Constipation in a toddler

Posted by Barbara F. Meltz  September 23, 2009 06:00 AM

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Question: Like many people, we have been having issues with our child's constipation. He is now 2 1/2, and for the first 18 months or so, our son pooped normally and fairly regularly, every 2 or 3 days. However, he then started not going for five, six, even seven days, and when he did go, it was extremely painful, sometimes causing bleeding and such. He then never wanted to go.

We eliminated foods that are known to cause constipation, such as cheese and bananas. That seemed to make no difference. Then, on our doctor's advice, we began using Milk of Magnesia. We still use it, but it is not working for us. Our son will go, given enough of the stuff, but it is not regular and he seems to go more by accident than anything else. And when he goes, it is a huge wet mess that goes everywhere and causes him some distress, despite our efforts to play it down and not make a big deal of it.

We are concerned about this as we move into potty training. He does sit on the potty, he is interested in it, but he fears going "poopies" and things do not seem to be getting better. He also often says "change, change," before he goes, as if he just wants the whole process to be over. Daycare isn't too happy about all this, either.

We've spoken to our pediatrician several times, but he seems to think the Milk of M is the way to go. Any thoughts? Thank you! We are getting very concerned that potty training will be much harder than it needs to be and that we may be doing more harm than good with the Milk of Magnesia.

From: Seanreporter, Mashpee

Hi Seanreporter,

If this really is constipation (and it sounds like it is), and it's been going on as long as you say, it's time to go back to the pediatrician and suggest that M of M is not doing the trick and you'd like to try some other remedy. And wonder aloud if it's time to see a pediatric GI specialist.

Whatever you do, hold off on toilet training until the constipation is cleared up, advises Alison Schonwald, a developmental behavioral pediatrician at Children's Hospital and author of the "Pocket Idiot’s Guide to Potty Training Problems.” "Constipation will only complicate the training," she says.

For those of you who are wondering, Schonwald offers this advice for how to recognize the difference between a behavioral problem (withholding) and constipation:

"Is a child hiding behind the couch to poop or making a face that shows he's hurting and tries to hold it in?" she asks. In other words, he goes because it gets to a point where he can't keep it in any longer. "A change of diet, stool softener, and removing the pressure to train often combines to allow a child to be able to let it out comfortably."

With constipation, there is often a tummy ache and loss of appetite. Blood on the stool indicates that the movement was so hard, it tore the membrane. There also can be what appears to be some soiling or diarrhea, but really is leaking of liquid from the hardened stool.

Regarding your question, Schonwald says, "They are describing a kid who hurts to go; he wants to go and get it over with. That’s the opposite of a withholding, which is a behavioral problem. Constipation issues tend to be GI issues."

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8 comments so far...
  1. Seriously, it's time to find a new pediatrician. This one doesn't seem to be listening to you or respecting your concerns. Start with looking for a second or third opinion, or asking for a general patient interview - lots of doctors will do that. When you find one that you like (like their style of practice) try to switch. Sorry that I have no advice about the constipation issue.

    Posted by Lizzie September 23, 09 07:38 AM
  1. I have had constipation my entire life. As a child, I would be forced to swallow a spoonful of codliver oil in order to go to the bathroom. As a result, I have had hemorroids for as long as I remember.

    As an adult, I saw a specialist who prescribed Glycolax (which helps the stool retain water and therefore not become rock hard). My friend's pediatrician prescribed this as well for her daughter when she was 2-3 years old and having constipation issues. When mixed with milk or juice, it is tasteless. Also, Glycolax seemed to be much gentler on the stomach than other medications/stool softeners.

    If the parents would prefer a non-medical solution, they could try dried apricots. They help a lot but you can definitely eat too many so just a few a day would be my recommendation.

    Good luck! It is such a stressful and painful issue that I hope they find a resolution that works for them.

    Posted by Anonymous September 23, 09 08:30 AM
  1. I agree with Lizzie. Our child had the same problem. The doctor prescribed a powdered laxative ( I forget the name) that was mixed in her juice(it was tasteless and she could not tell it was in there) once a day. It was like a miracle. You can regulate the amount you give - once a day, every other day, etc. based on how much your child needs it. Check with other doctors or ask yours about such a product. Also, add fiber to the diet, naturally if you can, or with supplements. And plenty of liquids.

    Posted by Dad September 23, 09 08:57 AM
  1. Our 2 and 1/2 year old daughter is also very reluctant to have a bowel movement. She tries to avoid going and will hold it in until she can't anymore. Our pediatrician recommended Miralax, a stool softener which has recently become over-the counter. I was on Miralax for constipation myself when I was pregnant, as recommended by a GI specialist, so it's very safe.
    It takes a while to get the dose right (1 tsp to 1 TB per day) so that you don't have runny stools that the child can't possibly hold in because you do want to encourage b.m. awareness for toilet training purposes. The right dose will insure that the stool is soft so that when the child does go, it's not painful and thereby doesn't add to the fear of going to the bathroom. Also, it takes a few days for Miralax to begin working so just keep at it.
    Good luck with this common-enough problem--it does require patience but can be remedied with the right medicine and consistent positive reinforcement. But it sure sounds like your doctor is a bit out of touch.

    Posted by Just1voice September 23, 09 09:39 AM
  1. Miralax is definitely the way to go. Our daughter also had constipation at about the time we were doing potty training. She peed on the potty no problem, but always asked for a diaper for pooping. But the Miralax (daily- don't stop when it gets better until he's been regular for a month or so) helped, and as she got older she transitioned to pooping on the potty too.

    Posted by anon September 23, 09 10:40 AM
  1. That all sounds very familiar. My LG is 3.3 yrs. and we're doing much better after trying SEVERAL things... The thing that really works for us is so simple -- prune juice! He doesn't like the taste (who does?!) so I've mixed it with water and a little white grape juice to improve taste - about 3 parts of each (maybe a little more pj and h2o). Apple juice seems to make it worse. We do have a prescription from our ped. for Lactulose and although it says 3 times per day, it usually only took one to get things moving. We only had to give it to him 1-2 times and then let the prune juice mix take over.

    Posted by Motherof2 September 23, 09 11:13 AM
  1. Please have your son tested for celiac disease! This can cause the constipation you're describing. It's very common. A simple blood test can identify it.

    Posted by Margaret September 23, 09 11:14 AM
  1. This is a *really* long shot, but has he ever been checked out for Hirschsprung's Disease? It's a congenital condition in which the nerves and muscles of the colon do not work properly. A relative of mine had it and was not diagnosed until he was five--it is so rare that no doctor in his pediatrician's office had ever seen a case of it.

    It's unlikely, but it couldn't hurt to ask about the possibility.

    Posted by di September 23, 09 02:16 PM
 
8 comments so far...
  1. Seriously, it's time to find a new pediatrician. This one doesn't seem to be listening to you or respecting your concerns. Start with looking for a second or third opinion, or asking for a general patient interview - lots of doctors will do that. When you find one that you like (like their style of practice) try to switch. Sorry that I have no advice about the constipation issue.

    Posted by Lizzie September 23, 09 07:38 AM
  1. I have had constipation my entire life. As a child, I would be forced to swallow a spoonful of codliver oil in order to go to the bathroom. As a result, I have had hemorroids for as long as I remember.

    As an adult, I saw a specialist who prescribed Glycolax (which helps the stool retain water and therefore not become rock hard). My friend's pediatrician prescribed this as well for her daughter when she was 2-3 years old and having constipation issues. When mixed with milk or juice, it is tasteless. Also, Glycolax seemed to be much gentler on the stomach than other medications/stool softeners.

    If the parents would prefer a non-medical solution, they could try dried apricots. They help a lot but you can definitely eat too many so just a few a day would be my recommendation.

    Good luck! It is such a stressful and painful issue that I hope they find a resolution that works for them.

    Posted by Anonymous September 23, 09 08:30 AM
  1. I agree with Lizzie. Our child had the same problem. The doctor prescribed a powdered laxative ( I forget the name) that was mixed in her juice(it was tasteless and she could not tell it was in there) once a day. It was like a miracle. You can regulate the amount you give - once a day, every other day, etc. based on how much your child needs it. Check with other doctors or ask yours about such a product. Also, add fiber to the diet, naturally if you can, or with supplements. And plenty of liquids.

    Posted by Dad September 23, 09 08:57 AM
  1. Our 2 and 1/2 year old daughter is also very reluctant to have a bowel movement. She tries to avoid going and will hold it in until she can't anymore. Our pediatrician recommended Miralax, a stool softener which has recently become over-the counter. I was on Miralax for constipation myself when I was pregnant, as recommended by a GI specialist, so it's very safe.
    It takes a while to get the dose right (1 tsp to 1 TB per day) so that you don't have runny stools that the child can't possibly hold in because you do want to encourage b.m. awareness for toilet training purposes. The right dose will insure that the stool is soft so that when the child does go, it's not painful and thereby doesn't add to the fear of going to the bathroom. Also, it takes a few days for Miralax to begin working so just keep at it.
    Good luck with this common-enough problem--it does require patience but can be remedied with the right medicine and consistent positive reinforcement. But it sure sounds like your doctor is a bit out of touch.

    Posted by Just1voice September 23, 09 09:39 AM
  1. Miralax is definitely the way to go. Our daughter also had constipation at about the time we were doing potty training. She peed on the potty no problem, but always asked for a diaper for pooping. But the Miralax (daily- don't stop when it gets better until he's been regular for a month or so) helped, and as she got older she transitioned to pooping on the potty too.

    Posted by anon September 23, 09 10:40 AM
  1. That all sounds very familiar. My LG is 3.3 yrs. and we're doing much better after trying SEVERAL things... The thing that really works for us is so simple -- prune juice! He doesn't like the taste (who does?!) so I've mixed it with water and a little white grape juice to improve taste - about 3 parts of each (maybe a little more pj and h2o). Apple juice seems to make it worse. We do have a prescription from our ped. for Lactulose and although it says 3 times per day, it usually only took one to get things moving. We only had to give it to him 1-2 times and then let the prune juice mix take over.

    Posted by Motherof2 September 23, 09 11:13 AM
  1. Please have your son tested for celiac disease! This can cause the constipation you're describing. It's very common. A simple blood test can identify it.

    Posted by Margaret September 23, 09 11:14 AM
  1. This is a *really* long shot, but has he ever been checked out for Hirschsprung's Disease? It's a congenital condition in which the nerves and muscles of the colon do not work properly. A relative of mine had it and was not diagnosed until he was five--it is so rare that no doctor in his pediatrician's office had ever seen a case of it.

    It's unlikely, but it couldn't hurt to ask about the possibility.

    Posted by di September 23, 09 02:16 PM
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Barbara F. Meltz is a freelance writer, parenting consultant, and author of "Put Yourself in Their Shoes: Understanding How Your Children See the World." She won several awards for her weekly "Child Caring" column in the Globe, including the 2008 American Psychological Association Print Excellence award. Barbara is available as a speaker for parent groups.

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