Expert: Dr. Frederick Blount - 10/30/2005

Question
My 15-month-old toddler has had problems with constipation and extremely large and hard stools since about 4 to 5 months of age.  They now are to the point where she starts to scream a particular way which we recognize as her having to have a bowel movement, followed by crying and straining.  Last night, as almost always, I laid her down and tried to push her legs up to help which she resisted and straightened out in order not to have a bowel movement. Once I could bend them to help I could see the beginning of stool and used a wetnap to help guide the stool out. It was as large as a stool I would pass, very hard and covered with mucous.  This is almost a daily occurrence with her. We've tried all we can think of (apple juice, prune juice, water which she loves, vegies, etc.)  She had to be on soy formula as an infant and, as stated, these hard stools and her horrible straining started about 4 months or so and it has just gotten worse. What can I do prior to seeking a specialist?

Answer
 A pediatrician is the only specialist she should consult for this is a common problem with some children. The child associates the elimination process with pain and no child wants to do something that causes pain. She needs the prolonged ( 3-6 weeks)use of a stool softener, even to the point of getting it so soft it sometimes leaks a little. Milkinol and Malt Soup Extract are the names of two but there are many more. Talk to your pharmacist, and be sure to start with maximum dose until the stools are soft and maybe reduce the amount, but keep going for a long time until she learns that movements don't cause pain. The pharmacist may warn you about prolonged use of a laxative but you don't want a laxative;you want a softener. Meanwhile keep up the rough foods - cereals, fruit, vegetables - and go slow on the low roughage foods like pasta, rice, white bread, white potatoes. If she seems to be in a lot of trouble right now use a children's size glycerin suppository to get her to pass the large stool that may be in her colon.