Toddler constipation

Pediatrics for Parents, August, 1995

Early treatment of toddlers with constipation lessens the chances they will develop problems later on. Rarely is constipation in children this age caused by any underlying disease or illness. Most often it's a matter of helping the child learn the signals indicating the need for a bowel movement.

According to pediatric gastroenterologist John F. Thompson of the University of Miami School of Medicine, diet doesn't have a huge impact on children with constipation. However, he feels that increasing the fiber in their diets may help. He recommends including bran or whole wheat cereals and bread in their diets.

He describes what he calls the "stool dance" - the classic signs of deliberate stool withholding - such as pushing against the wall, standing and tightening the buttocks, and wiggling his seat. If signs of stool withholding develop during toilet training, then he recommends "backing off." The child is signalling that he isn't ready for toilet training and pushing the issue will only lead to problems later on.

He thinks it's best for children to be given stool softeners and laxatives for bowel cleaning and reserves enemas only for the most difficult of cases. Milk of magnesia increases the amount of water in the stool and the bowel motility. It's usually effective overnight and is well tolerated by children.

He believes that mineral oil is the "mainstay" of maintenance treatment. Kondremul is essentially the same as mineral oil, but tastes better, but is more expensive. Neither should be used if the child is at risk of vomiting. Dr. Thompson also recommend Senekot when a natural stimulant laxative is needed.

If constipation is ignored, the child may develop reduced bowel sensation, problems controlling his stool and bowel movements, and "a lot of psychological overlay." He finds that most school-age children with stool smearing problems were not treated for constipation in the their toddler years.

Family Practice News, 3/15/96, p. 45.

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