Constipation, the passage of infrequent, hard, and painful stools, is a common problem, affecting three percent of preschoolers and one to two percent ofschool-aged children. Pooping once every few days is not abnormal if that is your child's usual pattern. In fact, 96 percent of children ages three to fourshow tremendous variety in pooping patterns: anywhere from three stools a day to three a week.

What Causes Constipation

The original cause of constipation might have been any one of these:

  • Diet. Not enough fiber-rich foods.

  • Behavior. Your child may have attempted to control stooling during the period when you began toilet training.

  • Response to pain. One painful bowel movement can cause your child to fear passing stool and withhold further movements.

Whatever the original cause, stool sits in the rectum, becoming larger and harder. Each passage hurts, and the problem starts to perpetuate itself as thechild resists relaxing and letting nature take its course.

Overflow Incontinence

When constipation persists for a while, sometimes soft stool coming down the pike leaks out past the old, hard stuff. Smears of semi-liquid stool or evenwhat appears to be diarrhea may turn up in your child's underwear. This diarrhea-like condition, known as overflow incontinence, is not a legitimate bowelmovement, nor is it in your child's control. It is, however, a sign that something needs to be done, especially if the soiling is affecting your childsocially.

What to Do About Constipation

Since there are some physical and medical problems that can involve constipation, it's a good idea to consult your pediatrician or health care providerjust to rule those things out. Your child probably won't need extensive tests; mainly the doctor will review the history of the problem and check yourchild's height and weight and do a general physical examination. Your healthcare provider may want to check inside the rectum with a finger, but if shedoes it gently, it need not be traumatic or painful.

Re-educate the Bowel

The first step is helping the hard stool come out. There are a variety of options. Your pediatrician may start with a simple glycerin suppository orsuggest a pediatric enema preparation. To maintain soft stools, she may want your child to take mineral oil or a stool-softening agent for a few weeks oreven months. The goal is to re-educate the bowel: to establish a regular schedule of bowel movements so that the stretched, and lazy, intestinal wallsregain their strength and tone.

Add fiber

Examine your child's diet. Children who drink excessive amounts of milk or who avoid fruits, vegetables, and whole-grain cereals and breads may simply havetoo little fiber in their diet. Add fiber any way you can: apples and pears instead of bananas, granola bars instead of chocolate bars, oatmeal cookiesinstead of regular cookies, and whole-wheat bread rather than white. Snacks of raw vegetables with a yummy ranch dip is also a good trick to get somevegetables down. For finicky eaters, your pediatrician may suggest a fiber supplement.

Focus on reward

Resist punishing your child or express anxiety or dissatisfaction when you see her withholding stool or being reluctant to try. Instead, establish a seriesof rewards when she does produce. Although some cramping and small amounts of blood may be a part of constipation and are nothing to worry about, be sureto consult your healthcare provider right away if your child's abdomen swells suddenly, if she is both vomiting and constipated, or if there is asignificant amount of blood or pain.

Finally remember that constipation is a common problem in young children, especially the fussy eaters. Tweaking your child's diet might resolve the issueeasier than you think!