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Children's Health

My 2 year old is having trouble pooping.

12/28/2009

Question:

My daughter is having problems pooping. I have tried prunes, prune juice, pedilax for children, and oatmeal, and nothing seems to be working. I don`t know what to do. Plus she won`t eat anything.

Answer:

These are certainly vexing problems for many mothers. The good news is that the causes of these problems are seldom the result of actual illness of problems with the body's function. They are vastly more likely to be the product of toddler negativity bumping up against well meaning efforts to be a good mother. If you daughter has been healthy and growing well with few bowel problems up until now, it would be best to focus on developmental causes and not worry about illness. If feeding and stooling are long term problems with your daughter, then a consultation with a pediatric gastroenterologist is the way to go.

So my advice will focus on the developmental struggles between parents and toddlers that often provoke toileting problems and feeding battles. Toddlers have made the wonderful discovery that they are not their parents or even a part of their parents. toddlers are devoted to discovering how they differ from their parents. They basically take the strategy of wanting anything other than what their parent wants. This accounts for why the word "No!" is so popular with toddlers and general negativity or contrariness. It does not mean that the toddler does not love the parent any more or that the toddler is purposefully trying to make a parent angry. Toddlers cannot help the drive to define themselves as opposites of their parents.

Most toddlers also have limited language skills, so they can't tell us how they feel and what they want clearly so we get it. In their frustration, they have meltdowns we call tantrums. Being hungry or tired makes tantrums a lot more likely. Crying is very hard to take as is the screaming and flailing of tantrums. So what is a parent to do?

Parenting a toddler takes an enormous amount of patience and self control to remain calm no matter what and assertive about how things will be done. Parents do know best what are healthy food and beverage choices, what behaviors are acceptable and which are not, as well as safety behaviors that must be observed. Just because our children are human does not mean that they know how to fit into family and community. They have to learn how to do this and parents are their trainers for life. Along with calm and assertive attitudes, a set daily schedule of meals and snacks, naps, and bedtime help a toddler to feel secure. It also minimizes the risk for tantrums.

Toddlers normally have a drop in appetite around a year of age as their rate of growth slows significantly from what it was during infancy. Add negativity to the decreased appetite, and the stage is set for struggles over eating. It is best to schedule meals and snacks evenly throughout the day. toddlers love choices but they can only handle a choice between 2 options. offering more only overwhelms them. Parents should offer only offer a choice between two healthful options and stick to it. Toddlers only need 1-2 Tablespoons of each food at each meal because their stomachs are small. They can be overwhelmed when faced with a seeming mountain of food they can't possibly eat. Offering small amounts also allows the child to feel successful when he or she eats and gives them the chance to feel in control when they ask for more. The only thing that more is not available for is dessert. Two year-olds can eat the family diet as long as the meat is tender and the foods are cut up in small pieces. Hard foods like carrot and celery sticks are not safe. Nuts, hard candy, hot dog rounds, popcorn, seeds, etc. are also not safe for toddlers. Parents should not be short order cooks or panic if a child does not eat much at a meal or snack time. appetites and food intake vary a lot day to day in toddlerhood. remain calm and matter of fact about the timing and content of meals and let the child choose whether or not to eat and how much to eat.

In order to avoid constipation, make sure the child had only about 16 ounces of milk per day or dairy food equivalents such as yogurt or cheese. too much milk or cheese can be very constipating. Make sure plenty of water is offered during the day and offer only 4-6 ounces of 100% fruit juice each day. Offer whole grain crackers, breads, and cereal as well as at least 5 servings of fruits and vegetables each day to  assure adequate fiber in the diet. Make sure the child has ample time to play actively to help nature along. When moving to potty training, make it a routine to sit on the potty after each meal in order to take advantage of the natural gastrocolic reflex for stooling after eating.

As readiness for toilet training draws near, help your child make the choice to be dry. Let her choose an affordable potty and place it in the bathroom. Have her come to the bathroom with her sisters and her mother so she learns the routine. Comment positively on her efforts to imitate good bathroom habits such as washing her hands. Let her sit on the potty with her clothes on if she wants. read books and watch videos about toilet training. Let her select her big girl underwear for when she is ready not to use a diaper.

The trick with toddlers is to set them up for success by helping them to choose to do the right thing on their own, providing you the chance to calmly offer low key praise for good choices and behaviors. You will still face bouts of tantrums and negativity but remaining calm and assertive, no matter what, will end tough situations quickly.

If constipation remains a problem, consult with your daughter's doctor and discuss the need for care by a specialist. Books that I highly recommend as good resources for parents include Barry Brazelton's Touchpoints Birth to Three, Child of Mine: Feeding with Love and Good Sense by Ellyn Satter, and Penelope Leach's Your Baby and child Birth to Five.  The each offer sound advice to handle the many challenges of parenting the young child and gaining insight into the why of developmentally normal, but trying, child behaviors.

I hope these ideas are helpful to you.

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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