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.
thanks for sharing~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Try to add some brown sugar in the feed. This works well for my child constipation problem. After the feed for a while, he has released the bowel that has held for 3 days ago. I continue feeding him until the next day to make sure that he has fully passed out all the stools that he has held for 3 days.
Constipation remedies are very subjective, it may not be helpful for every single child. If this remedy does not help to ease your child constipation. You need to look for alternative constipation remedies instead of focusing in one remedy. Probiotic is well recommended to ease constipation problem because it’s help in digestion. You may get some probiotic drop for your child and I believe it can help to ease the constipation problem. All the best.
I have followed the guideline of how to give my little one a poop massage. I have tried more than 3 days, yet to see her go for bowel. In the meantime, I have also fed her with some fruit juice. It isn’t helping either. I am desperate to seek for some more effective remedies. She has been suffering these days and crying hard at every morning and night. It’s really heartbreaking to see her crying daily.
I’m so sorry! I know how stressful that is! Right now you are in a bit of a crisis situation and I would call the doctor. They will likely recommend an enema, which will provide safe and quick relief. I would then go back through this post and apply some of the strategies.
The poop massage working great for me though. The remedy will not work, if you did not manage your child’s balance diet and It will not help. When my child constipated, I switched the formula to Mamil. I find that the Mamil contain of prebiotic which is good to prevent digestive discomfort. At the same time I have also applied with this poop massage to treat it as extra help to ease the constipation. After a few minutes, he is able to go for bowel movement and released an explosive poo. After feed him with Mamil, I find that his stools are getting softer and easier to pass it out. I am very happy with the result. Pretty recommend to try it out.
Thank you Alisha for the helpful tips and the massage. First time using this to my boy and it work like a charm to ease my boy constipation problem. After applying the massage for less than one hour hour, he had released her bowls well recommended.
Great tips. Thank you so much.
Hi there! I’m confused with the direction you’ve stated in step 1. Ascending colon starts on lower right. As a licensed massage therapist I’ve been taught to move in a clockwise motion. Work your way up ascending colon, over transverse colon to the right, then down decending colon. Is there something I’m missing with your steps? Thanks in advance!
Thanks for your question… My mom is a licensed massage therapist and she got her training in south carolina. This is the technique they taught her and she has used in her practice with great success over the last 10 years. From what I understand there are different techniques, such as the one your describing. From what she tells me they start on the descending colon because it starts to break up blockage and as you move backwards things will move through easier as it should be softer or the muscles more stimulated. By the end of the massage you do go in the direction you described but you work your way up to that point. Here is a you tube video that demonstrates this technique – I found it while researching for this post, but didn’t end up sharing it because it wasn’t very professional.
https://www.youtube.com/watch?v=42561H962UI
Hope that helps!
My daughter has had similar issues with constipation as well as poor muscle tone. I have found that using the massage technique you decsribed usally works, as well as upping her intake of fresh fruit. I also have started using Doterra DigestZen blend on her tummy while massaging, it seems to take away any pain and she usually has a BM shortly after. I think I will start her on a probiotic too, thanks for your insights!
That’s really helpful, as well, Sasha! Thanks!
This info on constipation really cleared-up some things for me, thank you. I do have a question though. Is there exercises that will help a with low tone?
Funny you mention that I was just looking some up… the Inspired Treehouse is my go to: http://theinspiredtreehouse.com/core-strengthening-activities-for-kids/
Hi Alisha, This is a great article with awesome links! I have been researching low tone to support my practice (I am a holistic nutritionist and I counsel parents whose children suffer from constipation and are going through picky eating stages). While I advise my clients on diet and lifestyle, they also need to work with a pediatric occupational therapist (like you) or physical therapist to strengthen low-tone muscles.
Thank you for this great article. It helped me understand low tone and be able to provide additional help to my clients.
Thanks for the comment Alina, I appreciate it. If you are looking for core strengthening activities this is a great site as well: http://theinspiredtreehouse.com/core-strengthening-activities-for-kids/
Hi, thank you for your post, but I also wanted to ask if your pictures got flipped around because the Massage is pictured the wrong way around. I am a physio therapist so I learned about this type of massage during my studies…the way you pictured it is counter digestion wise. Hope you don’t mind me pointing this out.
Anne is correct. I am also a pediatric PT and our clinic is known for treating pelvic floor dysfunction for constipation, UTIs, incontinence, etc.
The ascending colon is positioned more on the right side of our bodies and the descending colon (that leads the poop to the exit) is more on the left side. So poop massages should be a right to left rainbow pattern (or clockwise from the massager’s perspective, if that makes more sense.)
THanks for posting this, Alisha! Good, accurate information! And I will add that fiber usually is not helpful in cases of chronic constipation, megacolon and large impactions. You are right, if you don’t take fiber with significant amounts of water, it will only bulk up the poop more and do nothing to help kids get the poop out. Most kids are very dehydrated, and increasing water decreases your need for miralax. Your goal for a permanent fix should be to give enough miralax and/or to have 1-3 poops a day, no harder than a mushy banana…as long as it’s not liquid diarrhea that turns the water brown and sounds like pee coming out (ha!), then don’t be concerned if it is “too soft”.
typo* that is supposed to say “enough miralax and/or exlax and WATER to have 1-2 poops a day….
Thanks Wendy for adding your insights and experience, so valuable! The massage is just a different technique, the theory with this massage is that it breaks up the blockage first and at the end you do the swiping motions all in the direction that the poop ultimately moves. I know a lot of practitioners are only trained in the massage you described, which is great too!
I had my kid on Pegalax for few months after trying so many remedies, medicines. It worked like maricle for my kid..no concern after that and its 3 years now.
Will any of these things help for a 1yr old? He started getting constipated regularly after switching to whole milk and was formula fed before then. It clearly hurts him to poop (crying and death gripping us or whatever is near) but he is ok when its over. He drinks watered down pear juice and I’m trying to get more fruits into him but he’s become picky about many foods… maybe this is all related (or also because he’s 1)?? Thank you!
Sure, I would talk to you doctor before you give any supplements, but changes in diet can be huge. Being picky is probably a combination of being one (very common) and the constipation. Really watch his dairy intake and see if that helps. You may also need to go to 2% milk.
Thank you! We are seeing his doctor tonight to try to set things right. I’m hoping to just change his diet as much as we can before trying a probiotic or miralax.
I definitely understand wanting to avoid miralax, but probiotics are completely natural. Also, you may need miralax at some point, I would just recommend avoiding using it on a regular basis. Best of luck!
I know this is an old post, but in case others see this: if your child is having constipation issues, (especially if they have Exzema or skin issues) I highly reccomend having them tested for food allergies, and the sooner the better. It’s always best to have a full picture of a situation and perhaps avoid what happens with me and my daughter. Long story short, she had many food alllergies which we didn’t discover for 2+ years! 2 years of feeding a child what is causing her pain and constipation. I just kept thinking she needed more fiber and better foods- it never really occurred to me what should be REMOVED to heal her. Unfortunately, this was during the Oh So Important potty training years and there was a lot of tears (from both of us) and it caused her to form bad habits and delayed mastering potty training. Almost immediately when i removed the allergen foods, her accidents ceased and she was finally able to potty normally. We do still have bouts of constipation but it’s not the daily battle it once was. Please note: allergy testing is not a one and done, allergens can show up later in life and so I suggest having them tested yearly, which is what happened in our case, we discovered more and more allergies as she got older. By the time they’re one and eating solid foods, If you’re seeing skin or potty issues, I highly recommend allergy testing to avoid years of feeding them harmful foods. You’re the parent, follow you instinct and be insistent with your doctors on this testing. There’s no harm in testing and getting negative results, so you’ve got nothing to lose and everything to gain!
I have been praying for an alternative to exLax for weeks now. I can’t believe I happen to stumble across your website while on Pinterest. My 5 yr old son has been taking exLax since Aug 2014!!!! It worked for his witholding issue until recently when I progressively had to up his squares from 2 to 6!,!!! Tomorrow will will day 4 of no poop. I’m desperate and happen to see this!! While I haven’t read thoroughly threw everything, I feel like you r walking in my shoes. I’m excited to read more and try your suggestions. My son is also a picky eater and has low tone and sensory processing disorder. Sound familiar? LOL
GOD BLESS YOU FOR HELPING OTHER PATENTS IN SIMILIAR SITUATIONS
Thank you!! This is awesome info & I can’t wait to try the massage!
Question: how do you feel about upping fat? I don’t know enough about all this, & we’re about to start potty training… I’m nervous about constipation.
Is this worth trying? I don’t know that I can get my child to eat these foods, even in a smoothy… From Oh Crap Potty training “The BEST thing to get poop soft and easy going is to up your child’s fat. A lot of parents watch their fat intake and subsequently your child could be not getting enough fat. The 2 BEST fat sources are avocado and full-fat coconut milk.”
http://www.jamieglowacki.com/struggling-with-getting-poop-in-the-potty/
Hmm, that is interesting. I actually haven’t heard of that before. However, avocado is also an excellent source of fiber. I’d give it a try, let me know if you see any improvements.
Thanks for the massage info! I’ve also found low muscle tone and decreased core strength interferes with urinary continence and awareness of the bladder being full.
Thank you for sharing your story and strategies! I am curious as to why the massage is performed in the opposite direction of digestion? This seems counterintuitive to me. Thanks!