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Ask Dr. K: Modify diet and habits to treat toddler constipation

DEAR DOCTOR K: My toddler has frequent constipation, and I have been giving him milk of magnesia about once a week. Is there any risk with this over-the-counter medicine?

DEAR READER: I’d suggest speaking to your pediatrician or family physician before continuing to give your son milk of magnesia.

Normally, children pass stool at regular intervals without much effort or pain. Infants and toddlers typically have several bowel movements a day. Most children age 2 or older have one every day. My pediatrician colleagues tell me they consider a child to be constipated when bowel movements happen less often than expected, or when the stools are hard and difficult or painful to pass.

Still, even though most children do not have constipation, it is a common problem. That’s particularly true for children between the ages of 2 to 5. This is the period when toilet training and developmental changes are happening. Many toddlers eat little fiber and lots of foods that contribute to constipation, such as dairy products, rice and bananas. Children also often don’t drink enough fluids. All these factors can cause constipation.

Toddlers also often wait too long to go to the bathroom. When a child withholds stool, it becomes hard and dry, and this may cause pain with the next bowel movement. So the child begins a cycle of withholding stool.

Before turning to medication, try modifying your child’s diet and toilet habits:

— Give your son more fiber-rich foods, such as beans, broccoli, carrots, whole grains and fruits.

— Minimize the dairy foods, such as yogurt, cheese and milk.

— Have your son drink prune juice. It works for kids as well as for adults.

— Encourage your toddler to drink four to six glasses of water each day.

— Make sure he gets regular exercise.

— If your son is toilet-trained, help him establish regular bowel movements by sitting him on the toilet at the same time each day.

— If you think your son is acting out because he resents potty training, try stopping it for a few weeks.

These changes usually help. But if they don’t, ask your pediatrician or family physician if you should try stool softeners and laxatives (like milk of magnesia). These types of medications are available without a prescription and have minimal side effects.

You can also try a nonprescription glycerin suppository. You insert this small lubricating pill into your son’s rectum, making it easier for him to push out a stool.

Sometimes a constipated child will develop an impaction: The bowel movement gets so dry and hard that it can’t be squeezed out without a little help. That can be a finger inserted with a little lubricant, gently pulling out the hard stool. But don’t try this until you talk to your doctor.

Dr. Komaroff is a physician and professor at Harvard Medical School. To send questions, go to AskDoctorK.com, or write: Ask Doctor K, 10 Shattuck St., Second Floor, Boston, MA 02115.

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