Help my toddler's constipation
May 23, 2012 6:10 PM   Subscribe

Our daughter frequently suffers from constipation. It's her two year doctor visit in a couple of days. Looking for anecdotes and experiences from anyone with a toddler with a similar history that we can raise with the doctor.

Pretty much since we switched to cow's milk at one year old our daughter has had constipation. We manage it by making sure she has enough fiber and, at the doctor's recommendation, giving her Miralax. We've never liked her being on Miralax since we know it can be habit forming but she's taking it daily.

We switched her to goat's milk a few months ago. That didn't seem to have a discernible effect. She's been to an allergy specialist and we know that she has an allergy to eggs (skin reaction mainly) and possibly to peanuts. No mention of dairy or gluten.

We desperately want to end the Miralax although the doctor has o reservations continuing it. Would like to hear of any anecdata where toddler constipation issues have been resolved that we could discuss with the doctor during the visit.
posted by NailsTheCat to Health & Fitness (37 answers total)
My wife had const issues all her life until she gave up wheat. Fiber just made it worse.
posted by rr at 6:16 PM on May 23, 2012 [2 favorites]

Our son's constipation problems were finally solved with bran muffins, as many as he'd like to eat for breakfast or a snack. We kept asking our doctor about it, but he kept saying, "I'm not a fan of medication-type things, so if you find some food that seems to help, do that."

Good luck. I know it's frustrating to see the poor child in such a situation.
posted by circular at 6:17 PM on May 23, 2012

My first child was chronically constipated. I gave her a prune juice/apple juice/water cocktail twice a day. Not good for her to have the sugar but I felt at the time that her stomach was a higher priority than her teeth. She eventually out grew it mostly. I still give her this combo when she has trouble, she is four now, seems to work for her.
posted by supercapitalist at 6:18 PM on May 23, 2012 [2 favorites]

Could she be lactose intolerant, and not allergic to milk?
posted by epanalepsis at 6:19 PM on May 23, 2012 [1 favorite]

Why feed her any milk at all? There are other ways to get calcium. Try taking her off it entirely.
posted by emjaybee at 6:22 PM on May 23, 2012 [5 favorites]

Could she be lactose intolerant, and not allergic to milk?

I'm lactose intolerant. Trust me, it does NOT cause constipation.
posted by Lobster Garden at 6:24 PM on May 23, 2012 [2 favorites]

Are you by any chance potty training? Anxiety can make lots of kids tense up and hold it all in.

We had best results by offering dried fruit (mostly raisins; yogurt-covered ones if she doesn't go for the plain ones, or you could dip dried apricots in chocolate and eat them with her). I had sippy cups of water in easy reach in most of the rooms -- kids that age often misunderstand thirst cues, so seeing the cup helps.
posted by mdiskin at 6:33 PM on May 23, 2012

We did the prune juice as well, worked wonders!
posted by pink candy floss at 6:38 PM on May 23, 2012 [1 favorite]

Children can get enlarged colons due to constipation, which then cause further (and worse) constipation. Does your child have very large stools compared to their size?

more on faecal impaction and constipation

/my sister-in-law is a paediatrician and a young relative had an enlarged colon leading to constipation
posted by jb at 6:39 PM on May 23, 2012 [1 favorite]

My little brother (if you ever read this, bro, I apologize for telling the internet about your butt) had constant constipation issues as a toddler. He had a lot of toilet anxiety (we don't know why), and getting him to poop was always a battle. He'd flat-out refuse to go, and then once the time came that he needed to, he couldn't. Our "solution" was lots of prune juice and baby food pureed prunes (which go down a lot easier than the juice). Eventually, he grew out of his butt anxiety and, incidentally, the constipation.

Long story short, seconding mdiskin that this may not be food-related at all.
posted by phunniemee at 6:44 PM on May 23, 2012

Prune juice.
posted by St. Alia of the Bunnies at 6:49 PM on May 23, 2012

My daughter is in a similar situation, and has been even when she was on formula. We tried almond milk and hemp milk, neither really worked. Oranges help a little. For us, prune juice really didn't work either. We're still looking for solutions.

As a kid (and really to this day) I've had issues with this too and I rum at the sight of prune juice because my grandma was always forcing that horrid concoction on me.
posted by drezdn at 7:02 PM on May 23, 2012

I'm drezdn's wife. Here's a list of other things we've tried with our daughter:

coconut milk
prunes (she hates prune juice, but will eat prunes - go figure)
absurdly high-fiber diet...lots of whole grains, raw fruits and veggies

None of it worked, but our daughter was extremely constipated, to the point that I'd occasionally have to give her a suppository to end her misery. That is a hell I never want us to go through again.

We have not even broached potty training, so I know it's not that. She will proudly tell us when she's peed or pooped.

Miralax + high fiber/prune diet has helped, but not solved it. Perhaps some of the things we've tried for our daughter will work for your kiddo.
posted by christinetheslp at 7:14 PM on May 23, 2012

My son went through a terrible phase of constipation when he was four (unrelated to toilet training; he really wanted to poop but just couldn't). We had great luck with Fletcher's Laxative for KidsFletcher's Laxative for Kids and upping his water intake.
posted by Sweetie Darling at 7:14 PM on May 23, 2012 [1 favorite]

(My kingdom for an edit button, sorry to bork that)
posted by Sweetie Darling at 7:16 PM on May 23, 2012

This is a topic that's near and dear to my heart. Constipation runs in the family over here, and both of my kids began suffering with it from the moment they went off breast milk.

Here's the thing: what many well-meaning people don't understand is that the prune juice solution only works for mild constipation. Some kids just have a whole other level of constipation that needs a better solution.

We tried all the remedies: karo syrup, mineral oil, prune juice, lactulose. Of course, all of these were also combined with high fibre diets and lots of fluids. Both kids were seen by a pediatric gastroenterologist to rule out any physical/mechanical problems. By this time I'd given more suppositories and enemas than I care to remember. Finally we were prescribed miralax. It is the one thing that worked and we have stuck with it.

Importantly, however: we've gradually reduced the amount over the years. The kids (now 7 and 9) are still on a tiny dose (1/8 tsp about every other day). They are old enough now that they understand the correlation between their diet and their poop issues, so the need for miralax is greatly decreased (i.e. they WILL eat their veggies or drink extra water because they know they need to). I envision that as teens they will be off of miralax entirely if they can control their diet appropriately. Right now though, that tiny dose is still necessary for them. So: try not to feel too bad about using miralax if you have to. Know that you CAN reduce the dose over time.

Good luck, I know how horrible it is to see your child suffer and feel totally helpless about it. Feel free to memail me if I can help.
posted by yawper at 7:20 PM on May 23, 2012

A magnesium citrate supplement helps our 3 year old immensely.
posted by lizifer at 7:41 PM on May 23, 2012 [1 favorite]

2nding yawper - some of us have kids who really need that extra help

I actually wish we'd started the Miralax a lot earlier. We got to Miralax after going to the local children's hospital to see specialists and ruled out a variety of other issues, which took awhile. As a result of pain/constipation, DS ended up having a lot of issues around toileting (still does, to some extent). We started off w/prune juice etc., and in the end I feel badly that we didn't handle the issue effectively much earlier, because it led to a lot of behavioral issues and family stress. We've adjusted/reduced his dose over time, but we're staying on it for now.
posted by hms71 at 7:47 PM on May 23, 2012 [1 favorite]

We've had great (I mean GREAT) success with fiber gummies.
posted by Sassyfras at 7:49 PM on May 23, 2012 [2 favorites]

We did the miralax for our daughter at first. Then someone turned us on to Kefir. Stuff is miraculous.
posted by striker at 8:14 PM on May 23, 2012

A terrific variety of answers--all very appreciated and even better than expected. Some more background:

- Prunes: she consumes prunes in all their forms (juice, pouches and whole in their sticky goodness).

- No, we're not potty training. And this has been ongoing since she was one.

- I'm certainly weighing up giving up milk but only if I can find sufficient calcium, vitamin D etc. substitutes and only with the doctor's buy-in. I was considering splitting her daily milk consumption over almond / cow / another.

Interesting to see the success of Miralax. Frustrating that it doesn't give us much hope of weaning of it much I feel less worrisome.

And I'll definitely discuss the fiber gummies and Fletcher's.

Thank you so much hive mind. (Answers still welcomed.)
posted by NailsTheCat at 8:31 PM on May 23, 2012

My now 3 year old son has this issue too. We use Miralax if it gets serious, but our ped doesn't want us to rely on it, and definitely not use it every day. We limit our son to 1 cup of cow's milk a day, and he is able to tolerate this. The rest of the time he has almond milk or water, and the occasional juice as a treat, or when he is mildly constipated.

Our ped suggests rotating through all the various non-dairy milks to avoid concerns about hormonal imbalances from excess soy (I don't think we are certain this is true, but why take the risk). However my son hates soy milk, doesn't really like coconut milk, but enjoys almond milk, so almond milk it is. I should probably also try hemp milk.

As for vitamin D and calcium, he eats cheese and yogurt, and takes a vitamin supplement. I am not personally concerned about his diet on this front. If you are really concerned, then try making her a smoothie with some hidden veggies like kale, and ensure she plays outdoors for a few minutes each day (but I think that would be super paranoid unless you live very far north).
posted by Joh at 9:47 PM on May 23, 2012

My daughter and I both have Celiac Disease and the constipation that goes along with it.

Even on the gluten free diet I still had issues. Until I bought an insulated cup with a straw. I don't know what it is about that stupid cup, but I drink a ton more water than I used to. Suddenly, it's a whole lot easier to go.

When I pressure my daughter to drink more water she also has an easier time in the bathroom.

The obvious downside to all this water consumption is that we're visiting the bathroom a lot more, but it's really been worth it. It seems like a simple answer, but for me the normal 8-10 glasses of water a day just aren't enough. I have to basically be drinking constantly. When I do that things "flow" a lot smoother. Days I don't get enough water I'm back to the same old problem. (Well, actually the next day. You know what I meant though!)
posted by TooFewShoes at 12:42 AM on May 24, 2012

If you can consider old age as a second childhood my grandmother is on a low weight PEG as a mild constant laxative. It works wonders for her and would work by holding on to water as it passes through the intestines unchanged. She has a teaspoon in orange juice daily (it dissolves instantly and is tasteless) and it works wonders according to her. She is 96 instead of 2 but I would think that constipation is constipation and especially via the mechanism of how this works it should work for a child as well.

Again IANAD, but IAAMC (I Am A Medicinal Chemist) so I tend to know how things work and not the rules for prescribing them.
posted by koolkat at 1:33 AM on May 24, 2012

[tried on self, not child] Goat cheese can do remarkable things here. Easy to get chevre into a tot's diet; it can be stirred into hot food, spread on crackers, put in sandwiches, salads, pizzas. I scoffed at the idea initially (suggested to me by a midwife, during pregnancy) but. Wow.
posted by kmennie at 3:58 AM on May 24, 2012 [1 favorite]

Hi! Let me save you from the years of trouble I went through!

Lactose intolerance, lactose intolerance, lactose intolerance. It can ABSOLUTELY cause constipation in the very young. From what I vaguely recall, it has to do with the symptoms of diarrhea caused by the intolerance being unpleasant and so they clench up and then problems are caused and then a blockage happens and it's hard to get things around it. I can't remember the specifics, but by god, it is intensely likely lactose intolerance is possible.

Switch to Lactaid milk and see if that helps anything. Or memail me for exhaustive stories!
posted by corb at 5:01 AM on May 24, 2012

My kid's issues were due to autism-based retention/potty issues. A nice changeup from the prune juice: apricot nectar, per our pediatrician. Worked just as well. Lots of sugar, but if you're trying not to overdo any particular food, this is a viable prune-juice alternative.
posted by theplotchickens at 5:03 AM on May 24, 2012

30 days of no milk and Miralax made wonders for my son. It was about 5 years ago and he hasn't have any problems at all after that. He was not a toddler, he was 7 or 8...
posted by 3dd at 5:45 AM on May 24, 2012

if you don't know how to get off milk, I'd suggest not substituting a different milk but going for milk products that have been well digested by friendly bacteria -- yogurt, most notably, but also hard cheese, sour cream, etc.

you might wait a while before doing anything more radical, but the suggestion about wheat does resonate with me -- lots of people with constipation and other digestive issues find that they can get a virtual cure by going grain-free (that includes rice, corn) and/or trying a Paleo diet (where most energy comes from fats rather than starches). it wouldn't be that hard to try that for, say, a month, and lots of people raise their kids on perfectly healthy diets built that way.

good luck. sounds like a bummer.
posted by acm at 7:42 AM on May 24, 2012 [1 favorite]

One other note in my wife's wheat issue - it takes days for her to clear, like a week of religious avoidance of wheat and anything that might be contaminated.

As I said, more fiber just made things worse. It's amazing that even when fiber isn't working the answer is still more fiber. Deeply misplaced faith.
posted by rr at 8:20 AM on May 24, 2012 [1 favorite]

NailstheCat, could you keep us posted on what ends up working for you? My daughter is just a little younger (she'll be two in July) and I'm open to trying new things.
posted by drezdn at 11:15 AM on May 24, 2012 [1 favorite]

drezdn, sure thing. More than happy to update. We see the doctor tomorrow and I'll discuss all of the above.

Forgot to mention that we also use some infant probiotics--they don't seem to have done much either. Kefir sounds interesting too.
posted by NailsTheCat at 11:37 AM on May 24, 2012

I forgot to answer this: Does your child have very large stools compared to their size?

I don't know really. I don't have any yardstick. Most of the time they're bunched up in her diaper so it's difficult to say. A couple of times in the past when she's been constipated I've seen her rectum dilate and yes--it's diameter looks too big. Almost as big as an adult.
posted by NailsTheCat at 11:42 AM on May 24, 2012

I don't know anything about toddler foods, but the only things that help me with this problem are coffee and grapefruit. I'm assuming coffee is a no-no, but someone else mentioned oranges, so maybe it's the citrus component.
posted by stoneandstar at 11:43 AM on May 24, 2012

If you can get her to eat papaya, please add it to your list of foods to try.
posted by tinamonster at 7:46 PM on May 24, 2012

Follow up:

Our doctor had no qualms about our persisting with Miralax. She said that the best approach was managing the constipation, rather than treating it as it arose, because it meant our daughter was a lot more comfortable--and with that I agree. She didn't really have any opinions on other solutions--just Miralax.

However, a couple of days after my original post the NYT published this article: Miralax - A drug for Adults Is Popular as Children’s Remedy. This is somewhat unnerving: a medication that is advised to be used for no longer than a week for adults is being used as a long term remedy for kids. However, it's all we have.

We have also introduced the following into her diet:

* Fish oil each morning. (Although last time I just bought a brand I found at Whole Foods.)
* Pro-biotics

She is still on goat milk, around 24oz a day. I've been slowly holding back on the Miralax, we're down to about 1/8 of a cap twice a day. I don't know whether any of the above is helping or whether it's just as she grows but I'm hoping she'll soon be off it for good. And maybe we'll wean her back onto the cheaper cow milk if we can do that later.

I did buy the fiber gummy worms but my wife thought she was too young so we held off for now.
posted by NailsTheCat at 6:19 PM on September 25, 2012 [1 favorite]

Oh. And another concern our doctor had was that constipation might badly affect our daughter's potty training so we should tackle that first before risking any more constipation.
posted by NailsTheCat at 6:21 PM on September 25, 2012

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