Ode to Poop, Part Two: How Do We Prevent and Treat Constipation?

How Do We Prevent Constipation?

The best treatment is prevention, which often starts with how parents approach toilet training. I recommend not "toilet training" at all. Many children become hesitant to poop because they've been pressured into using the toilet before they are ready to. I recommend letting children decide when they want to use the toilet and supporting their autonomy to learn when they are ready. After all, why would it make sense for someone to tell you when it's time for you to learn a new skill? When I see my baby trying to poop, I ask her whether she'd like to poop in the toilet. If she says yes, we go to the potty; if she says no, I tell her that that's fine, and that she can poop in her diaper if she wants to. Of course, many families don't have the luxury of letting their children listen to their bodies, such as those who have to rely on a daycare or preschool program that requires children to be "potty-trained" by a certain age.

Our diets also play a big role in our poop because food is the main ingredient of our poop. Most young children prefer very carbohydrate-heavy diets. This is normal and fine. Carbs are a great source of energy that kids need for their active days. However, it's important to offer a wide variety of foods that include good sources of fiber. Highly processed snack foods like crackers are a reliable source of calories for kids that are tasty, convenient, and affordable, but they are also low in fiber and other essential micronutrients. Offer your children plenty of whole food options like fruits, veggies, and whole grains.

There is no good evidence that hydration plays a significant role in treating constipation, but it may help in preventing it. Many of us don't drink enough water during the day, which can lead to headaches and lightheadedness. Make sure your child has access to water throughout the day. I recommend keeping a full water bottle around them at all times. This is also a good idea for adults.

How Do We Treat Constipation?

The options above are great ways to reduce your child's risk of getting constipated, but they are not going to be enough to treat constipation once it sets in. This requires retraining the bowels by eliminating any obstructing stool, using daily laxatives to ensure children are regularly emptying their bowls, and teaching children to poop regularly.

I recommend starting with an over-the-counter laxative like Ethylene Glycol, also called MiraLAX. This is a safe and cheap laxative that pulls water into the gut to soften built-up stool until it can be pooped out. I like to think of it like water running through a canyon. The water gradually erodes the rock over time making the canyon wider and deeper. Start by giving a small amount, like half a capful or one capful of MiraLAX per day, and increase the amount every two to three days until your child is having at least one soft, mashed potato consistency stool each day. If your child starts having very watery stools, you may need to reduce the amount of MiraLAX you are giving them. Remember that the more they poop, the more water they need to drink to stay hydrated. I tell parents that it will usually take at least as long to treat constipation as it did to develop. So if your child has had hard poops for many months, they will need to be on MiraLAX for that long also. It takes time for that large ball of stool to be loosened up and pooped out, and then it takes more time for the gut muscles, which have been stretched out by the stool ball, to shrink back to their normal size and resume working normally.

For children who have learned to use the toilet, I recommend implementing scheduled toilet times after meals, during which children sit on the toilet for a few minutes without distractions. If they don't poop during this time, that is okay. Sitting on the toilet will make it easier for them to poop if they need to and ensure they aren't holding it in to avoid interrupting playtime. It can also help to place a step under the toilet to raise their legs and open the sphincter, which makes it easier to poop.

Constipation is extremely common in children and can be very disruptive, but it will improve with consistent treatment. If you have questions about your child's constipation, speak with their healthcare provider for more information.