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Can We Talk About Our Constipated Kids?

Photograph by Twenty20

OK, parents. Let’s talk about a subject near and dear to all of our hearts.

I want to talk about pooping.

Yes, I’m going there.

From those first anxious inspections of your newborn’s diaper to hovering outside the bathroom door because your preschooler “needs her privacy,” moms and dads of young children everywhere spend a crazy amount of time thinking and worrying and talking about poop. No wonder our kid-less friends just love hanging out with us.

We worry if our children aren’t pooping enough or pooping too much. We update each other on what time the pooping happened. How long did it take? Was it hard or soft? What color was it? Was there crying or complaining involved? And we speculate endlessly about what this all means about our children’s health and well being.

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And what’s the most common complaint stressing all of us out? Constipation. Yup. Our kids can’t poop, and no parent needs to be told how much that sucks for everybody.

If this is your daily reality, hey, you’re not alone. The National Institutes of Health estimate that constipation in American children ranges anywhere from 4 percent to 36 percent. And a 2009 survey of household medical expenses found that the extra cost of healthcare for children with constipation was $3.9 billion per year.

Seriously, you guys. Pooping is big business.

You might also be under the impression that kids in the U.S. or other developed countries are the only ones not pooping. It’s not true. Medical studies from Asia have reported equally high rates of constipation, from over 10 percent in Sri Lanka to over 18 percent in Japan.

Yes, it’s all very interesting. But as parents, we just want to know why this is happening to our kids and, more importantly, how we can fix it. Unfortunately, there are no clear answers to either question. If you start Googling or call your pediatrician or ask your great aunt Sylvia about your constipated toddler, trust me, you will get ten different explanations and remedies, and none of them might actually work for you.

The most common causes of constipation that (almost) everyone agrees on are:

1. Your kid isn’t eating enough fiber.

2. Painful pooping experiences or potty training have freaked your kid out, and he doesn’t want to poop.

3. Your kid is dehydrated.

4. Your kid has an allergy to cow’s milk, gluten, soy, eggs, tomato fish, cocoa, oranges, legumes, or um some other unknown food that you will have to do a super annoying elimination diet to discover. Good times.

Of course, the cause of your child’s constipation could also be none of the above. And the treatments for constipation are equally vague and full of strongly held beliefs that are rooted in cultures and family traditions, but have little basis in, you know, science.

So, the upshot is that childhood pooping issues are widespread, painful, expensive, and frustrating, and nobody really knows how to cure them.

Fiber is a big one. All you need to do, your mom friends might tell you, is to get more fruit, veggies, and whole grains into your child, and all your pooping problems will be solved. Putting aside the fact that convincing your child to eat those things might be damn near impossible, there is actually very little evidence to suggest that a high fiber diet will cure constipation. Doctors calculate children’s daily fiber needs as the child’s age + 5 in grams. Less than that is bad news for pooping. But adding more and more fiber for chronically constipated kids has no proven therapeutic value and can actually make things worse.

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Another big one is water. “Give more fluids,” your pediatrician says wisely. Unfortunately, at least three medical studies have found that increasing water intake had no effect on children’s constipation whatsoever. They just pee more.

And then there is my personal savior, polyethylene glycol 3350, more commonly known as Miralax. Just when we thought we had found a discrete, tasteless, effective little miracle cure for our non-pooping children, the FDA had to go and question its safety. They’re going to get back to us about whether long-term use of the popular laxative can cause behavioral or psychiatric side effects in kids. Yeah, that would be good to know.

So, the upshot is that childhood pooping issues are widespread, painful, expensive, and frustrating, and nobody really knows how to cure them.

“We don’t know a lot,” says Dr. Andra Fertig, a pediatrician at Bellevue Hospital Center in New York City. “But the GI tract has the second most nerves in the body after the brain.”

So, clearly, it’s complicated.

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