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Constipation in a toddler

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

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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 Idiotís Guide to Potty Training Problems.Ē "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. Thatís the opposite of a withholding, which is a behavioral problem. Constipation issues tend to be GI issues."

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