Topic of the week: Let’s talk poop!
I have been working in the pediatric field for over 20 years now, and there is one topic that seems to come up with alarming regularity: poop. Parents are obsessed with their child’s poop – how often they go, what color it is, what it smells like… Whatever question you could think of about pediatric bowel movements, I guarantee you I’ve already been asked. Therefore, in this week’s blog, I decided to get down and dirty with the facts about fecal matter.
Let’s tackle the one of the most common complaints first: constipation. It can be very distressing for both the child and the parents when things aren’t moving through like they should. Firstly, I try to stress to parents that constipation is about the consistency of the stool, not the frequency. In other words, it is not as important how often they go, it’s how the stool looks. Constipation produces very hard, difficult to pass stools. Often they appear like pebbles or rocks. Older children will report pain and straining with bowel movements, and they are often accompanied by bright red blood that comes from small tears in the anus from the large stool volume. If the child is pooping infrequently, but the stools are soft, that is not constipation. It is not necessary for an infant or child to have a bowel movement every day. In fact, some exclusively breastfed infants can poop once a week or so and have entirely normal and soft stools.
If a child is truly constipated, there are several home remedies that are perfectly acceptable to try. Giving the child extra water, giving juice half and half with water (particularly apple, white grape, or prune juice), and increasing fiber rich foods can all help. My favorite home remedy is Dark Karo Syrup. You can find it in the sugar aisle of the grocery store. 1 teaspoon a day of Dark Karo Syrup always gets them going!
The idea behind treating constipation in children is to soften the stool, not stimulate the moving and cramping of the bowels. In other words, we use stool softeners not laxatives. All the remedies listed above are stool softeners, which means they encourage the colon to absorb more water from the body, which in turn makes the stool softer. There are some medications I commonly prescribe that do the same thing. Miralax powder is effective and safe for children, as is Mineral Oil, Milk of Magnesia, and Colace.
Now let’s discuss the opposite problem – Diarrhea. The official definition of diarrhea is having at least three loose, liquid, or watery bowel movements each day. It is very common in toddlers, and is often seen in conjunction in a viral gastrointestinal illness along with vomiting. While this can be extremely upsetting to parents (not to mention hard on the diaper budget), diarrhea by itself is usually of little medical concern. I always encourage parents to take their cues from their child. Are they active or lethargic? Are they eating and drinking, or not taking anything by mouth? What does the stool look like? Does it contain mucus or blood?
If a child is acting normal, taking in adequate fluids with no vomiting, and there is no blood or mucus in the stool, it is not usually necessary to treat the diarrhea except with what we call the “BRAT” diet. These are foods that are gentle on the GI system and promote formed stool. B stands for bananas, R stands for rice, A stands for applesauce, and T stands for toast. This diet, along with fluid replacement with water or Pedialyte, is usually all that is needed. Beware of sugary beverages such as soda pop, fruit juices, and Gatorade. The sugar in these drinks can make diarrhea worse.
Sometimes for diarrhea I recommend probiotics. These are the “good” bacteria in the GI system that promote the normal production and passing of soft-formed stool. Most brands are over the counter and come in liquid, powder, chewable, and tablet forms. Some brand names include Culturelle, Florastor, and Lactinex.
So there are the answers to two of the biggest poop concerns. As always, if you are unsure about what to give your child, the home remedies aren’t working, or there are other symptoms along with either constipation or diarrhea, please bring your child into the office for an appointment. Otherwise I wish you and your child happy pooping!