The idea of potty training a toddler has always scared me, but what I witnessed with my three-year-old cousin brought this fear to another level. We were having a massive family dinner, one of those events bringing together our huge extended family for hours of eating, drinking, games and sitting around trying to fit three months’ worth of gossip into one evening. Right in the middle of everything, Olivia, a bright-eyed blonde little girl with enough energy for about four children, stopped, dropped the doll she was holding, and crossed her legs. A high-pitched squeal came from her mouth and I saw her mother dart across the living room, scoop the little girl up and rush off to the bathroom. Several minutes later they returned and Olivia went back to playing.

Fifteen minutes later the process repeated itself. This time Olivia squealed the entire time she was in the bathroom. This happened six times in the next two hours, each time becoming louder and more unnerving. Finally, Olivia seemed exhausted by the ordeal and fell asleep draped across her mother’s lap. Addison looked harried, but not as though this was something she had not gone through before. I worked up my nerve to ask what had just happened and she told me Olivia was constipated and retaining. Everyone knows the stress of constipation, but what had made it so traumatic for Olivia? Why was she having such a difficult time overcoming her potty training ordeal?

Constipation is not a fun experience for anyone, but for infants, toddlers and preschool-age children, it can be a genuinely traumatic experience. While not much is known about why severe constipation manifests in some children or the reasons behind many children not recovering from it fully, researchers have noticed trends among those little ones who suffer so terribly from the condition. While all children will experience fluctuations in bowel activity, some children will experience marked symptoms of constipation. Chronic constipation is characterized by symptoms including bowel movements fewer than three times per week, hard stools, difficulty passing stools, painful bowel movements often accompanied by screaming, soiling and the tendency to withhold stool as to avoid the pain and stress. These symptoms are often seen in higher numbers among girls, who tend to have a more psychological response to toileting.

Chronic constipation in infants, toddlers and preschool children can be treated with high levels of dietary fiber and doses of milk of magnesia. Children are considered to have achieved recovery when they no longer soil, are no longer withholding and are able to pass three or more normal-sized bowel movements per week even after stopping treatment. Up to a third of children, however, will not recover. Within days of stopping treatment the pain, soiling, withholding and lack of bowel movements will return. Parents coping with this condition with their young children may find themselves bringing their child to the restroom dozens of times per day only to see tiny bowel movements and hearing horrible screams from their children who are in pain due to the hardness of the stool, pressure of the unreleased stool and skin irritation and breakage due to passing hard stools and repeated wiping. Parents whose children do not recover after treatment should continue treatment and seek further medical treatment to reduce the pain and physical and emotional trauma to their children.

Source: Loening-Baucke V. Constipation in early childhood: patient characteristics, treatment and longterm follow up. GUT International Journal of Gastroenterology and Hepatology. Volume 34, Issue 10, pp 1400-1404, 1993.

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