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
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
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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.
Thank you so very much for this article! My son suffers with low tone and intestinal problems due to the effects of a birth defect. We are going to try the massage tomorrow!
I was looking up the link between weak core strength and chronic constipation, and was delighted to stumble upon your article! My son who will be 5 in August, has pretty much been constipated since we started solids! We have tried a myriad of things and at the moment he is on 4x the recommended dose of Osmolax with occasional Dulcolax (stimulant), which is working but it frightens me how much he has to take in to actually produce a normal bowel movement!!! He also had the same effect your son had re increased fibre – it just made things WORSE and put him in more pain, hence why we shifted to a stool softener, but then he wasn’t feeling the urge to push hence the stimulant. I was just wondering if you had any medical research to share regarding the link between core strength and constipation (because I am a reader and just LOVE to read more stuff about that) and am also considering whether we should see an OT about this or not. I have been doing core strength exercises with him at home (love your resources!) and am starting his swimming lessons up again, which I hope will help with muscle development in general!
I gathered my research from the book that is cited above. I’d check it out, it’s a good read!
Give him fruit that starts with P Give him prune juice and apple juice sometimes helps
I stumbled across this when looking for ways to help my ten month old who in the past month has had trouble with her bowel movements. Used the massage technique and she went while I was massaging her! While I’m still trying to work out what is causing her difficulty, I am so relieved to have found something which which help her. So thank you!!!
P.s. how often would it be safe to use this massage?
That’s a really good question, and to be honest I’m not aware of any precautions. I would check with your doctor though to let them know what you are doing and that it is working, and see what they recommend as far as frequency.
My 2 years old daughter is suffering serious constipation. I read your blog and try out the massage techniques, I bought Nature’s Bounty Advanced Probiotic 10 fr iherb, however it state it only for adults.
Any idea if 2 year old can try this?
Hi Ann, that’s good to know, it should be fine but you’ll give half the dose. I’d definitely check with your doctor though!
Here is a video to back up the way you do the massage. I saw the other video you posted that wasn’t professional but this one is very professional. He says you start at the bottom left like you to break up fecal matter first. He says that if you don’t do this and start on the right, you put too much pressure on the hard/impacted stool. Also, starting where you do and breaking it up gives room for stool to move once you star massaging and moving it along from the right. So to all the naysayers, Here is a great video explaining why he does it starting on the left. I also recommend that you add it to the post.
Thanks Rebecca, I’m not disputing this way at all, I’m simply saying that there is another way that is also being taught in reputable massage therapy schools as well, which is what I posted here. Thanks for sharing!
You are both talking about the same method–the video she linked to is the same, only the “left” is referring to the patient’s left. Whereas when you’re looking at them it’s your right. Your pictures and this video are the same method, only the video is more detailed. 🙂
I know for my 2 1/2 year old, fruit is good at getting things to flow, especially prunes whether juice or dried fruit. If I notice he hasn’t had any major BM in 2 days, I up his fruit intake and it generally works within 24 hours to result in some major poops (up to 4 in the same day). Luckily, he loves fruit in whatever form, so the only thing we need to worry about is him eating too much and getting the runs.
Thanks Ariella, prunes do work wonders for some kiddos!
Every massage therapist I’ve known (being I went to a school that trained them as well) has stated the direction in your image will back you up worse. The energy flow in the body and massage should always run clockwise.
Please see the other comments, there are documented references to another approach. Of course, parents are welcome to use either direction. This approach was taught to me by a licensed massage therapist.
I just wanted to add a few comments based on my own personal difficulties with constipation and also what I’ve learned from having 2 granddaughters who have also suffered with it.
My bowel shut down completely in 2010 and I had a barrage of tests which determined that I had a slow transit colon, a tortuous sigmoid colon and a loss of nerve sensations in the rectum. This resulted in a bowel resection.
Finding first one granddaughter, then a second (from totally different families), suffering with constipation has led me to consider a number of issues at play. These kids were around 5 when having their major problems and were therefore using an adult toilet. Children who are this small have trouble balancing on the edge of the toilet bowl, which makes it difficult to sit long enough to have a bowel motion. We have installed a combination seat for both adults and children, as well as having a step stool in the bathroom, so that they can sit comfortably and have something ro push on, to help them produce a morion. I also noticed that there was a tendency to go to the toilet and quckly say sge couldn’t go. So we said that she needs to sit there for long enough to allow her body to work. With the the addition of medication and increased water intake, we are starting to see results.
I use the step stool myself and certainly pray that they don’t end up with the complications from which I have suffered.
These are wonderful suggestions Jeanette! Thank you so much for sharing them, they will surely be helpful to other’s!
Have you had experience with giving your son enemas, or contemplated this idea? I am looking into giving enemas seriously, because my son’s constipation continues. However I have not done it and am consulting a pediatrician first. I have found an internet site promoting a quite drastic enema protocol, but am not posting it as am wanting to research more first (am happy to send it to you privately if wanted).
Thanks and best,
I have never done this, I think I know the website you’re talking about and I just heard of it for the first time, too. A student of mine is using it with her son and she is really happy with it. For me, personally, this would have been a last case resort. My son would have had an extremely difficult time with this. Hope that helps, I know it’s a tough decision.
Very good informative article! Thanks.
I have tried many remedies for my two (b4 and b7).
Happy to know the enema works for her.
I know other moms who give enemas and they tell me it is easy to give. The prefer giving the enema.
I also give the enema when needed.
Never a Fleet enema.
I administer the enema across my lap way. Have him laying on tummy on my lap on a towel.
Enema bulb syringe, large bowl or pan of water and jar of Vaseline within reach.
Once all is ready for the enema I Call or go get him. Strip from waist down.
The enema does not hurt, is not traumatic and always works!
Have him relax. Most of the time I sit on the couch so he can watch tv when getting an enema. This helps him relax.
The enema bulb cost few dollars and is available in most drug stores.
After his enema I have him rest some. I am always amazed how well it works.
Clean the syringe in the kitchen sink with warm soapy water and rinse well .
I leave it sitting out for a few days to be sure is dry before putting back in box and into bathroom closet.
Hugs and blessings
The enema works and I am also happy with giving mine enemas when needed.
As I told earlier, very good your student gives her son enemas and is happy with giving the enema.
I know many moms who give home enemas. Either with the bag or bulb syringe. They also are happy giving the enema.
The key to giving a successful enema to the child is having him relax and know it does not hurt.
It should never be a problem giving him an enema.
Talking and explaining is important.
Even showing him the enema bulb. Leaving it sitting out so he knows it is good for him.
Once he knows the enema does not hurt, will make him feel better and even relaxing and soothing to get the enema,,,he will accept the enema.
I was taught the enema procedure by a older nurse who was my neighbor. She worked for a holistic doctor.
She taught me by giving me enemas first so I knew what it is like and then she gave an enema to my two.
Then she had me take an enema and give enemas while there to assist and help.
So others can learn some and understand briefly…..
When mine were younger she taught me to give the enema on a table. Put a towel on the table. Sat down with him and told him he was going to get an enema (that’s if he is old enough to understand).
Then took him to the table. Had him lay on back. Filled the bulb full. Held legs up some and gave him the enema. When done took him to the bathroom to expel.
If he didn’t have a good BM or little water came out (which meant was absorbed due to being hydrated) I gave him a second enema. Waited about half hour to give the second enema.
I also gave the enema to help reduce a fever. Much better than giving OTC junk and miralax.
I now give the enema across my lap way.
Always talk to your doctor before giving home remedies. Including enemas.
I am glad your student is using the enema for her son and is happy giving enemas to him.
I am a believer in the enema. NOT the Fleet one.
Give it with a rubber reusable enema bulb syringe. I have given plain warm water, herbal and the mild warm soapy water enemas to my two.
Go to optimalhealthnetwork.com to find Made For Enema Soap bar.
Swish it in pan of warm water and then give the enema. Make very mild soapy water.
Strange I was reading on here and was a friend’s house earlier. She had just finished giving her 7 yo b an enema.
Consult with your doctor before giving any home remedies.
Lee, I believe the site promoting drastic enema protocol you read on is Soiling Solutions.
A friend of mine has the book and she is using the protocol for her boy.
It has step-by-step procedures. I took a quick look at the book. But forgot the steps. I know one is the “sitting time.” Where he has to sit on the potty for so long the same time each day.
The protocol does require enemas be given the first day. To clean him out.
The enema is the warm soapy water one given with the bag.
I think, dont quote me, the larger volume enema is given each day for a few days. I forgot how many days in a row.
I have no problem giving my two enemas when needed.
The enema is a very good home remedy. Natural remedy. Does work.
But, I give a smaller volume one. Using the bulb syringe for the enema.
I give herbal or plain warm water enemas.
I haven’t spoken to her in a while. So I dont know how it went.
The doctor who has the program and a book to go with it says it works for the child who with holds.
I’m in the same boat as most of the posts. My 5yr old picky eater just experienced another bout with constipation. I appreciate your information and look forward to trying the massage. Thank you!!!
You welcome Kennie, best of luck!
Thank you so very much for your post. I am an occupational therapist (in mental health though) and mother to a 2.75 year old who has struggled with constipation since he was about 1 year old.(from mildly hard stools, all the way to pain, crying, blood, huge/hard bms, and taking a whole day of struggle to slowly get the bm out:( Though it gets better at times, it is very much still a problem. I wonder if it is low tone for him, that is an excellent suggestion. Also I wonder if it is dairy or wheat intolerance, and I admit the thought of trying to cut it out makes me anxious that I cannot do it. IT also may be Too much fibre (see what I have fed him below!), particularly given that he does not drink a whole lot (plus low tone possibility). I will try to do the poop massage more regularly (have used castor oil with drops of lavender essential oil or DoTerra digestZen). I will share what I have used with the obvious disclaimer that 1) it is just experience not advice I am giving, and I may make errors 2) as people wrote above, it is so different for every child and 3) we have not solved the problem permanently as yet!
a) ‘NATURAL’/supplement PRODUCTS:
– magnesium – powdered form – makes stool soft in texture
– omega-3 oil, lemon flavoured, nutrasea (for general nutrition, not particularly for constipation but we mixed it with the other oils)
– olive oil
– flax oil
– psyllium husk (from bulk food store)(has high fibre content)
(I mix 1/4-1/2 teaspoon of 2-5 of these ingredients in a large spoon, put raisins or dried cranberries on it (to entice him, he likes them) and spoon the whole oily mixture into his mouth almost every day. Long story short – for a few weeks it seemed to work (daily bowel movements, soft stool) then it slowly seemed to stop working. However I would try to decrease what I used, maybe too fast, and did not try it long enough
b) not natural:
mineral oil – recommended by his doctor – petroleum by-product 🙁
– again, it would work well for a few weeks then stop
PEG (polyehtylene glycol) the Restoralax/LAx-a-day brand
– I have been using 1 teaspoon mixed in juice, for 2 months, daily or every other day, even though I did not want to, I started because he was in such pain. It has helped but AGAIN, seems to have just stopped working lately
c) food/beverages, some examples:
– dried apricots, (dried) prunes
– Heinz baby prunes (canned baby food, pureed, it says strained though they do have some fibre content listed)
– giving water, juice, watered-down juice, fluids in general (including milk), following him around with a sippy cup as much as possible. I do not know what his intake is
– continuing to breastfeed him 1-2 times daily (I estimate he gets a small amount only, about 50 mL)
– ground flax
– chia seeds
– sesame seeds
– canned black beans, red kidney beans, chickpeas, white beans (I rinse them off and give as finger food snacks
Thank you again,
Lee, thank you so much for taking the time to share your experience. It will be really helpful to other parents, for sure!!! Wishing you all the best!
This direction of massage is completely incorrect. The massage goes clockwise from ascending colon to transverse to descending. Correct immediately. Teaching incorrectly can cause more problems as you are going against natural motility!!!!!!
Hi Pam, thank you for your concern, but please read through the other comments and see the link listed in these comments as well to the video demonstration. There are two different massage techniques that are well documented, but depending on the school most therapists are taught one or the other.
Great article but your diagram is showing abdominal massage anticlockwise, it should be clockwise. You need to correct this. I am a massage therapist of 20 years standing.
Thanks Suzie, please see the other comments- I fully explain there. There are two different techniques, I’m sure yours is effective as well.
This is awesome and such a relief to read! My 3 year old has been struggling with constipation for 2 years and it just seems to be getting worse. We have found probiotics work, and I’ll start using them every day. One thing her doctor recommended is a natural product called Calm. This seems to work when things get really bad. I’m going to try the massage today! I got super worried this week because she just stopped eating almost completely. But then I realized she was struggling with constipation super bad this week, so your articles have brought me peace of mind. Thank you so so much!
You’re so welcome Michelle! I totally get it!!! It is so stressful. So happy to report we are totally managing it successfully with only natural remedies!
Very useful article, indeed. I have been researching for our 11-year son, who is underweight (55 lbs), short and seems constipated. He is very active but does slouch (low tone?). We have obviously performed all sorts of blood tests, consulted specialists, including nutritionists, but to no avail. He is also on Miralax although not regularly. I just want to make sure he doesn’t miss out on his growth potential. His puberty hasn’t started yet.
Our 8-year old son, while skinny, eats well and is tracking reasonably well to his growth chart.
Right, the slouching could be a sign of low tone, and the truth is it can be soooo hard to diagnosis. Sometimes kids have low tone just internally making it impossible to know for sure. The best we can do is a process of elimination. If you have looked at all the other causes then that is likely what is going on and you’ll want to follow the suggestions for low tone (i.e. not too much fiber) which is contradictory to normal constipation advice. I highly recommend the book I sited in the post.