Toddler Constipation: Causes and Solutions for Parents

Toddler constipation resistance?

My daughter is almost 4 years old and has been experiencing bowel issues for the past year.
I'm unsure if it was due to improper guidance during toilet training or if previous constipation caused anal fissures.
Now, she holds her bowel movements for at least 4 to 8 days, and we often have to use suppositories for her to have a bowel movement (we have seen a pediatrician at Mackay Memorial Hospital several times and have tried laxatives, stool softeners, and suppositories), but her condition has not improved.
Recently, she has been crying for no apparent reason, such as wanting to take a bath in the middle of a meal or feeling very sleepy and wanting to go to bed.
When asked if she feels discomfort in her stomach or doesn't want to have a bowel movement, she cries and says no.
After being questioned sternly by her father for a long time, she finally admits that her stomach is bothering her, but then she gets scolded for lying and being a "bad child." I would like to ask: 1) Can a 3 to 4-year-old child clearly identify their discomfort and lie to avoid having a bowel movement? 2) Since her gastrointestinal system seems normal after pediatric evaluations, is psychological treatment necessary?

Xiao Gongzhu de Ma, 30~39 year old female. Ask Date: 2017/02/15

Dr. Xiao Kaiwen reply Pediatrics

For children aged 3 to 4 years, it can be challenging to provide precise descriptions of their symptoms, so close observation by parents and examination by a pediatrician are essential.
Parents should guide their children using encouragement rather than reprimands or intimidation.
For instance, offering a reward that the child likes when they express themselves correctly (while ensuring that the expression is accurate) can be effective.
It is important to clearly explain to the child how to articulate their discomfort, as this will impact their future health.
Using reprimands may have the opposite effect, making the child less likely to communicate their true feelings.
Therefore, parents should first change their teaching approach and not immediately resort to considering psychological therapy.

Reply Date: 2017/02/15

More Info

Constipation in toddlers can be a challenging issue for both children and their parents. Your daughter's situation, where she experiences significant discomfort and has developed a pattern of infrequent bowel movements, is not uncommon. Let's explore the potential causes and solutions for this problem, as well as address your specific questions.

Understanding Toddler Constipation
1. Causes of Constipation:
- Dietary Factors: A diet low in fiber and fluids can lead to constipation. Ensure that your daughter is consuming enough fruits, vegetables, and whole grains, as these foods help to soften the stool.

- Psychological Factors: Children may develop a fear of using the toilet, especially if they have experienced pain during previous bowel movements (e.g., anal fissures). This fear can lead to withholding stool, which exacerbates constipation.

- Changes in Routine: Transitions, such as starting preschool or changes in caregivers, can affect a child's bowel habits. Stress or anxiety related to these changes can also contribute to constipation.

2. Signs of Constipation:
- Infrequent bowel movements (more than three days without a bowel movement).

- Hard, dry stools that may cause pain during passage.

- Behavioral changes, such as crying or refusing to eat, which may indicate discomfort.

Addressing Your Questions
1. Can a 3-4 Year Old Accurately Identify Discomfort?:
- At this age, children are still developing their ability to articulate feelings and discomfort. While they may not fully understand or express that they are experiencing pain related to constipation, they can indicate discomfort in other ways, such as crying or refusing to eat. It’s possible that your daughter is avoiding bowel movements due to fear of pain, which can manifest as behavioral issues or emotional distress.

2. Is Psychological Treatment Necessary?:
- Given that your daughter has been experiencing ongoing constipation despite medical interventions, it may be beneficial to consider a multidisciplinary approach. While her gastrointestinal health appears normal, the psychological aspect of her condition should not be overlooked. Consulting a pediatric psychologist or therapist who specializes in childhood behavioral issues may help address any fears or anxieties she has about bowel movements. They can provide strategies to help her feel more comfortable and confident in using the toilet.

Solutions and Recommendations
1. Dietary Adjustments:
- Increase fiber intake by incorporating fruits (like pears, apples, and berries), vegetables (such as broccoli and carrots), and whole grains (like oatmeal and whole-grain bread) into her diet.

- Ensure she is drinking plenty of fluids, particularly water, to help soften her stool.

2. Establish a Routine:
- Encourage a regular toilet routine, such as sitting on the toilet after meals. This can help her associate mealtime with bowel movements.

- Make the bathroom a comfortable and inviting space. Consider using a stool to help her reach the toilet and feel secure.

3. Positive Reinforcement:
- Use positive reinforcement to encourage her to use the toilet. Praise her for any attempts to sit on the toilet, even if she does not have a bowel movement.

- Avoid negative language or punishment related to her bowel habits, as this can increase anxiety and worsen the situation.

4. Consultation with Specialists:
- If constipation persists, consider seeking a referral to a pediatric gastroenterologist for further evaluation.

- A pediatric psychologist can help address any emotional or behavioral issues related to her bowel movements.

5. Medication:
- Continue to follow your pediatrician's advice regarding the use of laxatives or stool softeners. It may take time to find the right balance of medication and dietary changes to resolve her constipation.

Conclusion
Constipation in toddlers can be complex, involving both physical and emotional components. By addressing dietary habits, establishing a routine, and considering psychological support, you can help your daughter navigate this challenging issue. Remember to maintain open communication with her healthcare providers and seek their guidance as needed. Your proactive approach will be instrumental in helping her achieve regular and comfortable bowel movements.

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