Beyond a Fever and Runny Nose, Medical Woes for the Toddler Years: The Poop Scoop

Okay, so this is not a cute topic that parents tend to sit around and chat about at play-groups, but it is a topic that back in the day, I am sure mothers, aunts and nursemaids passed on from one family to another. And while it’s too late for me, a little shared knowledge on this topic may save other parents of tots an emergency trip to your pediatrician who may or may not make you feel like an excessively worried hypochondriac who runs their kid to the hospital every time they sneeze.

The Problem: My Toddler Won’t Poop!

No, I’m not talking here about the kid who just hasn’t gone for a couple days. Where a glass of prune juice might help things move along. I’m talking, in this case, about the kid who through some amazing will-power and muscle control can and will intentionally hold it in for a week or two at a time. (Note: I’ve posted this as a toddler issue because it most commonly occurs around the time potty training begins).

Believe me, it sounds crazy and a little unbelievable. But when it is your kid, and this happens to you, it is a really easy situation to totally freak out about. So, for those of you who might know this problem from first hand experience or for those of you who have little ones headed toward toddlerhood, here’s the scoop on our story, what we found out, and how we resolved this mini-crisis.

When I look back, the trouble first began after my daughter, who was 2 1/2 at the time, had been sick with bad cold virus. She had a short bout of constipation (about three days without a stool) followed by a painful and hard bowel movement. In the weeks that followed, we noticed she was expressing fear about going to the bathroom. She no longer wanted to use her potty, and when she felt a bowel movement coming on, she would hold onto her butt cheeks as best she could and squirm about with a worried red face trying to keep her poop from coming out. These episodes became more dramatic as she took to screaming “Owie. Owie. Owie. Go away mommy! Go away daddy! I don’t have to go poop!”

At first she was only able to hold it in for a short time, a day or two at the most. But we really started to panic when the days between bowel movements turned into a week or longer. We were incredibly worried as it appeared she was experiencing extreme discomfort. She was also eating less and less and her sleep (and ours) was becoming severely compromised. The longest holding period she went through was 14 days.

We tried everything we could think of to change her pattern of behavior and to get her to go. We jumped onto the web to look for answers, called the doctor and anyone else we could think of who could help us out. At first we focused on diet, cutting out foods like cheese and bananas and increasing foods like bran and peas. We also tried glycerin suppositories which not only didn’t do the trick, but made a bit of a mess.

What Our Own Research and Pediatrician Eventually Told Us

“Stool withholding” is described as when a child feels the urge to have a bowel movement, the child purposefully holds their stool in. It may even appear to the parent who is coaching and encouraging the child on, that they are making an attempt to poop when actually their attempt is to hold back.

There may be many reasons for this but most commonly the behavior is related to a child's desire to maintain control. A child who is actively engaging in this behavior may also have other issues related to eating and sleeping. It can become a more severe issue as the child becomes more adept at withholding because there is a possibility of developing a fecal impaction in the rectum. Discomfort from this impaction may lead to soiling in the underwear and a foul smell frequently throughout the day. This was happening to our daughter after her pattern became withholding for several days at a time.

On occasion, and as in our case, when the stools finally come out they can be huge, so big in fact that you can't believe it came out of your child. When this happens it can be very scary, and information on the web regarding the consequences of this action taken by your child are even scarier.

One article I read led me to believe that my daughter would be emotionally scarred for the rest of her life, not from the withholding, but from the emotional impact of having a soiled pull-up. I thought it was bad enough that I was losing sleep worrying about the physical impacts of the situation let alone wondering whether I was turning my child into a mental case.

Not surprisingly the advice in these articles was to seek medical attention right away or hire a child psychologist who specializes in toilet training to help your child through this important life phase. We settled on trusting our own parenting skills, common sense, and showering our little child wonder with an excess of encouragement. We set to creating our own plan of action which incorporated a little bit of advice from all our sources.

Our Plan

First and foremost we realized that we needed to approach this situation in a calm manner. I personally think the best thing you can do in this situation is not freak out. Be calm, don’t be aggressive about trying to change the child’s behavior. The reason is that the issue, in the tot’s mind, is control.

The more control you try to assert over the situation and them, the more they will try to assert in return. And since there isn’t some magic remote gadgit in which a parent can press a button to control the actions of their child, we need to resort to other tactics like reverse psychology and incentives. In our case we bribed (yes, flat out bribed) our child. We first used stickers, but our child was not in the least bit impressed with them, and we settled on candy. M&M’s to be precise. She got three pieces for going poop in her diaper and if she had the courage to actually use the potty, her prize doubled.

We also paid very close to her diet for a few weeks. We increased her intake of juice, cut out dairy and other foods which tend to have a counter effect while adding foods into her diet that helped her system flow better like raisins, prunes, peas, certain fruits and grains. Since at this age it is very difficult to introduce new foods to a picky eater, we found that ground flax seed was a life saver. We added a tablespoon to her Cheerios at breakfast, we mixed it in with peanut butter, and the most tasty solution was baking it into chocolate chip cookies. (I now add it to my cookie dough every time I bake, it gives the cookies a light crispy texture and a slight nutty flavor...very yummy.)

One of the first things we needed to do, since she had plugged herself up quite substantially, was flush her system. This is where the trip to the doctor’s office was most helpful. His recommendation was a medical regiment to follow for this incident and the ones to come. There were three to four more long periods (7 to 10 days) of withholding that we went through before curbing the behavior.

His advice was that if she went 7 days without pooping, to give her a child’s size dose of Mirolax (note: always consult a physician before giving medication to a child). He wrote a prescription for this and she was to be given one dose each day until she had a bowel movement. This worked each time with just one dose. Each time she had a movement within 10 hours of receiving the medication. Once the child has a bowel movement stop giving them the Mirolax.

He also recommended giving her a tablespoon of mineral oil each day. This can be kept up until the child starts to have regular bowel movements each day on a regular basis. Note, getting your toddler to swallow a tablespoon of mineral oil each day takes heroic effort.

Lastly, and probably the most lasting technique within our regimen was our “Its your Job to Poop Once a Day” Campaign. This included (and still does) a lot of positive communication, much candid discussion about poop itself, the bribery which was aforementioned, and several great books like “Everybody Poops”, and “The Gas we Pass”.

After four months we noticed that our daughter was no longer “holding it in” and she is most certainly now (eight months later) a proud pooper, asking for privacy in the bathroom, calling out that she’s “workin’ it” from the stool, and reminding us when she’s do some candy for doing her job.

Disclaimer: I just want to make a note to point out very clearly, I am not a doctor. I am a mom. This is our story, about our child. If you are experiencing a similar situation please make sure to talk to your child’s pediatrician.