Month 20 Worry: Is My Toddler Constipated?

What's the Issue?

In my practice of pediatrics, my colleagues tease me that there are only two diagnoses I ever make: sleep disturbance and constipation. Although I like to think my practice population is a bit more varied than that, it does seem that I spend an inordinate amount of time dealing with these two issues. And in the second year of life, constipation issues can get my appointment book really backed up.

Consider the Numbers

In a 2005 US study, 10.1 percent of children were clinically constipated between their first and second birthdays. The prevalence of constipation was equal between boys and girls.

• Ninety-seven percent of constipated toddlers had no medical diagnosis underlying their constipation, e.g., low thyroid.
• Dietary changes (increased fiber) and corn syrup resolved 25 percent of these cases.
• Additional stool softeners (milk of magnesia or polyethylene glycol) resolved the issue 92 percent of the time.

What Parents Can Do

Recognize that chronic constipation symptoms can start out subtly and they can worsen over an extended period of time. It is not unusual to have a grade-school student present with severe chronic constipation because of withholding which began in his second year of life. Right now at 20 months, your child is in the vulnerable potty training year, or the beginning of the Freudian "anal stage." Now is the time to steer away from this future potential problem … and its psychological Freudian implications!

Toddler constipation can present with common symptoms: hard, painful, infrequent, blood-streaked stools, for example. But did you know that a toddler can have daily, soft bowel movements and still be significantly constipated? Toddlers can also present with tricky symptoms of constipation, such as:

• severe abdominal pain
• vaginal redness/discharge
• recurrent urinary tract infections
• occasional HUGE poops
• doing the "poopy dance"—intermittently wiggling around with buttocks crunched in an effort to hold back a poop.