describe their physical experiences or are nonspeaking. Because of the lack of clear symptoms, it’s important to look for signs that constipation may be contributing to your child’s behaviour. These can include:

  • Disinterest in food or refusing to eat at mealtimes.
  • Self-injury, like hitting their abdomen, may indicate stomach pain.
  • Avoiding the bathroom or showing they don’t like toilet time may indicate pain when they go to the bathroom).
  • Frequent complaints of stomach pain.
  • Accidents involving diarrhea. Parents sometimes miss this sign because it’s counter-intuitive. However, it’s useful to know that this can happen when the liquid stool makes its way around the backed-up stool.

What to do if your child with autism is constipated

It’s important to understand that if constipation is left untreated, it can sometimes become serious. Chronic constipation is potentially dangerous and can cause structural changes in the colon. In cases where the colon is very backed up, children may need to be given a high dose of laxatives. But there are many things you can do to support your child before this condition becomes urgent. Here are some tips to help you intervene early to ease your child’s discomfort

  • Use a diary: Document each time your child has a bowel movement or ask your child tokeep a record. This can be done in writing or with pictures. The diary will allow you to get a better sense of how serious the issue is.
  • Dietary changes: Ensure your child is drinking enough water every day. Boosting dietary fibre will also go a long way towards managing constipation, but this can be challenging if your child is very picky. Get creative! Blend veggies into tomato sauce and serve it with pasta, cut veggies into fun shapes, hide them in waffles and pancakes or blend them into soup or smoothies. Keep trying different vegetables. Eventually, you will stumble on something your child loves.
  • Avoid mealtime battles: It’s important to keep mealtime relaxed. Place the food in front of your child – if your child doesn’t like it, take it away. The key is to ensure mealtime doesn’t become a battle. If you get upset or push too much, your child may become stressed about mealtimes.
  • Make toilet time easy: Make toilet time as stress-free as possible. Sitting comfortably on the toilet is important, but some toilets are too tall for young children. If this is the case, try placing a step stool in front of the toilet. This will help your child reach the toilet seat while encouraging them to sit up straight. This can help to encourage a bowel movement.
  • Time training: Also called bowel retraining, time training involves encouraging your child to go to the bathroom at the same time every day to help train their body to have regular bowel movements. Take advantage of the gastrocolic reflex. This is when eating or drinking a warm beverage stimulates movement, telling our bodies it’s time to use the toilet. Give your child a snack or warm beverage at the same time every day. About 20 to 30 minutes later, the child may go to the bathroom. Sticking to the same pattern every day is the key to success. Parents can bring an iPad to the bathroom, which will make time training feel fun and help your child relax on the toilet.

Know when to seek help for your child with autism

If constipation continues after a variety of at-home strategies, it may be time to get professional support. Here’s when it’s time to get help from a healthcare provider:

  • Your child refuses to eat new foods that will help resolve the issue
  • There is blood in the stool
  • Your child’s abdomen is distended
  • Your child frequently complains of abdominal pain that doesn’t seem to go away

If home-based strategies aren’t working, medication may be needed to treat your child’s constipation.

If you’re a parent or caregiver whose child has new or escalating high-risk behaviours like self-injury, aggression, or property destruction, you may be eligible for Urgent Response Services for children and teens registered with the Ontario Autism Program (OAP). Urgent Response Services offer brief, rapid support from a multidisciplinary team to quickly address new behaviours that have been emerging in the last 14 days or less.

Physical discomforts and medical conditions are one of many potential behaviour triggers, along with social, psychological and environmental factors.

About Urgent Response Services

This resource was written with support from staff in Urgent Response Services. Urgent Response Services are part of the Ontario Autism Program. They were created to support children or youth with an emerging urgent need. Surrey Place leads Urgent Response Services for Toronto Region in partnership with 2-Spirited People of the 1st Nations, Community Living Toronto, Family Service Toronto, Geneva Centre, Holland Bloorview, Kerry’s Place, Lumenus, SAAAC, SMILE Canada and Strides Toronto.

Resources

If you enjoyed this article, check out these other great autism resources:

Autism challenging behaviours

Autism mental health resources

Autism transition resources

Autism eating habits and hydration resources

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By 2 months

Has your baby had their hearing screened? YES NO

By 6 months

Does the child?

Startle in response to loud noises? YES NO
Turn to where a sound is coming from? YES NO
Make different cries for different needs (hungry, tired)? YES NO
Watch your face as you talk? YES NO
Smile/laugh in response to your smiles and laughs? YES NO
Imitate coughs or other sounds such as ah, eh, buh YES NO

By 9 months

Does the child?

Respond to their name? YES NO
Respond to the telephone ringing or a knock at the door? YES NO
Understand being told no? YES NO
Get what they want through using gestures (reaching to be picked up)? YES NO
Play social games with you (Peek-a-Boo)? YES NO
Enjoy being around people? YES NO
Babble and repeat sounds such as babababa or duhduhduh? YES NO

By 12 months

Does the child?

Follow simple one-step directions (sit down)? YES NO
Look across the room to a toy when adult points at it? YES NO
Consistently use three to five words? YES NO
Use gestures to communicate (waves hi/bye, shakes head for no)? YES NO
Get your attention using sounds, gestures and pointing while looking at your eyes? YES NO
Bring you toys to show you? YES NO
Perform for social attention and praise? YES NO
Combine lots of sounds together as though talking (abada baduh abee)? YES NO
Show an interest in simple picture books? YES NO

By 18 months

Does the child?

Understand the meaning of in and out, off and on? YES NO
Point to more than 2 body parts when asked? YES NO
Use at least 20 words consistently? YES NO
Respond with words or gestures to simple questions (Where's teddy? What's that?)? YES NO
Demonstrate some pretend play with toys (gives teddy bear a drink, pretends a bowl is a hat)? YES NO
Make at least four different consonant sounds (p ,b, m, n, d, g, w, h)? YES NO
Enjoy being read to and sharing simple books with you? YES NO
Point to pictures using one finger? YES NO

By 2 years

Does the child?

Follow two-step directions (Go find your teddy bear and show it to Grandma.)? YES NO
Use 100 to 150 words? YES NO
Use at least two pronouns (you, me, mine)? YES NO
Consistently combine two to four words in short phrases (Daddy hat. Truck go down.)? YES NO
Enjoy being around other children? YES NO
Begin to offer toys to other children and imitate other children's actions and words? YES NO
Use words that are understood by others 50 to 60 per cent of the time? YES NO
Form words or sounds easily and without effort? YES NO
Hold books the right way up and turn the pages? YES NO
Read to stuffed animals or toys? YES NO
Scribble with crayons? YES NO

By 30 months

Does the child?

Understand the concepts of size (big/little) and quantity (a little/a lot, more)? YES NO
Use some adult grammar (two cookies, bird flying, I jumped)? YES NO
Use over 350 words? YES NO
Use action words such as run, spill, fall? YES NO
Participate in some turn-taking activities with peers, using both words and toys? YES NO
Demonstrate concern when another child is hurt or sad? YES NO
Combine several actions in play (puts blocks in the train and drives the train, drops the blocks off.)? YES NO
Put sounds at the beginning of most words? YES NO
Use words with two or more syllables or beats (ba-na-na, com-pu-ter, a-pple)? YES NO
Recognize familiar logos and signs involving print (Stop sign)? YES NO
Remember and understand familiar stories? YES NO

By 3 years

Does the child?

Understand who, what, where and why questions? YES NO
Create long sentences using five to eight words? YES NO
Talk about past events (trip to grandparents house, day at child care)? YES NO
Tell simple stories? YES NO
Show affection for favourite playmates? YES NO
Engage in multi-step pretend play (pretending to cook a meal, repair a car)? YES NO
Talk in a way that most people outside of the family understand what she/he is saying most of the time? YES NO
Have an understanding of the function of print (menus, lists, signs)? YES NO
Show interest in, and awareness of, rhyming words? YES NO
Read to stuffed animals or toys? YES NO
Scribble with crayons? YES NO

By 4 years

Does the child?

Follow directions involving three or more steps (First get some paper, then draw a picture and give it to Mommy)? YES NO
Use adult type grammar? YES NO
Tell stories with a beginning, middle and end? YES NO
Talk to try and solve problems with adults and with other children? YES NO
Show increasingly complex imaginary play? YES NO
Talk in a way that is understood by strangers almost all the time? YES NO
Generate simple rhymes (cat-bat)? YES NO
Match some letters with their sounds (letter b says buh, letter t says tuh)? YES NO