Alleviating Constipation in Toddlers

Being a first-time parent in and of itself poses all sorts of challenges. Learning what each cry means, establishing a bedtime routine, childproofing...the list goes on and on. But there is one aspect of parenting over which--no matter how prepared you think you are--you have absolutely no control: Constipation. More specifically Functional Fecal Retention. This is not a pleasant topic, but I have been fighting this phenomenon with my daughter and feel that it needs to be addressed. She just turned two and I thought that we had gotten past the constipation that had plagued us at about 18 months. She had stopped crying and straining so hard that she vomited and she had been having regular bowel movements for months. Then about a week ago, we noticed that she was standing, straight as an arrow, trying to hold it in. I am in no way qualified as a doctor to give advice to treat this, I am simply telling you our story in the hope that if your child is having this problem, you might discover a new option that you can try-or at the very least discuss with your pediatrician.

Functional Fecal Retention, from what I have gathered in marathon internet searches on constipation in toddlers, is when the child has a large and/or painful bowel movement once and assumes that every one after is going to be the same. This breeds a fear into the child and from then on, every time the child feels the need to have a bowel movement, they forcibly hold in the BM. Each time the child succeeds in holding back a BM, the colon stretches to accommodate. It goes without saying that the longer this goes on, the harder it is to eliminate the bowel. If you have ever had a child with this predisposition, you know that it is not only painful for the child; it is agonizing for the parent. I have cried many times right alongside my daughter, waiting for her to pass mammoth BMs that in no way should have been able to pass from that tiny bum. I liken it to childbirth. Really.

The first thing that most sources suggest to alleviate the problem is to modify your toddler's diet. Reducing the amount of dairy that you feed your child helps (don't forget to supplement to make up for lost nutrients). Our toddler does love cheese, but not so much that it could have been the root of our problem. She also loves sugar snap peas fresh from our garden, blueberries, strawberries, nectarines, whole grain flatbread, beans of all kinds and peanut butter sandwiches. The kid eats better than anyone in the house. I did substitute American cheese slices with veggie cheese slices and she hasn't noticed the difference, but she is not too keen on the vanilla soy milk that I have been trying to slide in on her. I tried it and liked it...her, not so much. We also keep plenty of water (with a splash of juice for color) available throughout the day in her sippy cups and mix in a soluble fiber supplement into a couple of drinks each day.

With little to no result after a week of this dietary plan, I headed down to our local super center to see what the pharmacist had to say about this problem. To my pleasant surprise, she had a five-year-old that has this very same problem. (Unfortunately, her daughter has had this problem since she was two. I am hoping that my child's issues do not last that long!) This is where the "I am not a doctor" part comes in. The pharmacist recommended a product called MiraLax, and told me to give my daughter ½ the dosage a couple times a week, more or less depending on the frequency and consistency of the bowel movements that it produced. Ideally, she said, we would want one soft BM per day. Within a couple of hours of her first dose of MiraLax, my daughter passed the large, hard BM that had accumulated, and three days later, has soft BM.

The idea in using a product like MiraLax is to get the child used to having un-painful BMs and to re-teach them to not be afraid of going to the bathroom. It also, according to the pharmacist, makes it physically impossible for the child to hold back a BM. The mistake many parents make (myself included) is to stop the use of the treatments once the constipation appears to go away. I assumed that once my daughter had no trouble going, that I could stop using the fiber supplements...and you know what happens when you assume...

So what has worked for us is a combination of limiting dairy, lots of fluids, fiber supplements and MiraLax. Once again, I am not a doctor, so if you are not comfortable giving your child over the counter laxatives, by all means, consult one before doing so. At the very least talk to your local pharmacist...they are very knowledgeable, helpful...and free. So far, we have had success doing it this way, and if we can help someone else by telling our story, even better.