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Help for a constipated child
Q: I have a 2-year-old girl who is holding in her poop when she feels the need to have a bowel movement. Consequently, she is getting constipated and causing herself pain.

It started, I believe, when she had a bad diaper rash. She does not seem to understand when we try to tell her not to hold it in, so we end up changing many diapers with just a little bit in them because that is all she will let out at a time.

Do we just pour prune juice into her to help relieve the constipation? We have tried sitting her on the potty chair when this happens, but she never goes; she just complains about it and wants her diaper back on. What can be done?
A: Cindy, it’s fairly common for children between 2 and 5 years old to hold in their stool. Your daughter may be constipated if her bowel movements are hard and dry like pellets, sometimes even streaked with blood; she strains to have a bowel movement; and she has stomach or bottom pain.

Your daughter’s constipation may have started after the bad diaper rash or if she developed a little crack around her anus, which might have made bowel movements painful. Sometimes young children hold in their stool to show some independence and control when they feel pressured to toilet train. Children can also become constipated when they are picky eaters and don’t eat a wide enough variety of foods or drink enough fluids.

Here are tips for preventing & dealing with constipation:
  • Give your daughter more high-fiber foods such as whole-grain cereals and bread; fruits (e.g., prunes, apricots, plums, and raisins); and vegetables (e.g., peas, beans, and broccoli). For now, try to avoid foods that tend to be more binding, including rice, bananas, applesauce, citrus, and cheese.
  • Give your daughter more liquids to drink including water and juice (e.g., prune, apple, pear, or grape juice).
  • Make sure your daughter gets plenty of physical activity every day. This helps the bowels move.
  • Consider holding off on toilet training until her bowel movements are more soft, comfortable, and regular. Let her get used to pooping well in her diaper, where she feels most comfortable, before making the transition to the potty. Once she’s having regular bowel movements and seems ready for toilet training, encourage her to sit on the toilet for a short while after breakfast each day to try to develop regular bowel movement habits (see the article on this website on“Toilet Training”).
Talk with your pediatrician about your daughter’s constipation. If the above tips don’t resolve the constipation, your doctor might prescribe a stool softener such as mineral oil for a few months. This will make her stools soft enough so that she can’t hold them back and they will no longer be painful. Sometimes the doctor will prescribe a rectal suppository or enema to clear out the hard stool before starting on a stool softener.

Karen Sokal-Gutierrez M.D., M.P.H. Pediatrician