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Children's Health

Pooing Problems

05/12/2011

Question:

For quite a long time now my 2 yr old son has had extreme difficulty with the pooing process, he flat out refuses to eat anything and just drinks bottles of milk formula throughout the day and night. On average 20-30 times a day he will clench up his whole body and start crying for help until he is lifted, then he will continue to clench and contort for a couple of minutes until the feeling passes, most of the time nothing or very little comes out, sometimes its just wind but the panic and clench routine is the same, throughout the night myself and my partner will be in and out to him 15-20 times with the same problem, changing his nappy is also a terrible ordeal for him, he cries and squirms and clenches up. His poo is always either watery or at best pasty, he hasnt had a hard poo in over a year and his quality of life because of all this is terrible as he cant just relax and play. Both my partner and myself are exhausted from the constant attention required throughout the day and night, I`m concerned about possible kink in bowel type problems or something else but our GP says theres nothing we can do but wait til he`s old enough that we can reason with him to let himself poo, i want to bring him to a pediatric doctor but my partner says its a waste of time due to what our GP said, what should I do???

Answer:

I agree with you that seeing a pediatrician would be an excellent idea. At this point you may need to see a pediatric gastrointestinal (GI) specialist.

Your son is in the challenging stage of toddlerhood. He is working hard to test the limits in his world. Toddlers are notorious for the word "No!" and for refusing to do just about anything a parent wants him or her to do, e.g. use the potty. His stomach clutching and other attempts to hold stool back are typical of children with encopresis. The root of the problem usually goes back to a painful stooling experience that prompts the child to hold back his stool so that he does not have pain any more. It is not something you can reason a young child out of doing.

You need a good pediatric doctor or specialist to work with you to help him get rid of built up stool blocking his colon, keep his stool soft and easy to pass so that he has no pain with stooling, and keep it that way so that his gut has a chance to recover its normal ability to move food along. Right now, it is likely all stretched out and not able to function well just as a stretched out rubberband does not work well anymore. Fortunately, stretched out colon muscles can recover their function unlike an old rubberband. It is also possible that there is a narrowing of the colon or something acting as a partial block to stooling that is causing the distress.

You have a very difficult situation because, if I understand what you have written correctly, not only does he not want to stool, he is also refusing to eat a variety of healthy table foods that he should have mastered accepting long ago. It sounds as though you have him on infant or toddler formula, so he may be getting adequate protein, calories, vitamins, and minerals for growth. If he really is drinking cow's milk, his diet is most definitely inadequate for growth and development. Lots of milk can also cause anemia from lack of iron intake coupled with micro-bleeding in the intestines from irritation in response to too much cow's milk protein. By not eating fruits, vegetables, whole grains, etc., he is making his stooling problems even worse because he is not getting the fiber he needs.

The other thing I see are his efforts to get attention, not only all day but all night. This must be an enormous drain on adult energy and patience.

All of these things together lead me to the conclusion that you all, as a family, would greatly benefit from the help of pediatric and parenting experts to get things on the right track again. If there are underlying health issues feeding the problem behaviors, pediatric specialists will uncover them. If there are behavior problems, they will also know who can help you in your important role of parent. It will take a team effort between parents and professionals to get things straightened out. As a parent we each want to love and care for our children perfectly and to not cause them harm. In our efforts to show our love and not cause pain, we actually can support our children in behaviors that are harmful to their well being. You and your partner will actually have the hardest part of the job in terms of changing your child's diet, fixing the constipation (if that is the problem), and setting appropriate limits in the face of tantrums and meltdowns.

The best way to know what root problems you are dealing with is to take the child to a pediatrician or pediatric GI specialist. Most pediatric GI specialists are attached to children's hospitals, so you could self refer your son to the nearest such specialist by calling the nearest children's hospital and asking for the pediatric GI clinic.

I hope this is helpful and that your son's problems are resolved soon.

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Response by:

Mary M Gottesman, PhD, RN, CPNP, FAAN Mary M Gottesman, PhD, RN, CPNP, FAAN
Professor of Clinical Nursing
College of Nursing
The Ohio State University