There are several causes of constipation. There might not be enough fluid and fiber in the diet and the stool gets progressively drier, harder, and more difficult to pass. It is also thought that some children have gastrointestinal tracts that move at a more leisurely pace. There are families with more of a tendency to constipation, and one supposes that they have "slower" GI tracts.

The rectum has a complicated anatomy. There are many stretch receptors that detect the presence and quality of stool. Then there are two sets of circular muscle groups called sphincters that have to open. One of these sphincters is under voluntary control and is what you use to "hold it back" until the time is right.

Many children have an occasional bout of constipation. This often happens during vacations when everyone is eating on the go, not eating as much fiber, or not drinking enough water. Toddlers tend to like dairy products. If most of the diet is milk and cheese, their stool can become hard and dry as the milk is digested. Increasing fluids and giving children more fruits and fiber cereals will offset the constipation. When the child needs a little help, there are several over-the-counter laxatives you can use.

Some Laxative Doses
• Sennekot Liquid: 1/2 tsp twice a day (for 2-5 year olds); 1 tsp twice a day (for over 6 year olds). Use for a day or two. Sennekot is made from the Senna root and has been used for centuries. For babies, use 1 cc (for 4-12 months); 1/3 tsp (for 12-24 months). Sennekot is over-the-counter, and different doctors might recommend slightly different doses based on the baby's size. There is a similar constipation product by the "Little Tummies" company. Doses are listed on the box.
• Miralax 1/2-1 capful in 8 oz of clear liquid once a day as needed.
• Milk of Magnesia: 20-30 lbs take 1/2 tablespoon twice a day, 30-40 lbs take 2 teaspoons twice a day, >40 lbs take 1 tablespoon twice a day.

If you know your child is "working on" passing a large stool and they're not toilet trained, try to get them in a squatting position by taking them for a walk in a baby carrier or a stroller with their knees bent. Bicycling their legs while they lie on a bed also helps work the relevant muscles. Warm baths might help as well. If the stool has become very large, the child's rectum might bleed after it's passed. Putting on some A & D ointment or other diaper ointment can help.

Chronic Constipation

If constipation becomes an ongoing problem, the area just above the rectum can become stretched. As you can imagine, the problem worsens because backed-up stool can get larger and more painful to pass. The child can become fearful of defecation because it hurts. This becomes a vicious cylce because the child begins to withhold stool to avoid pain from having a bowel movement. When a person withholds stool, the colon removes water from the stool making it harder, larger, and more painful to pass. Miralax (polyethylene glycol) has been very helpful in treating chronic constipation. It works by holding water in the stool. The goal is to produce 1-3 soft painless stools per day. Frequently, treatment needs to be continued for several months to allow the stretched rectum to return to normal size. If you are concerned that your child has chronic constipation, talk to your doctor about treatment.

High Fiber Diet

While treating with Miralax, you want to start instituting a higher fiber diet. There are many stool softeners available for older kids such as Citrucel, Metamucil, or Fiber wafers.

Some High Fiber Food Suggestions
• Fruit cocktails and canned peaches or pears
• Crackling Oat Bran cereal (served by the handful as a snack, tastes like miniature oatmeal cookies)
• Corn Bran cereal (also served as a snack - pretty crunchy and tasty)
• Bran and Corn Chex cereal (also tasty)
• Homemade oatmeal cookies (use the higher fiber types of oatmeal)
• Popcorn (for older kids)
• Corn on the cob (or frozen corn given at dinner as a side dish)
• Dried apricots and raisins
• Cantaloupe
• Blueberries
• Fig Newtons
• Fruit Bar Cookies by Sunshine (made with lots of raisins)
• Fruit Rollups made from dried apricots
• Raisinets
• Add bran to recipes when making cookies
• Make cupcakes with frosting using bran muffin mix or a combination of carrot/bran cake mix.

Constipation is very frustrating for the parents, but more so for the child. Try to be as patient and helpful as you can.