Wednesday, March 14, 2012

It's always about the poop!

As soon as a baby is born, the parents know to worry about the poop! But it doesn't seem to stop once your child is older-- one of the top reasons for toddler visits to the pediatrician is constipation problems. 

Constipation is the passage of infrequent hard large or small pebble-like stools.  If your child has struggled with severe constipation since birth, they may have a serious condition that requires specialty evaluation and care.  Most toddlers, though, are constipated because of several factors:    1.) the physics involved in having a normal little toddler body,  2.) diet, and 3.) activity level.
1.) the toddler body:  Toddlers have a bigger belly than older children. Their belly sticks out because extra room is needed to store the important large organs of the body—the liver, spleen, kidneys, and intestines.  As toddlers grow, their whole torso grows as well, making more room for the organs in the belly.  By about age 5-6 years old, most kids have a flatter belly and stronger abdominal muscles.  This makes it easier to have a bowel movement.  Therefore, mild constipation problems will often resolve at about kindergarden age. 
2.) the toddler diet:  Some toddlers drink a lot of milk.  Too much milk can be constipating.  Limiting your toddler’s milk intake to no more than 12 – 16 oz of milk daily (2-3 child sized glasses) is helpful in improving constipation.  Sometimes, changing from cow’s milk to soy milk will improve constipation immensely .  Keep in mind, though, that it is important to limit any type of milk intake to less than 20 oz per day for a toddler.  Otherwise, they will not eat the other healthy foods that their body needs. Many toddlers are "picky" eaters, and prefer processed carbs (Goldfish crackers, anyone?) and processed meats  and cheeses. Eating a healthy diet full of fruits and veggies (at least 5 servings daily) and whole grains (oatmeal is a great breakfast for toddlers!) will have a big impact, too, in improving constipation.  While in general juice is not good for children, it can be helpful in relieving constipation in toddlers if given once daily, at one sitting, with a meal (and it helps to water it down - one part juice plus one part water). 
3.)  Toddler activity:  Make sure your toddler has the opportunity to have physically active playtime for more than one hour per day.  This type of exercise helps in developing abdominal muscles and keeps the body moving the food in the right direction.
Sometimes children need medication to help relieve constipation.  Usually it is best not to give a medicine that stimulates the bowels to move, like Maalox or senna.  The medicines that work best are fiber substitutes.   Fiber substitutes are not habit forming, and work naturally to keep more water in the gut so that the stool stays softer.  

Fiber substitutes are available over the counter as Benefiber or Miralax.  Usually 1 to 2 teaspoonsful, dissolved into a 6- 8 oz glass of liquid, once daily, will do the trick.   These fiber supplements are odorless, textureless, and tasteless.  Your child won’t even know they are drinking it!  The amount given can be tapered down or up by the parent as needed to get the desired outcome of one soft stool daily.  

Plan to always give the fiber substitute at the same time each day, dissolved in milk, water, or watered-down juice, with the meal that your child usually eats the best.  Then, when the meal is over, your child may feel their gut moving and have the urge to use the toilet.  You can encourage developing a regular bowel habit by establishing the routine of sitting on the toilet and reading a book after the meal that your child drinks the medicine. This will give your toddler time to sit, relax, and let nature take it's course.  Soon, your child may be one of those “regular” kids who poops in the toilet after dinner every night. 
Good Luck!