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December 2014

When Should A Child Take Responsibility for Treatment?

A mother I know recently became so exasperated with her 6 y/o daughter’s off and on cooperation with treatment that she told her, “I’m done! You know what you have to do to stop having poop accidents so you take care of it yourself!”

Up until then, this smart, usually compliant but shy first grader always needed to be told to take her laxative, sit on the toilet after meals, listen to her body and not hide her soiled underwear. When she complied she had daily bowel movements and no accidents, sometimes for as long as a month or more. However, when her parents tried to reduce their own involvement, these “good” months would always be followed by a period of two or more days between poops, having accidents and hiding her soiled underwear.

What happened after her mother said, “I’m done!” is amazing. On her own initiative, her daughter now takes her laxative every morning, goes into the bathroom to poop when she feels the urge, and has no accidents. In my experience, this strategy generally does not work with most children (see my post here about the inefficacy of negative approaches) but it’s worth a try with older, independently minded children who generally want to please their parents.

Parents who try this approach cannot use these kinds of statements lightly or often, or their effect is lost. Parents will need to remain committed to what they have said, at least for a period of time that is long enough for the child to recognize the parent's seriousness.  This may mean the child will have accidents again. Remember, it is always okay to change your approach, especially as extended stool withholding can cause real physical harm.  It's also okay to change if your child requests your help again (for example, they have an accident at school and are embarassed).  

Probiotics and Constipation

We usually think of bacteria as harmful germs but many bacteria actually help our body function properly. Probiotics (meaning “for life) are thought to improve our health in a number of ways such as by reducing harmful bacteria in the large intestine or by increasing the number of “good” intestinal bacteria.

Many parents give their children products containing probiotics with the belief that probiotics will improve bowel function as well as other GI symptoms and that probiotics are safe.

The fact is that the FDA has not approved any health claims for probiotics and although most people do not experience negative side effects or have only mild side effects, such as gas, there have been case reports of serious adverse side effects.

Remember that probiotics sold as supplements or ingredients in foods cannot legally declare that it can cure, prevent or treat a disease. Always consult with your pediatrician before giving a child probiotics. See Chapter 18 in my book for more information.