Constipation in the pre-school child can cause considerable distress to the individual and to the family. Most cases are idiopathic and with early diagnosis and effective treatment prognosis is good. In a teaching hospital paediatric unit, a year-long prospective study identified 42 new referrals for constipation in children under 5. Before referral for a specialist opinion there appeared to be considerable variation in both duration of symptoms and treatment given. Psychological factors in the family, as well as advice regarding simple behaviour modification and management of common secondary behavioural problems, seemed largely overlooked. Guidelines for for treating constipation in the community could help standardise and improve care. For children with refractory constipation referred to a specialist centre, we recommended a multidisciplinary assessment including paediatrician, paediatric surgeon and member of the child mental health team.