Constipation in Toddlers: Causes and Solutions

Bowel issues

My daughter is 1 year and 11 months old and has been training herself to use the toilet.
Recently, she has been having bowel movements only about every two days, with the initial stools being hard and pellet-like, followed by diarrhea.
She cries in pain every time she needs to poop.
I have been giving her more fruits and vegetables and encouraging her to drink more water, but there hasn't been much improvement.
Currently, she is drinking S-26 Gold formula, about 200cc around 10 AM, having a regular meal around noon, taking a nap, eating fruit in the afternoon, having another meal in the evening, and then 200cc before bed, with intermittent water intake throughout the day.
She also gets to run around outside.
What could be the cause of her constipation? Is the slight swelling she has possibly related to the constipation? I have been applying petroleum jelly and feeding her more fruits.

Alex, 30~39 year old female. Ask Date: 2020/07/13

Dr. Xiao Kaiwen reply Pediatrics

Younger children have not yet developed strong muscles for bowel movements, making it more difficult for them to defecate compared to adults.
To improve constipation, it is essential to enhance dietary and bowel habits.
Dietary improvements include: increasing the intake of fiber-rich foods such as fruits and vegetables, ensuring adequate hydration, consuming healthy fats to lubricate the intestinal walls, and eating brown rice to supplement vitamin B and improve the gut microbiota.
Probiotics can also be beneficial, and sometimes black date juice available in the market can help.

To improve bowel habits: respond to the urge to defecate promptly without holding it in, establish a regular schedule for bowel movements, spend sufficient time in the toilet, and avoid leaving before fully evacuating the bowels.

Reply Date: 2020/07/13

More Info

Understanding constipation in toddlers can be quite challenging for parents, especially when it involves a young child who is just beginning to learn about toilet training. Constipation in toddlers is a common issue and can be caused by a variety of factors. In your case, it seems that your daughter is experiencing hard stools followed by diarrhea, which can be indicative of a condition known as "overflow diarrhea." This occurs when hard stools build up in the rectum, and liquid stool leaks around the blockage, leading to the appearance of diarrhea.

Causes of Constipation in Toddlers
1. Dietary Factors: One of the most common causes of constipation in toddlers is a diet low in fiber. While you mentioned that you are providing fruits and vegetables, it's essential to ensure that these are high-fiber options. Foods like apples, pears, prunes, and whole grains can help promote regular bowel movements. Additionally, excessive consumption of dairy products can sometimes contribute to constipation.

2. Fluid Intake: Adequate hydration is crucial for preventing constipation. While you are providing water and milk, ensure that your daughter is drinking enough fluids throughout the day. Sometimes, toddlers may not drink enough water, especially if they are consuming a lot of milk.

3. Toilet Training: The process of toilet training can sometimes lead to constipation. Children may hold in their stools due to fear or discomfort associated with using the toilet, which can lead to a cycle of constipation. It's important to create a positive and stress-free environment around toilet training.

4. Physical Activity: Regular physical activity can help stimulate bowel movements. It sounds like your daughter is active, which is great. Encouraging her to engage in more physical play can be beneficial.

5. Medical Conditions: While less common, certain medical conditions can lead to constipation. If your daughter is experiencing significant discomfort, it may be worth consulting a pediatrician to rule out any underlying issues.

Solutions and Recommendations
1. Increase Fiber Intake: Focus on incorporating more high-fiber foods into her diet. Foods such as whole grain bread, oatmeal, beans, and a variety of fruits and vegetables can help.

2. Hydration: Ensure she is drinking enough fluids. Aim for water as the primary source of hydration, and consider limiting juice intake, as it can sometimes lead to diarrhea if consumed in excess.

3. Regular Bathroom Routine: Encourage her to sit on the toilet for a few minutes at the same time each day, especially after meals. This can help establish a routine and reduce the fear associated with bowel movements.

4. Gentle Laxatives: If dietary changes and increased fluid intake do not help, consult your pediatrician about the possibility of using a gentle laxative or stool softener. Products like polyethylene glycol (MiraLAX) are often recommended for children.

5. Monitor for Signs of Discomfort: Keep an eye on her symptoms. If she continues to experience pain, or if you notice any signs of dehydration or significant abdominal swelling, seek medical advice promptly.

6. Vaseline Application: While applying Vaseline can help with discomfort during bowel movements, it is not a long-term solution for constipation. Focus on dietary and lifestyle changes for more effective management.

Conclusion
Constipation in toddlers can often be managed effectively with dietary adjustments, increased fluid intake, and establishing a regular bathroom routine. However, if symptoms persist or worsen, it is crucial to consult with a healthcare professional to explore further options and ensure there are no underlying medical issues. Your proactive approach in addressing her diet and hydration is commendable, and with some adjustments, you should see improvement in her bowel habits.

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