Last year I posted an article on constipation relief in kids, and was very surprised at the response. So many more of you are dealing with constipation problems than I had realized. As I mentioned the first time around, I often support these issues with kids that I’m treating, but this isn’t my area of expertise. However, since I have been dealing with chronic constipation in children, personally, with my son for years now I have learned A LOT more about managing it.
If you haven’t read the previous post: Natural Remedies for Constipation in Children, you’ve got to check that out too, as their are addtional and valuable tips there. If you did read it then you know, that we, like many families, were using Miralax on a regular basis for several years. It is still shocking for me to admit that. Some things have changed in the past year and I wanted to give an update, as well as share a surprising revelation I had about this whole ordeal in case you are like me and still struggling to find a solution. (This post contains affiliate links.)
Let me recap and fill you in on what has been going on in the last year. At the time of last post we had basically omitted Miralax and we doing fairly well without it, but it was an extremely difficult balance and despite our best efforts it was still a source of stress for me. In fact, my son had more fiber in his diet than most adults I knew, yet the problem persisted. Something kept nagging me that there was something else going on.
Being the over analyzer I am, I kept running through his whole situation and ways I knew to improve it. For instance, I knew that eliminating milk didn’t have an effect and that drinking enough water every day helped, but didn’t seem to be enough. Of course, I revisit this topic at the pediatrician every time we have a check up, and there doesn’t seem to be any major medical issue. Actually, I learned at our last check up that pediatricians are talking about poop- or the lack thereof- a lot, with parents. Mine told me it was single handed the most discussed issue.
Somehow we had actually gotten to a place where Sam was only going once a week. It wasn’t a tremendous ordeal- although it was massive and seemed totally unnatural to me. The doctor assured me this was okay, and against my instincts I allowed it to continue (not to blame her, he wasn’t in crisis and I did have the option to use Miralax). A few days into the new year this whole episode reached its tipping point when we had a nasty little virus going around and around our home and Sam didn’t end up going for 13 days! This was an ordeal. I’m ashamed to admit that I didn’t realize until about 9-10 days as we were dealing with everyone being sick and a lot of other issues about taking medicine- that would be my other child that has difficulty with certain food textures AND medicine, a tale for another day.
Naturally, once I noticed he hadn’t gone in quite some time I started Miralax, lots of water, and really high fiber foods. Still no poop. Then, he was starting to complain of a belly ache. On the last day he actually ended up getting a fever from the toxic poop stuck inside of him and my husband was at the store buying suppositories when he finally had a massive poop that left him crying and yelling in pain- I’m leaving out many of the grizzly details.
In hindsight I should have gone to the suppositories sooner, but at the time I thought it would be really traumatizing to him and that he was going to go any minute. He had to right? I had called the doctor shortly before he finally pooped and we were only a few hours away from having to go to the ER for help removing it. I was shaken and knew beyond a doubt that I needed to find some other solutions. On a side note, Tylenol and Motrin are both constipating, Sam had taken a lot of these while he was sick with several high fevers. I believe this helped to exacerbate the situation!
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The Revelation: Causes of Chronic Constipation in Children
A few days later my prayers were answered, literally, when I came across the book, Cure Your Child with Food
. The book is filled with solutions to many childhoods ailments including constipation. I couldn’t read that chapter fast enough. I was relieved, validated, and mortified all at the same time when the author drove home the point that having a bowel movement once a week was NOT under any circumstances normal.
As I was reading, Kelly Dorfman, the author sited several of the typical reasons kids often suffer from constipation (and that I discussed in the previous post):
- Dairy intolerance or sensitivity
- Low fiber diet
- With-holding
As I mentioned before, I had clearly ruled all of these causes out, but then I came to the last reason and all of the stars aligned, bells rang, insert appropriate cliche, and I finally had an answer: Sam was low tone. I can’t believe I had missed it, albeit subtle low tone, but, nonetheless, I am an OT, I know all about muscle tone. And, that meant too much fiber was constipating for him, the opposite of what we expect.
What is Low Tone?
How to Start Relieving Chronic Constipation in Children
daily. I haven’t started the L-carnitine yet, as we are trying a few other ideas first, and if we go that route I would like to consult a specialist. Kelly discusses this in more detail, of course. By the way, I am endorsing her book on my own volition, this isn’t a paid sponsorship.Since our episode, now 8 weeks ago, we have occasionally used Miralax as we are trying to get back on track. I refuse to let him go once a week and four days is the absolute tops- for now. Currently we are about every other day and I haven’t used Miralax in two weeks. The long term goal is to poop everyday.Another important factor is that when kids have these really large movements their little colon gets stretched and they don’t have the urge to poop again until the colon is that full. Oh, this is such a terrible cycle, and hence why I’m willing to rely on the Miralax a little again so that his colon can regain its appropriate shape. Here’s a very helpful video from Chicago’s pediatric hospital that explains constipation, soiling, and stretching of the colon.
Tummy Rub for Constipation (aka: Poop Massage)
I’m using a poop massage (yes, you heard me right) a couple times a week to help improve bowel motility for Sam, as well. New research has actually shown that a regular weekly poop massage is likely to cut out the use of Miralax totally- no matter what the cause of constipation is. My mother is a massage therapist and while she is especially skilled at giving a poop massage (I’ve seen her get a baby to poop in 2 minutes) anyone can learn how to do it with a little practice. Here is a simple picture tutorial:
1. This is the overall direction that you will massaging in, as you move through the outline of the colon or large intestine. You will start your massage on the child’s lower left side just in from where you fell their hip bone.
***Please note that there is another method for completing this massage, starting on the other side of the colon. Either way is effective, although many massage classes only teach one. This method is taught and used by licensed massage therapists.***
4. Once you moved your way all the way up, across, and down the right side you can do some gentle but slightly firm sweeping motions with your hands from the top of their belly to the bottom.
6. Lastly, take their knees and push them up towards their belly on their right side and make a circular motion across their abdomen and back down. Now, you are tracing the colon in the other direction.
7. Ideally the entire massage should last at least ten minutes. You can repeat these steps several times over. Although this massage can be helpful in emergency situations, studies show that routine massage has the best outcome. Aim for at least once a week.
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The Plan for Chronic Constipation in My Child
- Daily Probiotic
- Cut out excessive fiber products
- Weekly poop massage
- Strengthen core muscles (I use these fun exercise printables for kids that make it really easy to follow through with).
I also continue to encourage water consumption of half his body weight in ounces (i.e.: he weighs 45 pounds so he is encouraged to drink 22-23 ounces of water daily.) However, more fiber needs more water or it can constipate even a child that isn’t low tone.
Updates for Kids with Chronic Constipation
1. I listed bananas as constipating. Since then I have read from several reputable resources that if the many has some brown spots on it and is ripe then it can help constipation. Un-ripe or hard bananas are very constipating.2. I have tried Heather’s Tummy Fiber 
for over 6 months and since fiber isn’t our issue and perhaps making the problem worse we are weaning off of it. I think there is value in this product, but it takes time to build up how much your child can take or it can cause cramping. It also needs to be drank in a large cup of water so it can be a pain trying to get a young child to drink that much at one time every day.
3. At the end of the last post I asked for suggestions for other strategies and products, and you guys delivered. I’m very appreciative for the many helpful ideas. Make sure you scroll all the way through to see all of the comments listed. Of course, I would like you to do the same here.
More Help for Chronic Constipation in Children
High Fiber Pumpkin Sweet Potato Bread Perfect for Kids
Healthy Snacks for Picky Eaters
How Much Milk Does Your Toddler Need to Drink?
The Best Position for Your Child During Mealtime
Did You Pin This?
Alisha Grogan is a licensed occupational therapist and founder of Your Kid’s Table. She has over 14 years experience with expertise in sensory processing and feeding development in babies, toddlers, and children. Alisha also has 3 boys of her own at home. Learn more about her here.
I’m a massage therapist and you want to massage with the flow not against it. The arrows on that picture should be the opposite way this is my opinion but do your research
Yes as a retired Massage Therapist I too noticed that the arrows show going against the flow but the wordage was right. Know, that the Poop exits on the left side of the body so start there, gentle and work up inch by inch backwards and then down, go up a few inches and down until you work the whole way up and across the Descending Colon and back down the right side, imagine you are breaking up the clog low in the abdomen first inching backwards to the top and then backwards to the opposite side. After doing this a few times you can do full relaxing big circles. Never push too hard.
Thank you for sharing this with all of us, I have one question? I believe my granddaughter has low tone by every description your son went thru, I read in a post that kids need 19-25 grams of fiber. If they have low tone is that the same amount they need? Since you mentioned too much fiber was backing your son up. Thank you
Hi Anna! Yes, same amount. We simply cut back on fiber. I’m not buying super high fiber bread or high fiber products. He is still having fiber, but a normal amount. Hope that helps!
I read that most of the time you need a prebiotic to get the full benefits of a probiotic. Do you endorse this and recommend anything?
Alisha is wonderful.
My neighbor and I read on here often. I let her comment on here using my name — Joan.
We love this blog.
Commented other day about Alisha telling her student gives the enema to her boy. Alisha comment was March 2017? Sorry forgot the date.
Glad you put the tummy massage on.
When is best time to give the tummy massage?
Before giving a detox bath or after it?
Also, since we both give the enema when needed, best to give the tummy massage before or after he gets the enema?
Blessings and hugs
Funny that a really soft banana produces soft stool and a hard banana helps harden stool.. and meanwhile a banana literally looks like stool. Too funny. God works in not so mysterious ways sometimes!
Hey Lisa!
Great to hear from you. That’s absolutely a great way to remember it 🙂
Best,
Andrea
The massage image direction is incorrect. The colon will become backed up if massaged against its rhythm.
Massage from right to left, in the direction the stools need to move to be evacuated
Thanks for your feedback. In our article we do note that it can be completed either direction. Typically it is only taught in one direction. However, Licensed massage therapists are taught in this direction as well.
How do you know if your child is getting too much fiber? Our 4 year old is currently gluten/dairy/egg free and consumes a significant amount of fruit. Could she be getting too much fiber from fruit? Is there a guide on the appropriate amount of fiber by size/age?
Hi I am really interested in the free exercise printable for core exercises to help with low tone and the link is not working. If you could re post the link, I would really appreciate it. Thank you!
Hey Deanna!
The link should be working now! You can check out the printables HERE.
Best,
Andrea
I really like your site and have gotten lots of useful ideas to help with my child’s constipation issues. Also lots of good, healthy snack and veggie ideas – thank you!
I just have to bring up the fact that ALL the other sites I read say to start massage on the child’s right side and go in clockwise direction which makes sense to me but from what I can tell is directly opposite to what you have pictured here. Am I missing something or should there be a correction?
Hey Cindy,
Thanks for reaching out! There is a note in the article that there is another method to start on the other side. Either is effective, but many massage classes only teach just one. The method shown is utilized by licensed massage therapists!
Hope that helps!
Best,
Desiree
Can you please tell me how you give your son the Probiotic capsule? Do you open it up and put it into yogurt? My daughter is almost 4 and cannot take a capsule. Thank you.
Hey Stacey,
Yes, you can feel free to open it and put it into any food that works for you! There are also other version of probiotics that are chewable if you’d want to go that route as well!
Best,
Desiree
I don’t see how I can post my suggestion. But my mommy Facebook group suggested spirulina in Apple juice with lemon. My child didn’t like it. So I just put it in a Naked Juice and it was fine. They also suggested vitamin C. Which I researched and Google said it helps. So hopefully that helps someone. We are still trying it. I do know the spirulina works because I was using it myself before ever knowing that it helps with constipation. I can keep posted and come back within a week.
Read quite a lot about constipation as my daughter with DS struggles a lot. Your article is one of the first that give me hope and a more natural alternative. Thank you so so much. By the way Im from South Africa.
YAY! So happy that you are feeling hopeful and that you found our article. We wish you the best 🙂
Best,
Desiree
Hi, this is a great article, my son sounds a lot like your son Sam 🙂 with the low tone, constipation etc. Are the probiotics you linked the ones you have found to work best? My son is 4 just wanted to make sure they’re OK for his age, etc. I’m going to try your ideas I was about to make a GI doctor appointment but my friend said they’d just push miralax on us and I’m not really a fan of that route. LMK thoughts. Thank you so much
Hey Meryl, So sorry you are dealing with this!! This is the probiotic that Alisha has used. As far as age, I’d check with the company. Keep us posted on what is working for you!
Best,
Desiree
Hi, my daughter is 4 years old and she withholds or bowels. She has vomited a few times because of it which then also forces her to poop. I’m like 102% positive this not normal 😅
She eats and drinks fine so I don’t think that is the problem. She is just stubborn.
I do belly massages and the bicycle motions too. It’s hard not to get frustrated because she will tell you she has to poop but then she will, I guess let the feeling pass and hold it in.
I don’t know what to do anymore. This is my second child and the first time dealing with this. Please help, any advice from anyone would be greatly appreciated.🙏
Side note: I bought Activa yogurts but I don’t know much about probiotics and young kids so I haven’t given her any.
Hi Thea! Thanks for reaching out! It sounds like she may have some sensory sensitivities. Sometimes, kids that struggle with sensory, have a hard time listening to the signals our body sends us about certain things, like going to the bathroom. We have a blog post about this. Check it out here, and then let us know if you have any questions!
Best,
Kalyn