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 “DDD 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, such as mineral oil, 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 the mineral oil off after another two weeks. The starting dose of mineral oil for a 4-year-old is usually about 4 teaspoons per day, but sometimes people need to go as high as 12 teaspoons 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! Lots of fruits and vegetables, high fiber cereals, whole grain breads, and whole wheat pastas should be regular parts of this little boy’s diet. Avoid constipating foods such as white rice, white breads, and “junk food”. In addition, daily prune or pear juice can help keep the stools soft once the DDD cycle has been broken.

Dr. Greene’s Answer:

As long as your daughter is in diapers, every single bowel movement will be right there for you to see when her diaper is changed. During the diaper years, the stools undergo several changes. The first bowel movements are the thick, sticky, tarry meconium stools formed while the baby is still inside you. During the first week, these give way, in breast-fed babies, to soft, yellow, breast-milk stools. These usually look like yellow mustard with little seeds. By the time a baby is one week old, she has an average of 8 to 10 of these pleasant (as stools go) stools each day. Formula-fed stools are often tan or yellow at this stage, and a little firmer than breast-milk stools. Either way, there are many dirty diapers!

By the time a baby starts solid foods, bowel movements have decreased to an average of once a day. Beginning solids usually produces a noticeable change in the character of the stools. They may be either softer or firmer, but they will likely smell worse (kids also smile and laugh more at this age, more than making up for the unpleasantness). Most children’s intestines are very responsive to the foods they eat.

Bananas, rice, soy, and products made from white flour tend to produce firmer stools. Pears, peaches, plums, apricots, peas and prunes make stools softer. By balancing the diet, you can often keep the stools comfortably mid-range.

Babies will normally strain from time to time to move the stool along through the intestines. If you want to do something when babies grunt, push, or strain, try picking them up to get gravity to help them in their efforts, or try holding the knees against the chest to help them “squat” — the natural position for bowel movements. Straining is usually normal. Crying while straining may be a sign of constipation.

When a child is constipated, the stool in the intestines has backed up more than it should. The longer stool sits in the colon, the more water is absorbed back into the body. When a child is constipated the stool tends to be hard, and passing it tends to be painful. Note that passing bowel movements less frequently does not necessarily mean that a child is constipated. Some children will naturally go through periods when they don’t have daily bowel movements. Some children may even go days without having a bowel movement. If they pass stool easily, softly, and without pain or blood, they are probably not constipated.

The simplest first step is to give the child more to drink to soften the stools. At the same time, readjust the balance of the foods in the diet to help.

If the stools are still too firm, juice is the gentlest medicine to soften them up. Apple juice twice a day is a good bet. If this doesn’t work, prune juice is even better. Baby food pureed prunes can also be used to soften the stools. In addition, when your daughter is straining you might want to put her in a tub of warm water. This will relax her muscles and make the stool easier to pass.

Glycerin suppositories can be very helpful if diet and juice don’t work, but overuse of suppositories can lead to dependence on them. Constipation stubborn enough to make suppositories necessary should be discussed with your pediatrician. The same holds true for baby laxatives (hint: if your pediatrician does recommend a laxative, 1/2 teaspoon of unprocessed bran, mixed with food twice a day, is about as effective as many laxatives and much cheaper).

With the right combination of foods, liquids, and medicines (if needed), every child should be able to have soft, comfortable stools. As they grow, their intestines will get less sensitive to the foods they eat. And someday soon, you will leave the diaper era entirely behind, and you will both get to enjoy life with no more dirty diapers!

Dr. Greene’s Answer:

As long as your son is in diapers, every single poop will be right there for you to see when the diaper is changed. During these years, the stools undergo several changes. The first poops are the thick, sticky, tarry meconium stools that consist partly of old skin cells that are shed and then swallowed while the baby is still inside you. During the first week these give way, in breast-fed babies, to soft, yellow, breast-milk stools. These usually look like yellow mustard with little seeds. By the time a baby is one week old, he has an average of 8 to 10 of these pleasant (as stools go) stools each day.

You can imagine that if these were 8 to 10 stinky stools, or if even the pleasant (as stools go) stools kept up at this pace, changing diapers would get real old real fast.

For most breast-fed babies, the number drops to about 4 per day by 4 weeks old (although many kids have a different pattern). Formula-fed babies usually stool less often at this age, and the stools do not change much with time until solid foods are introduced (because unlike breast milk, formula doesn’t change over time). Formula-fed stools are often tan or yellow at this stage, and a little firmer than breast-milk stools. For any baby, tan, yellow, green, or brown stools can all be normal. By 8 weeks old, the average drops to 1 per day. Most formula-fed babies will not go less often than daily, but many breast-fed kids will poop even less often than this. I know many babies who only go every three days. If a happy formula-fed baby goes 4 days, or a breast-fed baby goes 7 days without a stool, I recommend that he or she be checked once by a pediatrician. If the child seems to be in pain, has vomiting, or has blood in the stool, he should be seen by the pediatrician immediately. Otherwise, it can be completely normal to go only once every eight days — as long as the stool is soft when it comes out. Breast milk is an amazing food that leaves very little in the way of waste.

Babies will strain from time to time to move the stool along through the intestines. If you want to do something when babies grunt, push, or strain, try picking them up to get gravity to help them in their efforts, or try holding the knees against the chest to help them “squat” — the natural poop position. Straining is usually normal. Crying while straining may be a sign of constipation.

When a child is constipated, the stool in the intestines has backed up more than it should. What “more than it should” means varies depending on the age of the child and the diet. The longer stool sits in the colon, the more water is absorbed back into the body. When a child is constipated the stool tends to be hard, and passing it tends to be painful.

Stool that is hard (firmer than peanut butter) or foul smelling (you’ll know) in a child who has not yet had solid foods may represent something as simple as needing more to drink (especially during hot weather), but it may also be the sign of a disease. Contact your pediatrician to discuss the situation. If the baby is otherwise healthy, one teaspoon of light *Karo syrup in 4 ounces of water will often get things back on track. Also, contact your pediatrician if the baby is less than a month old and hasn’t gone for 4 days. When kids begin to take baby food, the stools change once again. They may be either softer or firmer, but they will likely smell worse (kids also smile and laugh more at this age, more than making up for the unpleasantness). Most children’s intestines are very responsive to the foods they eat.

Bananas, rice cereal and applesauce all tend to produce firmer stools. Carrots and squash are constipating for some babies. Pears, peaches, plums, apricots, peas and prunes make stools softer. By balancing the diet, you can often keep the stools comfortably mid-range. If the stools are still too firm, juice is the gentlest medicine to soften them up. Two ounces of apple juice twice a day is a good bet. If this doesn’t work, prune juice is even better. Also, when your son is straining you might want to put him in a tub of warm water. This will relax his muscles and make the stool easier to pass.

Glycerin suppositories can be very helpful if diet and juice don’t work, but constipation that is stubborn enough to make these optimal should be discussed with your pediatrician. The same holds true for baby laxatives (hint: if your pediatrician does recommend a laxative, unprocessed bran, 1/2 teaspoon mixed with food twice a day is much cheaper than Maltsupex, and about as effective).

For most breast-fed babies, a 3-day break from dirty diapers is a reason to celebrate, not a cause for alarm. It’s nature’s reminder that breast milk is the perfect food for babies — or more broadly, that giving of yourself is a perfect gift for your child. This normal poop-pause is also a little foretaste of what life will be like when there are no more dirty diapers!

*Note: Children under age 1 should not eat honey because of the risk of infant botulism. Today, corn syrups are manufactured under sanitary conditions to prevent this, but the manufacturers do not make any guarantees. Of course, neither can I. The 2009 AAP Report of the Committee on Infectious Diseases states, “Manufacturers of light and dark corn syrups cannot ensure that any given product will be free of botulism spores, but no case of infant botulism has proved to be attributable to consumption of contaminated corn syrup.”

Dr. Greene’s Answer:

Babies will strain from time to time to move the stool along through the intestines. If you want to do something when babies grunt, push, or strain, try picking them up to get gravity to help them in their efforts, or try holding the knees against the chest to help them “squat” — the natural poop position. Straining is usually normal. Crying while straining may be a sign of constipation.

When a child is constipated, the stool in the intestines has backed up more than it should. What “more than it should” means varies depending on the age of the child and the diet. The longer stool sits in the colon, the more water is absorbed back into the body. When a child is constipated the stool tends to be hard, and passing it tends to be painful.

Stool that is hard (firmer than peanut butter) or foul-smelling (you’ll know) in a child who has not yet had solid foods may represent something as simple as needing more to drink (especially during hot weather), but it may also be the sign of a disease. Contact your pediatrician to discuss the situation. And contact your pediatrician if the baby is less than a month old and hasn’t gone for 4 days. At two months old, healthy breastfed babies may go 8 days between stools without being constipated. Healthy formula-fed babies at that age usually go every couple of days. When kids begin to take baby food, the stools change once again. They may be either softer or firmer, but they will likely smell worse (kids also smile and laugh more at this age, more than making up for the unpleasantness). Most children’s intestines are very responsive to the foods they eat.

Bananas, rice cereal and applesauce all tend to produce firmer stools. Carrots and squash are constipating for some babies. Pears, peaches, plums, apricots, peas and prunes make stools softer. By balancing the diet, you can often keep the stools comfortably mid-range. If the stools are still too firm, juice is the gentlest medicine to soften them up. Apple juice twice a day is a good bet. If this doesn’t work, prune juice is even better. Also, when your son is straining, you might want to put him in a tub of warm water. This will relax his muscles and make the stool easier to pass.

Glycerin suppositories can be very helpful if diet and juice don’t work, but constipation that is stubborn enough to make these optimal should be discussed with your pediatrician. The same holds true for baby laxatives (hint: if your pediatrician does recommend a laxative, unprocessed bran, 1/2 teaspoon mixed with food twice a day is much cheaper than Maltsupex, and about as effective).