Pooping on the Potty - Don't Make Me Go!

“Currently, our toddler is practicing willful control of her bowels - in a bad way. Potty training was going well for awhile, but suddenly she's refusing to let herself have a BM. (We made no changes to routine, diet, etc.) She's just flat out clenching and fighting for all she's worth to not have a BM, even when we add high fiber foods. After 3-4 days of a grumpy, constipated child, we finally pull out some PediaLax products, which then seems to *make* her go 1-2 days later. Then she'll be regular for 2-3 days, but after that, the cycle starts all over again. Any advice for me and/or your blog readers?”

Going poop in the potty is a common issue for toddlers.... something about pooping into that bowl really bothers some kids.  So they end up holding it in and get constipated.  Then it hurts to go because they are constipated, and they are even more afraid to go next time... so they hold it in.  Then they get more constipated... and so on.  It’s a painful cycle for your toddler and can throw a monkey wrench in what had been successful potty training efforts.

So... here's what to try if it happens to your toddler or child.  Buy some Miralax (an over the counter stool softener - very safe for kids, can use up to a year if you had to).  Other stool softeners can work, but often result in more cramping and cannot be used for long periods of time. Give 1 capful a day (17g) of Miralax mixed in liquid (if the stools are too soft, cut back a little).  But do this for at least two months - even if the stools are normal.  Stop pushing potty training temporarily while you do this.  She needs to forget that pooping hurts. 

Her colon needs to get used to normal-sized, soft stools for several months.  When constipation occurs, the colon gets stretched out of shape (think of how a woman’s belly gets all stretched after being pregnant – it takes time to get back to normal) (although I think mine will never get back to normal!).  The stretch of the colon sends a signal to our brain to tell us that we need to go.  If your colon is stretched out already, it takes even more stool to send that signal to your brain.  So, it’s important to give your child's colon time to shrink back to normal size before you stop the Miralax.  

It is very important to change your child's diet.  Avoid constipating foods (bananas, rice, applesauce, toast (white bread), cheese).  Give more fiber (oatmeal, bran, fresh fruits, vegetables), prune juice (if she'll drink it), prunes, and water.  For some children, too much milk or dairy can be constipating.  Toddlers need around 16-20 oz of milk to get enough calcium, but more than that can result in constipation and anemia (too much calcium can interfere with iron absorption which then leads to anemia or low red blood cells).  

Then in about two months, start trying to potty train again.  Don't remind her that she used to do it... just start from scratch... stickers, rewards, etc. 

Don't worry – there are very few kindergarteners still wearing diapers to poop or pee... so everyone gets it eventually!  Refusing to poop in the potty is very common and very normal toddler behavior.

If she hasn't poop in five days, has vomiting, has blood with stools, or severe stomach pain, call your doctor for help.  Do not use Miralax in infants.  If your baby is constipated, consult your child's doctor.

Hope this helps!  Thanks for reading and Happy 4^th of July! 

Tantrums – Can I Throw One?

“No!”  

(pleading adult voice)  

“NO!” 

(more pleading from the tired grownup) 

“NOOOOO!”  

  

This is my two-year old son in his gymnastics class today.  I can hear them as I am sitting in the waiting area for the parents.  I feel bad for the coach.  I knew it was going to one of those mornings.

You know how you just know on some days that your child just woke up on the wrong side of the bed?  Everything is a battle.  From changing clothes (“I can’t dooooo it!”) and then to brushing teeth (“I don’t waaaant to!).  Eating breakfast is a mini-Congressional debate.  “Eat your oatmeal, you said you wanted oatmeal.”  “I want pancakes!”  “You told me you wanted oatmeal, now you have to eat it.” “I want pancakes!”…. and so on.

The “terrible twos” start somewhere around fifteen months and end around age 4.  This is a normal part of development and can be very trying for most parents.  Your cute, adorable sweet baby has turned into a seemingly stubborn little monster.  Tantrums are a normal part of this.  It’s caused by your child’s need for independence and inability to harness feelings that they are having. 

Approximately 20% of toddlers have at least two tantrums a day.  And most will have at least one a week.  They are emotional outbursts that help children express the feelings that they are having.  For young children, they revert to primitive behaviors that express their feelings – yelling, crying, hitting, kicking, and even biting.  Luckily, most are short-lived and children recover quickly from them once they are distracted.   

How to handle tantrums? 

1.)  Ignore them.  Tantrums require an audience.  Has your child ever thrown a tantrum when no one was around to watch?  Children naturally want attention, especially from their parents.  So, when you are paying attention to them because they are screaming and throwing themselves to the floor, you are just reinforcing to them that “Hey, this is a great way to get mommy to put that computer down (or that baby , or that book, or those dishes, etc) and, by the way, I should remember to do this again in the future.”

2.) Be sure your child is safe.  If the tantrum is happening somewhere unsafe (as you are crossing the parking lot), pick your child up and move to a location where they can flail and cry and dramatize the end of the world because you wouldn’t buy the toy that they suddenly need.  

3.) Avoid the tantrum.  If at all possible, avoid your child’s triggers.  Hunger, tiredness, overstimulation are common triggers for kids.  Make sure they are well fed, that you are avoiding activities during naptime or late afternoon, and that your child is prepped for the activities to come.  Every child has a different temperament.  If your child gets a little crazy every time you go into a crowd, it may be too much stimulation for him/her.  Go to the festival or the museum when there aren’t so many people around.  It will be better for all of you.

4.) Take deep breaths and count to ten in your head.  It’s easy to throw the adult version of a tantrum when you are frustrated with your child or embarrassed by your child’s behavior.  Losing your own temper in front of your child just teaches them that yelling is okay.  Spanking is a grownup temper tantrum , hurts your child, and teaches him/her that hitting is fine.  Don’t be surprised if your child hits or “spanks” other kids when they think the other child has done something wrong.  Child abuse happens commonly when adults lose their patience.  If you need it, make sure that your child is safe and give yourself a time-out. 

Well, apparently, this coach knows how to handle cranky frustrated two-year olds, because my son is now happily working his way through the mini-obstacle course in the gym.  Thank goodness.  Perhaps today will be a good day after all!

Thanks for reading!

Constipation – The Pain of Strain

Poop – a necessary part of life.  It’s amazing how traumatic it can be for kids and parents alike.  So, if your child has a problem with constipation.  Then here are some things that you can do to make it a little easier. 

Some of what you can do depends on the age of the child.  

Young Infants – Babies tend to strain when the poop, especially newborns.  This is normal as long as the poop is soft.  As doctors, we don’t consider it true constipation unless the stools are hard.  It really does not matter too much how often they poop, or how much they grunt and groan and turn purple when trying to go.  Parents often assume that it’s hard for the baby to poop (if we did what they did, we would feel constipated!).  Not true.  However, if they haven’t pooped for 5 days or more, or if they are having hard stools, then it’s constipation.  (If you have a brand new baby, your baby should poop at least once in the first two days of life.)  

So, if you think your baby is constipated, you can try giving 1-2 oz of water. or take your baby’s rectal temperature to see if you can stimulate a bowel movement.  If this fails to produce a prize, then some doctors recommend giving a teaspoon of karo syrup.   If your baby still cannot go, or seems like he is in pain, or has blood in the stool, call your child’s doctor.

Older Infants/Toddlers – Again, it’s the consistency of the poop (how hard it is) as opposed to the frequency (how often) of the poop that determines constipation.  For older infants and toddlers who are now eating foods, there are certain foods to avoid if your baby is having hard stools.  Bananas, Rice, Applesauce, and Toast (the infamous BRAT diet) are foods that cause constipation.  So, avoid giving your grunting groaning toddler these foods when they are having trouble.  Also, too much cheese or milk can sometimes constipate.  Your baby needs at least 16-20 oz of milk (formula, breastmilk or whole milk if older than age 1).  More than that may be adding to the hard poop problem.

What can help?  More water, fresh fruits and vegetables (other than bananas).  More  fiber – in the form of oats (oatmeal), bran, whole wheat, will help.  I like to say that white foods constipate (rice, white flour), and brown foods help (whole wheat, bran, etc).  Check the labels of your whole wheat products.  Sometimes the wheat is so processed, that the bread appears brown, but has almost no fiber content.   Prune, raisins and prune juice can also help.

Potty-trainers – This  group is notorious for holding poop.  Something about pooping into the freedom of a potty terrifies those who are learning.  Often, a child will hold his poop until someone puts him back into a diaper.  By holding it in, more water is absorbed from the poop… and voila, constipated, hard stools that hurt.  Then, they are not only worried about the potty, but they are afraid of the next painful poop.  So, they hold it in… and the vicious cycle continues.  

Give your potty-trainer the best chance to succeed.  People tend to poop about 20-30 minutes after eating.  So, if you can, try to put your child on the potty around that time.  Read a book, color, listen to music, watch a portable DVD… do something to help your child to relax and forget about the fact that they are sitting on a potty.  Then, if they happen to go – CELEBRATE!  If they don’t, no reason to make a fuss.  Just wait until the next time.

Some children need Miralax, an over-the-counter stool softener.  This is a flavorless powder that you mix into your child’s drink.  It helps to keep the stools soft and can help children get back into a regular pattern with soft, painless stools.  It is safe to use for a period of time.  Ask your doctor for guidance.  And don’t forget the diet changes (it’s the same as what I’ve written for toddlers above).

Big Kids (and Grownups) – it’s hard to tell sometimes that an older child or teenager has constipation since you no longer are involved in that process anymore (thank goodness).  However, if your child complains of intermittent mild stomachaches, it may be related to constipation.  Avoiding the BRAT diet (Bananas, Rice, Applesauce and Toast) and too much cheese and milk (make sure they get calcium from other sources) might help.  Increasing fiber and using fiber supplements such as Metamucil or Benefiber will help.  Drinking plenty of water makes a difference.  Prunes, raisins, prune juice will help a lot of people.  If your child has not had a bowel movement in 3-4 days, call your doctor to see other medications are needed.  If the stomach pain is severe, there is blood in the stool, or your child is vomiting, call your doctor immediately. 

For a cute video on constipation by DadLabs, see the link below:

http://www.dadlabs.com/videos.html?view=dvideo&sid=1

Hope this helps those who are dealing with the pain of strain!  Thanks for reading!

Car seat safety - Rear Facing is Safer!

I have ten car seats... it's insane.  When my fourth child was born, the oldest was only five years old - so everyone needed a car seat.  And of course, my husband needed to have car seats for his car so that we wouldn't be moving them around all the time.  Then as the kids grew, we had to move to booster seats for the older ones.  Thus... ten car seats..

"When can I turn the car seat around?"  It's one of the most common questions I get from parents.  If your child is a big baby, then you may be anxious to turn him around to give him more space.  Several times, parents have told me that their child seems to "squished" in the car seat facing backwards, and that their child's legs seem cramped.  If your toddler is a picky eater and seems to be stuck at the 18-pound mark forever (like my daughter was), then you wonder if you child will be three years old before you can turn her around!

Many parents (including me) look forward to the day that they can finally turn their child around to be forward-facing in the car seat.  It's a milestone of sorts.  Your child can turn around like a "big boy" or "big girl."  Finally, you can see what your baby is doing (although you shouldn't be doing this while you are driving!). 

Studies have shown that rear-facing is much safer for young children.  They are disproportionately top-heavy, with their heads being big relative to their necks and bodies.  Therefore in a front-on impact, the rapid forward and back motion that a child's neck and head sustain can result in severe injury and even death.  In some European countries, it is even recommended that children stay rear-facing until 4 years of age!  I imagine that they much have a different type of car seat than what we have in the U.S. that allows larger kids to be comfortable.

It is recommended that you keep your child rear-facing as long as possible, up to age two years if you can.  Many states have laws that require rear-facing positions for children under 20 pounds and/or under one year of age.  This is good, but please realize that even longer is better.

Take a look at this video that shows the dramatic difference between forward and rear-facing car seats.



In addition to staying rear-facing as long as possible, studies have shown that five-point harnesses are safer.  Once you move your child from an infant seat to a toddler/convertible seat, look for those that have five-point harnesses.  There are also booster seats that have these as well.