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Toddler Constipation

Our 20 month old daughter is holding her stool in and is in a great deal of pain.  We try to give her foods to soften her stool, but she doesn't want to go to the bathroom.  We have not started potty training yet.  We try talking to her about it, but nothing seems to work.  Do you have any suggestions?

Constipation is hard, painful stools.  Even though you are not actively potty training your daughters constipation may be caused by her mentally preparing for potty training.  As children learn to control their bowel movements sometimes they get too good. What ever the cause it must be addressed prior to successful potty training.

If not addressed, her constipation will continue.  When stooling hurts children tend to hold in there stools to avoid going.  This leads to larger, harder and more painful stools. Painful stools in turn leads to holding it in.

I agree the first thing your should try is dietary modification.  I often recommend increased dietary fruits and fiber.  Apple and white grape juice work well for short term relief, but should not become a major component of a toddlers diet.  When using juice to help with constipation do not dilute it with water as it is the sugars that help the child stool.

If dietary intervention has failed, you should discuss the issue with her doctor.  When starting medications for constipation, I typically start with a class of medications called non-absorbed sugars.  These "medications" work like a diet soft drink.  You eat them but the sugar it is not absorbed.  As these sugars pass through your intestines they draw in extra water and loosen the stool.  My favorite over the counter non-absorbed sugar is milk of magnesia (MOM).  There is no set dose for MOM, it is dosed by effect.  I usually start with a teaspoon a day and adjust weekly.

The goal when treating constipation is to obtain one to two peanut butter soft stools daily. Only after she her stools have been habitually soft and painless can you begin actively potty training.

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Written February 2011 by
Dr. Gordon, Orlando Pediatrician








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