Let’s face it, dealing with kids and their poop is never a fun experience, and it can be particularly tricky with toddlers, whether they’re in diapers or potty training. However, if your toddler is not pooping, that’s especially challenging for both you and your kiddo. Here’s what you need to know about toddler constipation, including how to deal with it so that you’ll all feel better.
Everyone’s body is different, so missing a daily poop is not likely a sign of constipation. However, if your child has fewer than three dirty diapers or trips to the potty in a week or the poop is hard, dry, difficult to pass or so big that it nearly clogs the toilet, your toddler may be constipated. Other signs and symptoms may include pain with a bowel movement, a tummy ache, traces of liquid poop in underwear (this may mean that poop is backed up in the rectum) and blood when wiping or on the surface of hard stool (due to small tears in the rectum from trying to pass hard poop). Because your toddler thinks pooping will hurt, they may cross their legs, make faces, clench their butt, rock their body, walk stiffly on their tiptoes or sit with their heels pressed against their perineum to try to avoid having to go.
Toddlers, in particular, can get constipated from a number of different factors in their wild and crazy toddler lives. Kids this age often get fixated on certain foods and, chances are, the “all-beige diet” (like crackers, cereals and toast) may not have a lot of fibre. If your toddler drinks a lot of milk, that can be constipating, too, says Roxanne MacKnight, a family physician in Miramichi, NB.
Sometimes, anxiety over pooping in the potty or on the toilet rather than in a diaper can make a toddler try to skip the whole thing. Other times, toddlers are so busy playing that they may ignore the urge to go. Starting preschool or changing rooms can also throw them off—maybe the routine or bathroom is different. “Ninety-five percent of the time, constipation isn’t related to a medical issue,” says MacKnight. (Constipation can also be linked to a metabolic or digestive issue, but that’s rare in kids.)
First and foremost, many health professionals suggest changes to their foods and drinks. “One of the things that can help most is extra water,” says Jennifer House, a registered dietitian in Calgary who specializes in kids and families. “Water helps move things along and soften stool.” Pick out a favourite water bottle and bring it with you, or add some frozen berries to make it look a little more fun, she says. House also recommends giving your toddler up to half a cup of pear, prune or apple juice once a day (all at once), not watered down. “These juices contain a type of sugar called sorbitol that helps draw water into the bowel and soften stool,” she says.
Next, try to get some fibre-rich foods into their diets. Offer fruit with the skin on or try whole wheat macaroni or bread. “The best dietary sources of fibre are beans and legumes, so see if your kid will dip veggies in hummus or eat bean chili,” says House. “When my kids were toddlers, I would put a few canned black beans on their trays as finger foods.” Smoothies are a good option, too, as they provide fluids and fruit and you can blend in ground flax for fibre. MacKnight also recommends dried apricots and prunes (they may be sticky and hard to chew, so be sure to cut them up into raisin-size pieces so that they won’t be a choking hazard), broccoli and peas.
Quite often, toddlers aren’t down with new foods, so try using their “me-me-me” independence as a tool. “Get them involved as much as they can,” says House. “They can pick out foods at the store or rinse produce. They like to take control and ownership rather than just being presented with something to eat.”
House also suggests looking into probiotics. “They certainly won’t cause any harm, and research shows that some probiotic strains, like Lactobacillus casei, might help with constipation,” she says. Look for a paediatric powder that you can mix into applesauce or yogurt. Or try paediatric drops, which you can place on their tongues or add to a spoonful of food, or chewable paediatric tablets.
Try not to get into a power struggle over the potty, but gently encourage your toddler to go at the same time every day. If they’re using the toilet, a little step stool can help support their feet and create the right position for pooping.
If you’ve noticed that your toddler is constipated or having trouble with bowel movements, try the recommended food and drink options for a week to give them time to work. But if they’re not doing the trick, see your healthcare provider. “Sometimes you don’t see children until the situation is quite severe and they’ve reached the point where they’re extremely constipated and withholding stool,” says MacKnight. Your doctor will gently feel your toddler’s belly to check if there are any particular areas of tenderness or bumps that are abnormal. “We often spend a lot of time talking about non-medical treatment,” she says. “Sometimes we need to prescribe a laxative first [to] and then get into the routine of improving their diet to prevent this from happening in the future.”
MacKnight says that there are several common approaches. Your healthcare provider may recommend mineral oil mixed into yogurt or other soft foods. Other recommendations may include Lactulose, a liquid laxative that’s added to food and drinks, and PEG 3350 (usually sold under the brand name Pegalax), a flavourless powder that can be mixed into water or juice.
Remember that constipation may be an uncomfortable part of toddlerhood, but it will be OK. “Parents have to be persistent with a healthy diet and sometimes medications as well,” says MacKnight. “This is generally a temporary situation and solvable.”