Dr. Greene’s Answer:
As a result of stool holding, a child’s appetite will drop. Kids can withhold stool for a variety of reasons, but one reason is something I call the D3 Cycle–Discomfort-Dread-Delay. Kids have an uncomfortable stool, they get afraid of the next one, hold it for a while, the next one hurts worse, and the cycle continues–and gets worse. It can start at any point, often with delay (if they are busy playing, for instance). They can also do it from anger or fear–as with the arrival of a new baby in the home, parental divorce, a stressful move, or other life changes.
If the DDD cycle is the problem, the best way to break the cycle is often with medicine that will soften the stool and make it impossible to hold in. The dose is gradually adjusted until kids have a soft stool daily, and then left at that level for about two weeks while they learn that stooling doesn’t hurt and while the intestines shrink back to normal size. (Often kids who have withheld for a while are so stretched out that they can no longer feel the urge to go until it is too late.) Taper off after another two weeks. The starting dose of Miralax (one option) for a 4-year-old is usually about 2 to 4 teaspoons per day, but sometimes people need to go quite a bit higher before seeing the results. Have the parents check with their pediatrician to see if this might be a good approach for their boy.
Kids with this problem should also be encouraged to have a high fiber diet as well. This is something that you can help with! Ideally, lots of fruits and vegetables should be part of the diet. Any cereals or breads are best as high fiber cereals, whole-grain breads, and whole wheat pastas. Avoid constipating foods such as white rice, white breads, and junk food. In addition, papayas, beets, or daily prune or pear juice can help keep the stools soft once the DDD cycle has been broken.
Photo credit: globalmoments
Linda Cohen
Laundry detergents are not marked as could be hazardous to your health. I read that Tide is toxic as are many others. Do you write about the use of strong detergents and best way to wash clothes. My grandson is 6 and developed skin problems. I believe the new water saving washing machines are not sufficiently rinsing the soap out of the clothes. Do you agree that this is a problem. Thank you.
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Lori Rustin
Odd that you would say that about water-saving washing machines. We got a new one about a year ago. The instructions are to run a Clean Washing Machine cycle once a week. This is without soap. Just water. When I do that there are still suds. So they must stay in the washer … and our clothes.
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Mistie
I have a daughter who turned 5 at the end of August 2015. She started stool holding and having bowel accidents over a year ago. On the weekends she has accidents all day long. She has never had a problem with constipation but we lost our home to a fire a year ago this coming February and then her dad left in April and she has only seen him once in July. What can I do?? This is driving me crazy!! I am a nurse and have had her examined by her pediatrician. She has no physical problem causing this and I believe it is psychological due to the changes in her life this past year. I have taken her to counseling but didn’t see where it was making any difference and it was too expensive to continue. She started Kindergarten this year and just started talking to the counselor at school. Please help! Any suggestions would be greatly appreciated.
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Cheryl Greene
Wow, I’m so sorry for your multiple losses. What a tough year for you both.
Have you read Dr. Greene’s Q&A The D3 Cycle? If not, I think it would be very helpful for you.
@MsGreene
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