This week’s tip comes from Dr. Nanci Pittman, assistant professor in the Department of Gastroenterology and Hepatology

Stool withholding is a common problem seen in toddlers. This is when toddlers try to hold in their stool rather than passing it.

Often this can occur when a child has constipation and is experiencing pain when passing stool. Because of the pain, the child prefers to hold in their stool in order to avoid the pain that they have felt in the past. By holding in their stool, the constipation becomes worse and the stool burden becomes greater. As a result, they start to have some abdominal discomfort and possibly some abdominal distension. In addition, once they do finally pass the stool, it is usually hard, wide and large which leads to discomfort and reinforces their desire to continue to stool withhold.

  What to look for:

• Often, when a child is exhibiting stool withholding, they make their body straight. This can be seen by straightening the legs, crossing the legs, clenching the buttocks, standing on their toes, etc. They can even appear red in the face and look like they are straining trying to pass stool, but rather they are working to hold it in.

In order to break the cycle, the constipation needs to be addressed. This can be done with rectal medications, oral medications and a change in diet.

  First steps:

1. Make the stool very soft so that the child can no longer hold in their stool.
2. Keep the stool very soft so that the child passes one or two soft bowel movements daily. With this, the child will slowly regain the confidence that it does not hurt to pass stool and they will stop withholding.
3. Plan on having your child try and use the potty several times a day, whether or not they feel the need.  Some children have difficulty knowing when they need to go and thus can be prone to accidents.  going frequently will help make a habit of toilet use and avoid arguments.

This not just simply treating constipation, but rather we need to reset the toddler’s perception/fear of passing stool.

  Tips to get stool soft:

1. Limit the amount of dairy your child consumes during the day
2. Put your child on a high fiber diet, including fruit, vegetables and whole grains (their daily fiber in grams should be at least the child’s age plus five)
3. Limit other constipating foods like white rice, white bread, pasta and bananas.
4. Encourage drinking lots of water, at least 3-4 cups a day.

If your child’s stool does not soften with diet changes, then speak with your pediatrician.

 Setting the mood:

1. Take a break from talking about your child’s bowel movements (whether positively or negatively) for a few weeks while trying the medical tips above.  This can take the pressure off.
2. Make it comfortable.  Try using a stool to help your child’s feet touch a surface for support.  This can help them relax the muscles needed to have a bowel movement.
3. Pick a few activities to do in the bathroom to encourage your child to sit longer.  Read a new book, sing a song or listen to music that is special and fun.

To find out more on constipation and stool withholding, visit HealthyChildren.org

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