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
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
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
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.