Let’s say your 2-year-old has red, swollen gums and brown spots on her teeth. No dentist on the planet is going to say, “Well, she’s in the early stages of tooth decay, but eh, don’t sweat it. Try cutting down a bit on the sugar.”
Instead, the dentist will sound the alarm about oral hygiene and sugary drinks and explain that left unchecked, decay in baby teeth can lead to decay in adult teeth, infection, and all sorts of long-term problems.
But if your 2-year-old shows up at the doctor with just-as-obvious signs of constipation?
If she’s writhing and howling, pushing so hard that sometimes her stool is bloody? If she goes days without pooping and then cranks out a hard, dry, adult-sized log? Or a few measly rabbit pellets?
Alarms will not be sounded.
Instead, the doctor is likely to say, “Don’t worry, she’ll outgrow it” while recommending your baby drink prune juice and more water, eat more fiber and maybe eliminate dairy — remedies that are woefully inadequate.
Never mind that undertreating constipation in early childhood can lead to enuresis (bedwetting and daytime pee accidents) and/or encopresis (poop accidents). Never mind that these consequences are just as damaging as the consequences of undertreating tooth decay, not to mention more embarrassing and stressful for the child.
I’ve worked with countless parents who were advised to treat constipation in their babies or toddlers with dietary measures alone.
For example, here's what happened when one mom in our private Facebook support group took her constipated 6-month-old to the doctor:
The general practitioner refused to give him a laxative and told me to up his fiber and give him prune juice and lots of water. This was a weaning baby whose main foodstuffs were pureed fruit and vegetables! When he was 1 1/2, I took him to the doctor again and was told he was “too young for laxatives.” I took him again at around 3 years, when soiling started, and was finally given a laxative.
But by that time, a laxative wasn’t sufficient, and the child needed a month of daily enemas to resolve his encopresis.
I understand why physicians are reluctant to put constipated babies on laxatives and suppositories. At first blush, these remedies seem overly aggressive, too invasive and/or unwarranted for such small children. After all, the Hippocratic Oath is, "First, do no harm."
Dietary recommendations seem like a more prudent way to go. What goes in does affect what comes out, and in adults and older children, chronic constipation is strongly related to our culture's over-consumption of highly processed foods.
But when a 10-month-old strains to poop, it’s clearly not because he frequents McDonald's and binge watches Netflix with his hand in a bag of Doritos!
As for the Hippocratic oath, the harm here is in failing to take aggressive action. It is a harm generally unrecognized by the medical community.
The fact is, most babies — even those who are severely constipated — have excellent diets, and improving the eating habits of a 1-year-old won’t fix the problem. (How did these babies get so constipated? I explain in The Pre-M.O.P. Plan.)
Prune juice, fiber, and water can help prevent a recurrence of constipation but will not clean out a chronically clogged rectum.
When it comes to treating constipated babies, the medical community needs a new way of thinking!
Chronic constipation in early childhood must be treated with a combination of laxatives and glycerin suppositories (solid or liquid, depending on the child’s age) — what I call the Pre-M.O.P. regimen.
Here’s a look at 7 popular constipation remedies for babies and young children and why they just aren’t good enough.
• Prune juice and pear juice. These juices do have somewhat of a laxative effect because they contain sorbitol, a natural sugar alcohol that helps draw water into the intestines, softening stool. But juices aren’t laxatives!
They’re just not potent enough to resolve the problem in most chronically constipated children, no matter how much the child drinks. Besides, juice is loaded with sugar, and for nutritional and dental reasons, guzzling juice isn’t a good habit for any baby or toddler to start.
I don’t think there’s any harm in giving a young child a few ounces a day of sorbitol-rich juice, but these beverages are unlikely to clear up chronic constipation.
• More fruits and vegetables. I am never, ever opposed to anyone eating more fruits and vegetables. Fruits and veggies are the best! Children should eat loads of produce every day, whether it’s fresh, frozen, or canned. These foods are packed with fiber, which adds bulk to poop and helps speed up its transit through the colon, and they contain lots of water, which helps lubricate stool and ease its journey through the tunnel.
Some 95% of children (and adults) don’t get the recommended daily amount of fiber — 19 grams for children ages 1 to 3 and 25 grams for children ages 4 to 8. So, loading up on apples, berries, green beans, and broccoli will help kids meet that recommendation and will serve them well as they go through potty training, school, and life.
But fruits and veggies, like juices, cannot dislodge a hard mound of stool impacted in a baby’s rectum.
• Fiber supplements. Strawberry-flavored fiber gummies are not a great way to compensate for not eating strawberries. For a child averse to eating fruits, vegetables, and whole grains, fiber supplements can be somewhat helpful, but they are not a solution to chronic constipation and won’t help your child develop healthy eating habits. There’s no shortage of terrific websites devoted to helping families eat more nutritiously (one of my favorites is Real Mom Nutrition), so I’d start there rather than aim to get your child’s fiber from a bottle of gummies.
• Drink more water. Fluid helps lubricate stool so it can move at a jaunty pace through the intestines. So, if your child has been weaned from breastmilk or formula and is not drinking plenty of water each day, by all means, get that child a fun sippy cup or water bottle and encourage frequent sipping.
But water, like juice and veggies, will not empty a clogged rectum. If these remedies worked, I wouldn't have a clinic full of constipated patients.
• Probiotics. Probiotics are live microorganisms intended to enhance the trillions of “good” bacteria in your digestive system, the “gut microflora” that help protect against
intestinal infections and possibly disease. This does not mean probiotics function as laxatives.
I know many people swear by probiotics as a constipation remedy, but research does not support a laxative benefit. Probiotics may help restore the gut after a viral or bacterial illness that causes diarrhea, but again, if probiotics were a magic bullet for constipation, we’d know it!
• Eliminating dairy. For constipated children with an intolerance or allergy to dairy, eliminating cow’s-milk products is likely to help, often in a big way. But not always. Some dairy-intolerant children quickly learn to associate pooping with pain, so even after you eliminate the offending foods from their diet, they are still prone to withholding and need an aggressive regimen such as Pre-M.O.P. or M.O.P. (M.O.P. is the Modified O'Regan Protocol, an enema-based regimen highly effective at treating enuresis and encopresis.)
There’s no downside to eliminating dairy from your child’s diet for a couple of weeks and noting any changes. But if cutting out dairy is going to help, it’ll help quickly. I don’t recommend prolonged elimination diets for kids who don’t exhibit dairy intolerance, which is . . . most kids.
• Eliminating gluten. Removing gluten from the diet rarely helps. Unless your child has been diagnosed with celiac disease or another condition that directly connects gluten intake with digestive problems, I don't recommend this remedy.
Constipation Remedies That Work: Laxatives, Suppositories, and Enemas
It's impossible to overstate the importance of aggressive treatment for constipated babies and toddlers.
Virtually all of my patients — the 7-year-olds who have accidents at school, the bedwetting teenagers — showed signs of constipation before age 3, but the signs were not heeded.
The fact is, everyone who eats every day — aka everyone — should poop every day. Not every other day. Not twice a week. Every single day. And these poops should be mushy blobs, not formed like logs or rabbit pellets.
If your baby or toddler is not fully evacuating daily, laxatives and suppositories (or pediatric enemas) are in order. Do not be afraid of rectally administered treatments!
It's only when parents actually start implementing Pre-M.O.P. (or M.O.P.) that they realize just how bad useless their prior treatments were.
Here's what one mom in our support group posted, years after she was told by a pediatric GI doc that frequent enemas are dangerous for children:
Doctors are so scared of enemas that they prefer your toddler go at least 3 days without pooping before getting a liquid glycerin suppository, and at least a week before getting an enema. My children were on adult doses of Miralax for long periods of time, and the situation kept getting worse. My son would only ever poop diarrhea, and he could hold in diarrhea for about a week, every week. Now that I see what a large volume of perfect consistency poop comes out of a child when they are having a bowel movement daily, I’m shocked most doctors are so comfortable with letting kids go an entire week without pooping, over and over and over again.
Want more details on how to effectively treat constipation in your child?
Read The Pre-M.O.P. Plan if your child is under age 3 or is age 3 and struggling to potty train. If your child is already toilet trained but having pee or poop accidents, read The M.O.P. Book: Anthology Edition.