Get The Scoop On Your Child's Poop-How to deal with your child's constipation

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Warning:  This post talks about feces therefore it's best not to read while eating your breakfast. 

I've had many readers asking me to do a post on childhood constipation.  So, here it is!

I hate to admit, I'm one of "those" parents who's fixated on my child's poop. Yes, I said it!!! Not only do I examine my children's bowel movements, I also interpret my children's health from the COCA(color, odour, consistency and amount) of their poop.
My obsession with my kids' poop began when Sapphire and Opal started experiencing severe constipation problems.  I soon found myself documenting their bowel movements and consulting with our pediatrician about treatment options. { I told you I liked to journal}
Little did I know, that over the next several years I would become extremely schooled at not only changing diapers but also interpreting feces.

So, what's the real "Scoop on Poop"
This is a very brief overview of normal and abnormal bowel movements as well as treatment options for constipation.

We all remember the days of changing diapers. You may recall this colorOOOOOO or maybe it was closer to this*******.  Typically, all newborn bowel movements are described as seedy, yellow and liquid.
Each baby will develop their own pattern of pooping. Yes, it's true! Babies as young as newborns have a pooping patterns.  Some will poop 10-12x's/day, while others will poop every 2nd to 3rd day.
You may witness your newborn exhibiting forceful or strained bowel movements.  This is because the nerves in the lower rectum and anus are still maturing in newborns.  As long as the bowel movement is not solid your baby is NOT considered constipated. There is no need to be concerned with this type of  straining.  The organs of the digestive system are conducting the complex tasks of digesting and absorbing nutrients from the foods and liquids your baby consumes. The digestive organs of a newborn are extremely weak.  This is one of the reasons why it is so important to delay introducing solid food until  your baby is 4-6 months of age.
Once the child is introduced to solid food the COCA of their feces becomes extremely altered. At this point it is much more important to monitor the COCA of the stool.   It is crutial to observe the stools and well as the types of foods you introduced.  New foods can sometimes explain a sudden onset diaper rash.
It is also important to note that your child's feces will "firm up" when rice cereals or solid foods are introduced.  This is the stage that most babies experience their first bout of constipation.
Do you remember the days when you happened to find chunks of undigested peas or carrots in your child's diaper?  This happens for several reasons.  Mainly because young children are not experts in chewing  and therefore sometimes swallow pieces whole.  Add to this the fact that the digestive tract is still maturing and still lacking some of the "good bacteria" and enzymes necessary to break down food.
Usually around 12 months your child's feces will start to resemble the "classic" formed brown poop, much like that of an adult.


Now I'm going to discuss one of the most common Digestive Tract Problems in children.

Constipation

First I want to show you a little chart that is a very useful tool when discussing feces and constipation.{ Health professionals love charts because it gives them a guage or visual to compare incoming data}

This is a good tool to use when talking to your health care provider about your child's constipation issues

Constipation is defined as infrequent painful solid stools. Having had 2/3 child experience ongoing constipation, I sympathize with any parent who has witnessed a child pass "football" sized poops.
Trust me when I say we've tried it all.  Laxatives, diet restrictions, homeopathic remedies, probiotics and fish oils. You name it and we've tried it.
As you would expect, the most common cause of constipation in babies is a result of their diet!
Again, I want to point out that a baby's digestive system is still in the developing stages, therefore the introduction of constipating foods impact their ability to pass stools.  Foods to avoid if you find your baby passing painful solid stools include: bannanas, rice, applesauce and toast (known as the Brat Diet).  This includes rice pablum. 
Some excellent foods that promote soft stools include:  prunes, pears, spinach, beans, pumpkin and blueberries.   {I have a excellent spinach blueberry brownie recipe that my children love.  I fed it to them whenever they get a little bit constipated}
Dehydration is another common cause of constipation in children.  When children become sick with a fever or flu they often drink less and have greater water losses.   It is very important to promote fluid intake during times of sickness so that your child does not become constipated. 
The most common cause of constipation in older babies, toddlers and young children is "Withholding"
Unfortunately, it only takes a few painful bowel movements for a child to develop Encopresis aka "withholding of stools". Children are expert procrastinators and are great at ignoring the urge to pass stool. This allows them to hold their poop in for literally for days.  As a result their feces becomes firmer and firmer. When they do finally pass the stool it can be extremely painful for them--consequently creating a vicious cycle.
A child who continuely withholds poop can loose the sensation "to go" because the bowel becomes stretched and the muscles become weak.
Sapphire and Opal both suffered from Encopresis. Their bowels became completely blocked and liquid feces began to leak out around the solid stool. 
With the help of our pediatrician we were able to deal with the problem and overcome it.  Eventually, they grew out of this withholding stage.

Now this is probably the part that most of you are interested in.

Treatment options

• Of course diet restrictions, increased fiber/fluid intake and exercise are the most natural remedies of constipation and the first line defense in prevention. 

Here is a good rule of thumb when it comes to fiber intake.  5 grams + your child's age.  Therefore, if your child is 2 years old than they should be consuming 7grams of fiber/day.  Yep, it's a lot but that's what it may take to prevent constipation in your little one.

• If your child  is experiecing impaction  (how do you know if your child is impacted?  If you notice your child forcefully trying to pass stool but only passes or leaks liquid stool than chances are they may be impacted) than your child may need to start a "clean out" regime.  This should be done under guided supervision from a health care professional. A clean out process involves treating constipation orally and rectally to clear the entire contents of the large and small bowel.  Once the "clean out" process is complete it is critical to keep the stools very soft {almost mushy or pudding consistency} for quite sometime.  This allows the child to erase the memory of painful pooping and it improves muscle development in the bowel. Consider an athlete who trains at the gym each day to build their muscles.  It is important for the bowels to move daily in order to strengthen the muscles in the rectum and bowels.

• Most laxatives and stool softners are available over the counter but it is very important to understand how these products work in the bowel before introducing them to your little one.   Some examples include:

Lactulose- This product is considered a stool softner.   
Lactulose is a sugar that is broken down in the small intestines.   It draws water into the bowel and ultimately into the stool, making it softer.  It comes in a syrup form and most children don't mind taking it because of it's sweet taste.  This is a good product for "withholders".  It is a maintenance product, meaning it should be taken regularly and may take up to 48 hours to soften stool.  It usually does not provide immediate results.  It should not be taken if the child is diabetic or on a low glucose diet because the main component of it is sugar.  Consult your doctor for appropriate dosing recommendations.  The one problem that I have found when my children took Lactulose is that the bowels may become somewhat dependant on the medication.  These may lead to increased dosing requirements

Pedialax- This product falls in the category of laxatives.  It is made of Senna-a natural vegetable based laxative that has been used for centuries.  It provides natural overnight relief. Typically working within 6-12 hours.  I prefer to treat with natural products than synthetic medications.  It has a grape flavour and dissolves instantly on the tongue.  This form is easier to take than the Sennekot tablets available.
Doseing:  For ages 2-5 :1 strip
                     ages 6-11:2 strips
If you can't find it on the shelves of your local drug store or health food store than you can ask a pharmacist to have it brought in for you.

Fiber Gummies-1.5 grams of fiber per gummie
This product is not a laxative but rather a supplement if you are having difficulty getting your child to consume the recommended daily dose of fiber

Miralax-This is a osmotic-type laxative.  In other words it draws water into the bowels and into the stool.  It also promotes more frequent stools.  I liked this product becasue it is easily incorporated into juice or food.  It can be provided in a colorless, odorless and tasteless crystal powder.  I appreciate the fact that I could give them medication without them knowing   Consult your health care provider for dosing

Enemas are not a pleasant experience for your child however sometimes they are a necessary part of a clean out regime.
It is important to lay the child on their left side with the knee up because this allows the solution to flow more easily into the bowels making it more effective.  It is also wise to administer the enema solution slightly warmed as to ease discomfort.
It typically provides instant relief of constipation. Usually after 3 minutes (So,be prepared for potential explosions)  






These are just a few of the many laxatives and stool softeners available on the market.  Please take time to learn about any medication you buy otc before you give it to your child.  As well, please consult a health care provider when giving your child any medication. 

I hope this post provided you with useful, up to date information on Constipation and Treatment Options. 
Feel free to contact me by leaving me a comment or emailing me if you have any more questions. 
If you have any suggestions on future medical posts than I'd love to hear from you. 
Again, this post is for information purposes only.  As a Registered Nurse, I am not authorized to diagnose but I do have an ethical obligation and passion to heatlh teach others about medial issues. 

Cheers