When it comes to poop, what’s normal? Should a child poop every day or just a few times a week? What should you do about really hard poop? How do you know when a child is constipated? Will drinking more water help? And what about prune juice? These questions often come up while staring into the empty diaper of a screaming baby or when rubbing the tummy of a toddler who refuses to go to the bathroom because "it’s gonna hurt," or when "someone forgot to flush" and there appear to be rabbit turds in the toilet.
Bowel habits are very individual. What’s typical for one child is probably not what’s typical for another. Some people have a bowel movement three times per week and others go three times per day and it’s all considered normal. Some parents are very focused on their child’s bowel habits and want to see results every day, but the child may only have every-other-day bowels.
The bottom line (pardon the pun) is that if your child’s bowel movements are easy and the stool is soft then they aren’t constipated and there’s no reason for concern.
From a medical standpoint constipation is defined as (1) fewer than three bowel movements per week, or (2) hard, dry and unusually large stool or (3) stool that is painful to pass. Constipation may begin when you change your baby from breast milk or baby formula to whole cow’s milk, and when you switch from baby food to solid food. Sometimes constipation happens after your child has been sick or has taken certain medicines. You should not be concerned if your child becomes constipated for a short period of time. Almost everyone is irregular now and then but it usually passes naturally.
Chronic constipation is when these problems last for more than two weeks. Some young children develop chronic constipation because they ignore the urge to have a bowel movement. A child may not want to interrupt play or may be afraid or embarrassed to ask a teacher or use the bathroom.
When a child becomes constipated they may have a very painful bowel movement. In an attempt to avoid pain some children resist going to the bathroom. When children refuse to go, it makes the problem worse because stool that sits in the bowels for a long time gets larger and harder to pass, making bowel movements even more painful and difficult. Eventually the child will have to go through the painful process of expelling the large, dry, hard stool, which reinforces their fear and refusal to go. It can be a vicious cycle. This is called "stool holding" and it often occurs around toilet training, but can be seen in older children, too. Stool holding can lead to complete stool blockage, which requires your doctor’s help to manage. If abnormal bowel habits begin to develop around potty training, stop until a normal bowel pattern can be established, then re-start. If an older child is stool holding you’ll need your doctor’s advice, along with a good behavior program.
Constipation is bound to happen, but there are things you can do to decrease its frequency and avoid problems.
First, take a look at your child’s diet. The fiber in fruits, vegetables and whole grains is critical for maintaining a healthy bowel. Try to limit high fat foods and candy because they are usually lower in fiber. Make sure your child gets plenty of fluids to keep stools soft—adding a little prune juice to the diet every day may help.
Teach your child not to wait to have a bowel movement. They should go when they feel the urge. For some children it’s useful to have them sit on the toilet for about 10 minutes a day around the same time every day. Make sure your child’s feet are firmly on the floor or a stool. Parents may want to sit with younger children and read a book while you wait for results. This should be a low stress time for the child. If the child makes a bowel movement, you can give a reward (verbal praise, sticker or star chart), but if not don’t make a big deal of it. Just remind the child that "poop wants to go in the toilet and the child can help it get there" whenever they feel the urge to go.
Sometimes medications are useful, but you should talk to your doctor to get the best treatment for your child’s age and degree of constipation. You should also involve your doctor if constipation keeps coming back because in rare cases it can be a symptom of a more serious medical problem.
Dr. Lisa Thornton, a mother of three, is director of pediatric rehabilitation at Schwab Rehabilitation Hospital and LaRabida Children’s Hospital. She also is assistant professor of pediatrics at the University of Chicago. E-mail her at firstname.lastname@example.org.