You may find yourself reading this title and having to double check that this was written by an RD not an MD. Alas, yes this is your Pediatric Essence RD-approved message. Pooping, while it makes many people uncomfortable to talk about, this is a question that we talk about multiple times a day and at every session. A preceptor of mine back in my dietetic internship days told me a dietitian proverb, “Food goes in, and poop comes out.” Simple it may seem, but any issues in this process and you may find yourself in need of a doctor and dietitian!
I have seen many parents accompanying their child with a chief complaint of constipation. If you take your child to the gastroenterologist with this complaint they will tell you that there is no data to support the first line approach of increasing fiber intake and fluids for functional constipation in children. This statement is unfortunately true, but only because there is limited or low quality data to support increasing fiber and fluid to improve bowel function. There is also limited data actually analyzing the amount of fiber which children are consuming in their daily diet (which from my clinical experience is far below the dietary recommended intake). What we see in literature is not always what we see in practice. Every child is different. I have seen twins who eat a similar diet and one poops daily and pain free without any medication, and the other requires MiraLax to go regularly and if not will have a painful potty time. Children who are “carbitarians” and those who could give Bugs Bunny a run for his money on snacking on veggies, yet still require MiraLax.
Many times families will come to me stating that they don’t want their child to be dependent on MiraLax to poop (which isn’t a thing) and that the doctors are ‘medicalizing’ their child. As a result, the child is getting a fraction of the prescribed amount of laxative from the physician. I then come to find out that their child is in pain, withholding, possibly bleeding and traumatized by the mere thought of having to potty. Parents want to fix the problem with diet. While this problem may be helped with diet, if the constipation is so chronic and severe, diet alone will not fix the problem, but cause more trauma to the child if not tackled from various approaches. Remember your pediatrician and dietitian wants to inflict the least harm. Laxatives do work. Diet can help, but not immediately and sometimes not completely. High amounts of prune juice will not dislodge a large stool that is stretching a rectum. It may however cause some gas, bloating and discomfort (thanks sorbitol and fructans). Dietary changes in a constipated toddler can be quite a challenge with a selective eater, and will take patience. We want to help your child reach a healthy bowel pattern, but getting there may take several months and require a stepwise approach. Working with a team including your pediatrician or GI and dietitian is key to help ensure the food that is going in is painlessly going out!