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February 2019

"Does your book apply to children under age 2, like my 18 month old?"

I received a question from the mother of an 18 month old child asking if “The Ins and Outs of Poop” applies to children as young as hers. In fact, Chapter 3 of the second edition of the Ins and Outs of Poop is dedicated to infants and toddlers. Signs of functional constipation in toddlers include hard stools of any size, painful bowel movements, daily withholding and stool incontinence or leakage. For toddlers I recommend that parents initiate treatment right away if they see signs of functional constipation or encopresis. For otherwise healthy toddlers treatment usually starts with dietary changes including giving the child more water or juice such as 100% apple, prune or pear juice.

Because the treatment of encopresis in children is more successful the less time that hard stools and pain persist, I recommend that an oral laxative be strongly considered if a child's stool does not soften within 48 hours. Always consult with your pediatric healthcare provider if you any questions or concerns about the use of oral laxatives.


3 y/o Refuses Laxatives: Sneaky Chef Helps

The mother of a 3 year old girl, whose painful episodes of constipation began when she was 11 months old, recently told me that her daughter was now refusing to ingest any laxative in ANY form, even though laxatives had previously made her bowel movements soft and painless. No matter how we tried to disguise Miralax in countless liquids or Ex-Lax (chocolate form), even in foods like chocolate chip cookies, she refused them.

While working on this problem, we decided to increase the fiber in her diet (obviously she was a picky eater generally, so this, too, was difficult!) and came upon some really wonderful books by Missy Chase Lapine such as The Sneaky Chef: Simple Strategies for Hiding Healthy Foods in Kids' Favorite Meals.

Increasing dietary fiber was helpful for this girl but, as I explain in my book, fiber is much more important and effective for preventing serious constipation than it is for treating it.  Keeping stool soft and bowel movements frequent for extended periods is typically only accomplished via laxatives.


Constipation and encopresis in the first year of life

Parents are often surprised when they learn that their less-than-12-month-old baby is constipated or has encopresis. They did not know that infants become constipated as often as older children and that infants who experience constipation go on to develop functional constipation more frequently than older children. Mothers who breastfed their baby were surprised because they thought breastfeeding prevented constipation, forgetting that the introduction of solid foods can lead to constipation even while breastfeeding.

Parents should contact their pediatrician at the first sign of constipation. Warning signs include: hard pellet-like stools, crying and screaming before or during a bowel movement, arching of the back, stiffening the legs and appearing to be straining to push stool out or hold stool in. A formula fed baby should have at least one bowel movement a day. Less than one bowel movement a day, especially if the baby appears to be straining more than usual, may be a sign of functional constipation. For treatment recommendations see Chapter 3 in the 2nd edition of  The Ins and Outs of Poop: A guide to Treating Childhood Constipation.