What to do when your child can’t poop?
Does your child have trouble pooping? Is the stool hard when it comes out? Does your child not poop for many days and when the bowel movement finally comes, it clogs the toilet? Is there pain or discomfort during the process of pooping? Does your child get abdominal pain and you notice that their belly seems overly distended? Most likely your child has a very common problem that many kids get - CONSTIPATION.
As a pediatric gastroenterologist, this condition is our bread and butter. Constipation is so common in kids that about 12% of all kids at some time suffer from constipation(1). What exactly is constipation? Constipation is when a child has hard stools that are difficult or painful to pass and much fewer than the number of stools than normal.
The basics: Fiber and Fluids
Fluids:
Research shows that fluids BEYOND the recommended amount for your child’s age and height is not known to help with constipation. However, most kids chronically run dry and dehydrated. And if it’s a hot day, or if your child is doing a lot of great physical activity, they may need even more. How do you know how much your child needs?
For a rough estimate (please consult your doctor or dietician for exact amounts):
Teenager/ Adult - 8 glasses of water / day = 64 oz
Elementary School Age Kid - 6 glasses of water/ day = 48 oz
Toddler - 4 glasses of water/ day = 32 oz
Drinking fluids takes planning and practice!
1. Potty time: Work with your doctor and your school to make sure kids have adequate access to the restroom, and ample time to use it. One of the biggest barriers to drinking enough at school for my patients is that they don’t want to use the bathroom at school. Maybe they don’t have enough time, or maybe the bathroom is always dirty and not well maintained. Or perhaps they are embarrassed to go poop at school. If this is the case, work with the teachers and the school to find a more comfortable spot to go when nature calls.
2. Bring a water bottle around and know how much water you need to drink as a goal: (ex: three 18 oz water bottles.)
3. Make it fun! Flavor your water with natural flavorings. Some of our favorites include lemon slices (freeze them to allow for easy grab and go), mint leaves (mint in frozen cubes also easy), or other fruit like strawberries and melons.
4. Food as Fluid: Many foods that are high in water content can count as the total fluid intake for the day. Fruits such as watermelon, melon, stone fruits (peaches, plums, apricots) and many others have a good amount of fluid per serving. Soups and smoothies are also a good option!
Fiber:
After fluids, this is the second item I assess when I child comes to for constipation. Most kids do not get enough fiber in the US. True confession: my kids are children of a Peds GI poop doc, and there are many days that they don’t get the recommended amount fiber. It’s tough! However, I’m a huge fan of food as medicine, and if your child is suffering from constipation, it’s a good goal to increase this in the diet. I will often advise a laxative in the short term with the long term goal to increase fiber and fluids up to the recommended amount.
What is fiber?
Fiber is dietary material in food that is resistant to the digestive enzymes in our GI tract. Fiber often helps to make up the structural components of plants, and are most commonly found in plant-derived foods.
How much fiber should my child eat?
An easy formula: Age of child + 5 = total grams of fiber (up to 25g for the average grown up)
Some of my favorite ways to add fiber to your diet:
Cooked greens - can blend these in soups, smoothies, curries, sauces if they aren’t yet ready to enjoy a plateful of deliciously sautéed greens.
Sheet pan veggies - Something magical happens to a vegetable when it is drizzled with olive oil, seasoned with your favorite salt and spice blend! The sugars in the vegetable caramelize at 425 degrees for 10-12 minutes. The vegetables are sweet with crispy edges and are irresistible. Try it!
Smoothies - There are so many different smoothie recipes out there! Adding greens and/or nuts to a fruit based smoothie can be an easy way to get your fruit and veggies in.
Soups: Soups are a favorite way to clean out the fridge. Some veggies that might be a bit past their prime get new life in a pot of soup.
Roasted Sheet Pan vegetables
Pooping Position:
The positioning of a child’s pelvis, legs and hips are super important to help relax the pelvic floor and allow for easy defecation.
What is a good position? The child’s knees should be as high as the hips, and the feet should be planted squarely. If their feet can’t touch the ground, then a stool (or sometimes two stools on either side of the toilet) or a squatty potty can help with the positioning.
Are they trying to hold it in?
Stool withholding is super common. Kids are smart! They might remember a painful poop in their past and their bodies might not want to relive that painful incident. So, instead of relaxing the muscle that lets the poop out (the anal sphincter), the muscle actually contracts and keeps the poop in when they get the urge to poop. This causes what we call dyssynergia - this is when the pooping muscles are not coordinated with the each other.
Signs that your child is holding it in include:
Stiffening legs when pooping
Standing up while pooping
Straightening legs out in front of them.
If you see this, you should encourage your child to get into a squatting or frog leg position (or good pooping position on the toilet), to prevent the withholding. Some kids resist, and laxatives may be needed so that the stools are softery.
Take heart!
When your child is constipated, it can be so heartbreaking. After taking care of constipated kids for over a decade, I know that it can be hard to watch. Take heart! Know that it is a treatable condition that often resolves or gets better with time and some easy behavior, diet, and medications as needed. Talk to your pediatrician or primary care provider, and when needed, as for a pediatric gastroenterologist. You are not alone! We are here to help.
References:
Mugie SM, Benninga MA, Di Lorenzo C. Epidemiology of constipation in children and adults: a systematic review. Best Pract Res Clin Gastroenterol. 2011;25(1):3–18.
