Poop jokes are not my favorite kind of jokes. But they are a solid number two!!

Joking aside, constipation can be a major pain in the behind. I just can’t stop myself!

Let’s get down to business. Constipation is NOT HOW OFTEN you go, but what it looks like WHEN you go. I have infant patients who only poop every 8-10 days, and what comes out when they finally poop is a volcanic explosion of the normal newborn yellow, seedy stools. Children can have vastly different pooping patterns, some poop three times a day, others poop once a week, and that is their own normal pattern. However, hard to pass, rabbit pellet or large hard balls of stool are never normal. “Normal” stools are Type 3 and Type 4 on the Bristol stool scale.

That’s right, enjoy the pictures of poop while you’re perusing this article during your lunch break; the things we do for our kids is special, right?!

Constipation is usually diet-related due to picky eaters. Favorite foods of toddlers and children that can worsen constipation include: bananas, sweet potatoes, milk, cheese, crackers, bread, pasta, and cookies. You can add a few things into your child’s diet to help relieve the hard stools: yogurt, probiotic, fiber gummies, flax and chia seeds, plenty of water (six or more cups per day for elementary age and older) and eating high fiber fruits and vegetables (think celery, spinach, apples with skin, berries). Also, a sedentary body will be more prone to constipation, so get up and get at least 1 hour of strenuous physical activity daily.

After making dietary changes, the treatment of constipation depends on the age of your child.

For infants who are solely on breastmilk and/or formula and truly are constipated, you can help facilitate a stool by checking his or her rectal temperature, or massaging the tummy in a clockwise motion.

For infants older than 6 months who have started pureed foods, remember the “p” foods help you poop: pears, peaches, prunes. So offer “p” fruit jars and a variety of green vegetables. You can also give 2-4 ounces of an electrolyte solution, such as Pedialyte, per day to add more fluids into the gut.

For toddlers, elementary age and beyond, discuss with your doctor if medication can be helpful. Over-the-counter stool softeners, such as Miralax, used short term can add fiber bulking to the stool and start allowing it to pass more comfortably. Give this a few days to work, it is not a magic quick fix as it is not a laxative. Your doctor may consider prescribing a laxative medication (I sometimes prescribe lactulose for my patients) if his or her symptoms warrant its use.

There are several medical reasons why your child may be constipated, so a problematic pooper is precisely a proper purpose to pop it to your pediatrician.

Constipation is the cause of alllllll the things. Just joking.

No, but really – it’s one of the most common things I see in my office at Willow Park, and it causes strange problems sometimes. Parents often don't believe me when I tell them it's constipation causing the problem. 

What is constipation? It doesn't necessarily mean your child isn't stooling daily. A kiddo can be constipated and poop many times a day. Constipation means hard, dry stools. They’re often painful to push out. And yes, most kids with constipation will go a few days between stools.

I really feel that constipation has become more prevalent over the years because of how our kids' diets have changed. In general, kids are eating less fresh fruits and veggies and depending more on packaged goods for snacks and meals. 

There are lots of medical causes for constipation as well. Did you know that hard poops can cause:

1. Stomach pain
2. Withholding of stool
3. Vomiting
4. Refusal to eat
5. New urinary accidents
6. Wetting the bed
7. Diarrhea
8. Poop accidents 
9. Blood in stools, blood in diaper
10. Fever (yes it can cause fever! mostly lowgrade)

Here's the deal - and let's get down and dirty about it. The things your kids eat affect the quality of their poop. If they eat and drink things that don't have much fiber (think cheese, yogurt, pastas, cookies, white bread, bananas, milk, goldfish crackers), their stools will be harder. 

Also, did you know our bodies absorb water out of our stools if we need it? So if your kiddo isn't drinking enough water, his body will just take it out of the poop, and it will become hard. 

The poop gathers at the “end of the tube” in a child’s body – the rectum and descending colon – and stretches everything out a lot. See the pic. This chronic distension leads to problems with the “valves” inside the rectum. Sometimes, this leads to leaking – soft stools can leak out without the child being able to control it. 

These big bulky stools can also push on neighboring organs, like the bladder, and even push urine out sometimes. And children with chronic constipation tend to develop poor control of their pelvic muscles and can lose control over their bladder, leading to leaking. One study showed that after being treated for constipation, 89% of 250 kids had complete resolution of their daytime wetting problems.

When the stools become hard, they hurt to push out. So kids don’t want to poop. So they hold it in. And the body slowly takes water out of it. And the stools get harder. And more difficult and painful to push out. Thus starts the painful cycle. 

Kids can get constipated anytime, but I find it’s most common 1) when babies start solid foods, 2) when kids start potty training, and 3) when kids start school.

So how do you fix the problem? Well, that depends on the severity of the problem and the age of the kiddo. But some general rules:

1. WATER. LOTS OF IT. Children and teens should drink at least 6 to 8 cups of water a day. 
2. Fresh fruits and veggies! I encourage kids to eat green veggies, prunes and other fruits (but not bananas), bran, whole grain bread. Sometimes those puree pouches with the kale, spinach, and broccoli are a good start for the picky kids.
3. Certain fruit juices – ok, we pediatricians are NOT big fans of juice. But I’ll make an exception in this case – go with prune, or pear.
4. Fiber supplements – flax seeds are great. Fiber gummies and cookies are good, too.
5. Behavioral and schedule changes – encourage a routine for “potty time”. 20-30 min after meals, have your kiddo sit on the toilet for 5 minutes. Encourage your child to listen to his body and stop playing when he feels the urge to “go” (and not hold it in). 
6. Do not punish your child, or get mad, if he has an accident (urine or stool) – remember, this isn’t under his control!
7. Avoid those foods I mentioned before for a few days – bananas, cheese, crackers, milk (if over age 1), breads, pastas.

If there is anything I can’t express enough to parents – it’s BE PATIENT! It takes many months for the intestines to stretch out and constipation to form in toddlers and children, and it takes many months (sometimes even years) to treat it. Sometimes we use safe laxatives or glycerin suppositories to help during the really rough patches – call or come visit us to talk more about that if you think its necessary. 

Hugs,Dr. Poop (er, Diane)

So, you have a new baby. That means your automatic, "I worry about poop" button is switched into active mode. It seems that you can't have a new baby and not worry about their stool. Suddenly, it's the main topic of conversation at the dinner table, in bed before you go to sleep at night -- anywhere, anytime is the appropriate time to discuss pooping habits. (Just remember, your child might be discussing your pooping habits and diaper changes around a dinner table in the future.)

So, what is normal poop?

We generally state that babies should be having wet and dirty diapers about six to eight times per day in the first week. However, there can be a lot of variability in this. Babies can poop every time they feed or just once a week and still be normal. You should worry if the baby is having hard stools or has a lot of swelling of their belly.

Normal stool color and consistency also varies. The color can be all over the place.

Also, straining and turning red and pushing with all their strength is normal. They're learning what muscles to push with to get the stool out. Imagine if you didn't know and were just guessing how to poop. It wouldn't go so well.

There are many varieties of normal stool but if you are concerned about your newborn’s poop, call your pediatrician.

Newborn U

Having a new baby in the house is an exciting, and generally, very happy time. It can also be a time of worry and fear. Learn more at Dr. Smith's Newborn University.