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Expert Q&A

	By John Dorsey, M.D. Pediatrician

My 3-year-old is always constipated. What can I do?

Constipation is a common problem in young children. When in occurs in toddlers just at or past toilet training stage it can be a vexing problem. On the one hand the child is learning how to control an important bodily function -- bowel movements. On the other hand the bowel movements in the constipated child become a source of pain and discomfort. This in turn can lead to social and psychological stress on the one hand for child and parent alike; and to physical problems such as anal fissures, rectal bleeding, and perineal (bottom) rashes on the other. In extreme cases constipation can evolve into encopresis which is pathological constipation marked by intermittent self-soiling, paradoxical diarrhea from liquid stool flowing around solid immobile stool, oppositional behavior, and social ostricization related to failure to develop normal habits of personal control. In extreme cases constipation can be a sign of systemic disease such as hypothyroidism so a thorough evaluation is warranted if other signs of illness are present.

While cause is important, systematic and phased correction of the problem is more important. A competent pediatrician working in conjunction with a pediatric gastroenterologist can help parents develop a successful program. Step one is to evacuate all old, hard stool -- a bowel clean out. Step two is to "convince" the child that bowel movements need not be a painful struggle and to elicit cooperation with the basic goal of establishing a regular pattern of going to the bathroom. Step three involves consolidating and maintaining the gains made during steps one and two, thus assuring the child does not regress with advancing age, a real possibility that may persist for years.

In the final analysis, constipation is not usually life threatening -- though intestinal perforation from overly aggressive efforts to evacuate or remove stool have been reported. It is however lifestyle threatening and thus should be dealt with as a solvable but chronic problem on a case by case basis. Find a caring, competent, knowledgeable pediatrician to get the right start in solving constipation. It will be a gift your child may never thank you for but it will last a lifetime.

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