How often should my child "go"? Sometimes he skips days and then we have a huge poop that clogs up the toilet! He says that they hurt coming out, even though they are usually pretty soft. Is this normal?
Most young children have daily soft bowel movements. Although every child is different, if you notice that your child is skipping days, or that her BMs are smaller and harder than usual, it’s important to pay attention. Occasional changes in BM patterns are normal, but if your child is having fewer BMs than usual and you notice that some or all of them are hard or dry, then your child is constipated. Simple constipation may be helped by simple changes in diet. But if your child has a a bowel movement that HURTS it’s important to make changes so that a simple problem does not become a bigger, more complicated problem.
BOWEL MOVEMENTS SHOULDN’T HURT!
When children have painful bowel movements they may begin to hold in their BMs because they don’t want to be hurt again. Of course, holding the BM doesn’t help, and it actually makes the problem worse. The longer the child holds, the bigger (and harder) the BM becomes, and the more it can hurt when it comes out. If this happens, your child may develop CHRONIC CONSTIPATION, WITHHOLDING, or sometimes ENCOPRESIS.
If you aren’t sure whether your child has simple or chronic constipation, make the changes in his diet that you’ll find later in this article. If his bowel movements continue to be hard or uncomfortable after a week, call your health care provider and ask what else you can do. The rest of this article will help you understand why chronic constipation is a problem for young children and provide guidance for getting the best treatment.
WHEN DOES CHRONIC CONSTIPATION START?
Although many babies begin to have harder BMs when they start eating solid foods, adjusting the amount of fruit in their diets is often enough to keep BMs soft. However, babies who frequently have hard BMs or trouble pushing them out should be checked on a well baby visit to make sure there isn’t another problem.
Toddlers are the children who are most likely to have the hard bowel movements that lead to chronic constipation. Sometimes it’s because they are picky eaters who drink a lot of milk, sometimes it is because they are rebelling against toilet training, sometimes it’s because they only want to have their BMs at home, and sometimes it’s because it just happens! For a toddler, having just one big, hard, painful bowel movement can be enough to cause him to fear having another. Sometimes the hard BM causes a slight tear in the anal area (called an anal fissure). The tear may be small, but it can as painful as a paper cut might be to an adult. A bout of diarrhea may also cause irritation and then pain during a BM. In these situations a toddler thinks it’s better to hold in than let out. He doesn’t understand that he won’t cure his problem that way!
Another cause of constipation is withholding, which means holding a bowel movement back in despite the urge “to go”. As toddlers go through toilet training, they may hold in too long causing their bowel movements to become large and/or hard. A toddler may withhold a BM because he is resisting using the potty. He may be rebelling against sitting altogether, or resisting because parents have taken away diapers before he knows how to voluntarily release urine or a BM. Some children, even if they have mastered using the potty for urination haven’t learned to use it for having a BM. If they are taken out of diapers before this last step, they may begin to withhold and then become constipated. Children who are fully toilet trained at home may not want to have a BM at preschool and so withhold. There are many triggers that can cause a pattern of withholding and constipation.
Most parents aren’t aware that this pattern is beginning until their child has had many hard bowel movements. Occasionally children develop a pattern that parents may not notice as unusual for some time. Their child may withhold a BM for several days and then produce a huge (what a four year old describes as “ginormous”) BM. He then waits several more days before letting go of another. In between BMs he may seem uncomfortable, especially after a few days. He may have a decreased appetite. Quite often parents notice that their child is “moody”: irritable and demanding until he has a BM and then happy and pleasant for a day or two until he is backed up again.
If the description of BM patterns here sounds like what is happening with your child, make an appointment with a health care provider who is knowledgeable about this problem. Get started on changes in diet, extra fluids, and more exercise and keep track of your child’s patterns. If you don’t see improvement by the day of your appointment, you’ll know that it’s time to get a personal plan.