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My son has been chronically constipated since he was 22 months old. He is now 28 months. Prior to that he had great BM and made 1-2 poos a day by himself. He started having trouble when the weather got colder and the air got bad, and perhaps because he got to go outside less and drank less water. His grandparents were also in town for a couple of months so his routine was disrupted a bit. Since then, we have gone to see pediatrician several times, put him on a high fiber diet and make him drink tons of water. We set aside time each day to remind him to go potty. The thing is, it's really hard to convince him to start. He seems more interested in playing and doesn't ever seem to have the urge to go until day 3 or so. By then he has a really hard time. His poop gets so hard it won't come out. I had to gently help the poop out once as it was stuck at the anus, and was just like giving birth. He was so traumatized and so was I. Another time I had to use enema after him trying for 2 days and nothing came out. One pediatrician suggested putting him on Miralax (a stool softener) daily, but I'm hesitant to go that route. I think his issue might be more psycological as if we can actually convince him to poop everyday, which happens on some days, he has no problem. The hard part is to get him to try. We have tried cheering, positive reinforcement, reasoning, bribing. Recently my husband is so frustrated I see he's starting to force my son by taking him into a room and losing patience. He has not been potty trained (a battle I don't want to start) and doesn't seem to be scared to poop. He just won't try. He just won't bear down to poop! I now live in China so there are no specialists I can take him to. Please help!

Dear Julie,

At the outset, let me say that you seem to have grasped the essentials of idiopathic constipation pretty well, and your approach to the management of your son's problem seems quite logical ... at least until you came to the hesitation with using laxatives.

Modern reviews of different laxatives show comparable efficacy and somewhat similar side-effects profiles of most laxatives on sale now. Regular bowels movement that accrue after using laxatives will actually increase your son's self-esteem. He will come to realise that there is no "psychological" problem with him and his anxiety and stress will REDUCE. You say that there is no specialist in your region. I find that hard to believe, Julie. Also, does he have any excoriation or wound or cuts in the anal region? The pain that comes when the emerging stool hits a fresh anal skin cut is too big a problem to allow him to agree to keep straining in the potty.

You also need to look into the issue from a rewards and positive re-inforcement point of view. His father doing what he does certainly will aggravate the problem, and you need to firmly tell him not to do what he has been doing.

Last, but not the least, have sufficient investigations been done to rule out Hirschsprung's disease? If not, you must show him to a paediatric surgeon as soon as possible.

Hope that helps.

Dr. Taher


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Dr. Taher Kagalwala


I come from India, and have been practising since 29 years. I am specially interested in infections, asthma, newborn care and parenting. I have authored a book on Parenting.It is called "Child Care: From Birth to Eighteen". The e-book is now available on
and on and all local versions, including I have my professional site at Blogger. Here, you can read good advice and also seek a professional online consultation for a small fee. Do check out


Qualified Pediatrician practising since 29 years.
Currently working in the United Kingdom. You may reach me on my cell number +447440622670 or email me on only if I have not responded to your query here in a reasonable time. If you directly call me or email me, I might not be able to respond. Thank you for understanding. Please do not Whatsapp me.

Indian Academy of Pediatrics, life member. Mumbai Branch of the I.A.P., life member. Genetics Chapter of the I.A.P.

Indian Pediatrics, Indian Journal of Pediatrics, Toxicology Abstracts.

M.D., M.R.C.P.C.H. (U.K.), Ph. D. (U.S.A.) D.C.H.

Awards and Honors
Gold Medallist in D.C.H., April, 1985
Highest aggregate marks in University of Mumbai, for M.D. ( Pediatrics ), October 1986.
Passed out with distinction from the Royal College of Paediatrics and Child Health, U.K. in 2015.

Past/Present Clients
1. Municipal Corporation of Greater Mumbai (K.E.M. Hospital) 2. Private consulting practice. Worked as the Asst. Paediatrician and DNB Teacher at Masina Hospital. Also visiting Saifee Hospital, Mumbai. 3. Ministry of Health in Kingdom of Saudi Arabia as a Specialist Paediatrician. 4. Now with the NHS, UK as a Specialist Paediatric Registrar at Blackpool, Lancashire, UK.

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