Toddler Constipation: How to Prevent It, What’s Normal & When to See a Doctor with Dr. Caitlin O'Connor | Ep. 114

0:00Hello, it's Layla, your official mom friend. Welcome back to the best podcast on motherhood because you get to be encouraged and supported on hard topics with actual tangible tips without being overwhelmed. I'm so glad you found us, mom friend. Now this podcast does tend to lean a little bit on the crunchy and holistic side. We love screen-free play, barefoot outside adventures, intentional family time, and always questioning the status quo. Asking ourselves, is something is truly the best choice for our families or just today's cultural norm? If that sounds like your vibe, you're going to absolutely love it here.

0:37Now, each expert guest comes with their own perspective and background, so please note that the content presented in this podcast is designed for general educational purposes only and is not a substitute for personalized professional medical advice, diagnosis, or treatment. Hi, Dr. Caitlin. Welcome to the Learning to Mom podcast. Hi. Thanks for having me. I'm very excited for today's conversation. It is one that is heavily requested, if you can believe it. As a mom, I believe it. As we were talking about, what 12 to 24 month old does not deal with constipation? But before we get into today's episode, can you just tell us a little bit about yourself?

1:16Awesome. Yeah. So I'm a naturopathic doctor. I practice in Denver, Colorado. I'm approaching my 20th year of clinical practice, which feels wild to say when I do that math, I'm like, oh man, how, how can it be? It's, it's flown by. So first let's talk about why constipation is such a thing, especially at this age. Yes. So I think constipation is a huge issue because a lot of, you know, if we think about even what our bodies evolved with sort of a hundred years ago, so much of our lifestyle is sort of different as far as how much movement we might get in a day. What are the types of food that are available to us?

2:00How were we born, right? If you look at hospital birth becoming like the norm, that's fairly recent in the spectrum of human history, which isn't to say there's, you know, really great medical investments when it comes to birth. Like people used to die in childbirth pretty frequently, but there's some downsides as far as like what does that mean for microbiome how are we feeding our babies all of that is going to shift microbiome quite a bit hand sanitizer antibiotic right there show any things that have shifted in our environment that have a negative impact on the gut I don't think it's very surprising when we sort of do a compare and contrast to how a gi system potentially evolved in the not so distant human past to like how we're doing things right now, it's like, oh, yeah, that makes like a ton of sense.

2:53I also think, for example, potty training, right, where we've got a lot of ideas about like how and when we do potty training. A lot of times parents are nervous because preschools will be like, well, your kids can't go to school until they're potty trained. So there's like this line in the sand, like, oh, my God, if they're not potty trained by two and a half, they can't go into this child care that we have planned for them. So there's these logistical things that we've sort of imposed on to our expectations around like toilet habits that all of a sudden put some stress in the system. And we're putting stress into the system right at that developmental age where kind of toddlers are individuating.

3:34They're saying like, I'm the boss. I'm a different person than who my parents are. Like, I am my own person. And then they start to perceive, oh, and not in like a manipulative way. Like, I don't think Like they're, you know, trying to change the outcome, but they're like, oh, where and when I poop is something only I have control over. Right. I am the boss of my external. So this is an interesting place for me to sort of experiment and play out with this idea of, you know, what I can and can't control. so if they're getting this theme of like whoa there's a lot of um pressure or interest around when and where i go to the bathroom that can sort of backfire because it just feels stressful and they're like well maybe i just don't want to poop then if it's going to be this big of a deal or i'm gonna have to go sit on that big scary toilet or everybody's gonna stare at me or you know everyone's you know waving these sticker charts in my face they're like maybe i just don't want to do this thing anymore.

4:40No, that's a good point. Actually, I'd never considered that. And we can't have this conversation without talking about the gut health, as you just mentioned at the beginning of that. So I do want to dive in deeper. I do just want to say we do have someone coming on to talk about gut health specifically. So I know that's going to be like the deep, deep dive. But can you just give us like a little spiel about that here? Because we can't have this conversation without that piece. Yeah, essentially. So when we're looking at sort of constipation, one component of that is our gut microbiome. Our gut microbiome is essentially, you know, the ecosystem of our GI tract that sort of starts with the mouth and ends at the rectum.

5:20We're essentially like one long tube. And that tube is host to billions and trillions of of organisms, bacteria, viruses, yeast, sometimes parasites that are all working together, sometimes for the benefit of the whole system. It can be a symbiotic relationship, right? Sometimes we think like, oh, bacteria, that's bad. Oh, yeast, that's terrible. And what the gut microbiome is sort of doing is it's helping us digest our food. It's helping us create certain sort of vitamins and nutrients. It's creating short chain fatty acids. It's interacting with our immune system. It's talking to our brain, right?

6:03Like all of these things are happening. And in a well organized system, that gut microbiome is sort of stimulating peristalsis. So that's like the movement of that sort of GI tube. It is fermenting fibers in a way that creates like a nice soft sort of bulky stool. So ideally, we have this ecosystem that's working like on our side. Occasionally, and not sort of that rarely, you know, something can disrupt that, right? We can have antibiotics, which are sometimes needed and helpful, but disrupt the gut microbiome. It can be how we're fed, right? We're going to have a different microbiome with breastfeeding versus formula feeding.

6:47Our microbiome is going to shift when we introduce solids. Our microbiome is going to reflect the microbiome of the people of our household. So let's say we, you know, the maternal microbiome was a little dysbiotic or imbalanced. We're going to pass that microbiome down to our kids through the placenta, through the method of delivery, through like living in a environment together. So when that microbiome is disrupted, we can see a change in stool consistency. We can see a change in how the brain and gut are coordinating. Oh, is it safe and relaxed to have a bowel movement now? Or are we like tense and sort of holding things?

7:29So one of the things that we look at with sort of constipation is, is there a microbiome component? And we can do that via history or you can do that via stool testing. There's lots of like pretty cool gut microbiome tests that are available. I think the biggest issue is working with somebody who has the experience to understand them and put them into the context of, hey, is this like a big deal? Yes or no. So helpful. Interrupting this episode super fast because if you love the podcast, you'll want to hear about our club on Patreon, where episodes go deeper and your confidence goes higher. Here's what you'll get inside.

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8:53Choose the tier that fits your life and budget. Either way, you'll get more support, guidance, and confidence as a parent. And guess what? If you join this month at the Mom Club Bestie tier and sign up with the annual plan, you'll automatically be entered into a special November giveaway. I'm reimbursing two besties who join this month for their entire year inside Mom Club. Yep, your whole year free. So if you've been waiting for the perfect time to join, this is it head to learning to mom podcast.com slash join choose the bestie tier and I'll see you inside um now what about so back to like poop yeah and as I said this is mom's listening right nothing is TMI we're all down here in the trenches I always tell patients every day I'm like listen I'm gonna talk to you about your poop way more than you are comfortable with there's nothing There's no such thing as TMI.

9:55I'm like, everything is just I. It's just information. The more information I have, the better it is. I love that. Everything is I. Okay, so then what does normal toddler poop actually look like? What should it look like? And also how frequent should it be? Yes. And I think this is important because toddler bowel movements can be funky looking. Sometimes they have teeth. Sometimes they don't have teeth, right? Like teeth are coming in at different times. Sometimes they're chewing. sometimes they're not chewing. The gut in general doesn't really fully develop to two to three years. It's still in like this developmental stage.

10:30So that means sometimes certain enzymes aren't kind of coming online till later. Sometimes the immune system is like, oh, have we seen this food or that food before? So there can be a wide variety of like normal. And I think a lot of times people think, oh, my toddler has diarrhea all the time. And I'm like, well, what does it look like? They're like, oh, they have one to two bowel movements a day. And they're kind of mushy and a little bit looser, but they're not like liquid. They're not like burning. We're able to wipe it off. It's not like super sticky. I'm like, oh, yeah, toddlers can have looser stools and that can be a variation of normal.

11:10We don't really start to see these like tubes, right? Like if we think about like an adult bowel movement, what are we looking for? We're looking for like nice, well-formed tubes one to two times a day. Toddler poops can be a lot softer. They can be a lot funkier. They don't kind of move on to tube life until maybe like, you know, three, four, five. Sometimes if we have babies who are still sort of breastfeeding through their toddler life, they're going to have those like softer stools for longer because of the prebiotic content of the milk. So I think there's a range of how normal looks. What I like to see for sure is bowel movements almost every day.

11:54In the conventional world, they define constipation as less than three bowel movements per week. To me, we're getting into tricky territory then, right? Because if we are skipping bowel movements, the likelihood of having a hard bowel movement, a painful bowel movement, goes up quite a bit. once we start having hard or painful bowel movements the child is like hey when i do that thing it hurts so why would i want to do it so they start to feel the urge to poop and they contract they hold it in because why would you want to have that painful experience exactly you don't know that you know having a bowel movement every day is important to detoxification and for your bowel health and if you hold it in you're gonna have a tummy ache like all you know is the last time you did that thing it hurt yeah so my default position is we want to have bowel movements that air on the looser side and that air on the side of more frequent ideally every day certainly we can skip a day you know here there we're traveling diets changed maybe we had you know more rice or crackers or whatever that particular food is it doesn't have to be like oh my gosh we skipped a day like call you know call in the troops but the pattern should be at least daily the vast majority of the time and the consistency should be soft enough that it doesn't hurt okay that's kind of what i'm looking for it can be kind of a mushy pancake scenario it can be looser than that but we don't want to have balls right if we're having like pellets, rabbit pellets, deer pellets, golf balls, that's a sign that the stool has been like sitting in the rectal vault.

13:41So the rectal vault is just a fancy word for like where the poop hangs out before it comes out. It's been sitting there too long and it's gotten dehydrated, right? The problem with that is one, it could be harmful, it could be painful, which then is going to result in withholding behavior. And it's just a sign that it's been there sort of too long. So what we don't want is pellets, tubes, golf balls. We don't want to be regularly skipping days. Our default is sort of every day for the most part. If kids are, you know, every other day, but their stools are soft, they have no issue. Like, all right, maybe, but really every day is the goal.

14:20And not hard, not painful, not balls. That's kind of the general gist I'm going for. Now, the one caveat to that is sometimes in kids who are really chronically constipated, they have like a bunch of hard stool in their like rectal vault and little bits of diarrhea or soft stool will go around it. So these are often kids who are like pooping their pants essentially, or they always have those little like skid marks in their underwear or diaper. They're not having frequent bowel movements. They're not having like frequent full bowel movements, but they're having lots of little soft diarrhea. So that can sometimes be this tricky thing where parents are like, oh, they have a loose stool.

15:08They're having like leakage. They are having bowel accidents. A lot of times kids are having bowel accidents. They're actually constipated and they can't feel the urge to have a stool anymore because they have that like stretched out rectal sort of vault area. and they just have this loose stool that's just like leaking out all the time. So that's like the little like, hey, you might not think your kid is constipated because they're having little bits of liquid stool or they're having a hard time with like poop accidents, but it's actually because they're constipated. And that's where, again, working with a provider that can really like dig into the details there is helpful.

15:49But in general, we want daily soft bowel movements that are not stressful and easy to pass. Now it's time for this week's segment of MomMail. If you're new here, this is the part of the show where I answer a listener submitted situation or scenario. Basically, you write in your tricky situation and I give you advice only a real mom friend would give. Here's what I received. Hi, mom friend. Thanks for making the podcast and for creating the MomMail segment. I love it. And I actually do need some advice. I know you're not a huge fan of screen time, which my experience with it might be the reason.

16:27But my two-year-old has suddenly become obsessed with the tablet, and I feel like every time I try to put limits in place, there's a meltdown. I want to encourage independent play and creativity, but it feels like a constant battle. How do I set boundaries around screens without feeling like the bad guy or making every day a total fight? Okay, I don't want to say anything harsh because I am a pretty black and white person. So sometimes my delivery can be very like black and white. First of all, a few things that I want to just say. Like we still use screens. Honestly, what we do, I would suggest.

17:11I think it's a good balance between like there are some screens, but not all. And also screens can be such a helpful tool. And that's what I expect is why you're using them. Like you're probably not just giving your kid a tablet just for the heck of it. It's probably because there's a need. Like maybe you work from home and your kid, your two-year-old is also home. So you're a full-time mom and a full-time worker. Or maybe like you had a long airplane, so you give airplane rides. So you give them a tablet. Like I understand that it's a tool, but then I understand that like meltdowns still happen.

17:43so one no shame in that secondly though I would suggest reading the anxious generation anxious generation by Jonathan Haidt it's H-A-I-D-T and I believe that is how you pronounce his last name the mom club on like our book club on mom club read this book and I am so grateful that they picked it because it forced me to read it. And it changed my life. And it changed the way that I view screens. And it changed how I went to parent around screens. And it changed how I view the neighbor that I grew up next to. And all of a sudden, when she turned 12, she became depressed. It has changed so much. So highly recommend that book because I think it will help you in navigating this whole screen journey that our generation of parents have to deal with.

18:42First, I want to say I am not someone who's going around giving my unsolicited advice. I'm not walking up to moms in public and being like, we don't use screens or we don't do tablets or blah, blah, blah, blah, blah, whatever. No one gives a crap and I'm not. But I am giving my two cents to you because you asked. So want to throw that out there. I'm not some like aggressive person. You asked. So here we go. I would not give a tablet. That is like the last thing that I would give. When we use screens, we use them on the TV. Like it's family time. It's movie night. Or Or we have an open concept.

19:28So when I'm in the kitchen making dinner, I can still see what's on the screen because I think adult eyes on your child's screen at all times is very vital. They have no self-control. They could end on a very adult content, even on YouTube kids. I think once you start kind of researching this realm and like the algorithms of all this stuff, just like all that's really happening from the business side of the algorithm, them, it's very eye-opening. I believe parents' eyes should always be on their children's screens prior to an age of maturity. And even then, then there needs to be boundaries and such.

20:10But what we do is maybe I'm making a dinner and I really need a break. So we'll put on a old, low, stimulating show. It's easier than to turn it off when their brain hasn't just been being pushed with dopamine hit after dopamine hit of all of these bright lights and colors. Like literally these shows that are made today is made so that our brains become addicted to them. There is so much science behind it. So it's no wonder that your toddler is having a hard time letting go of the screens when you say no more because their brains have become addicted. Like it's hard enough for us to put it down our screen.

20:58Imagine a two-year-old. So how do I set boundaries around screens without feeling like the bad guy? To be honest, I would rip off the band-aid and I I would not give the screen. That might not be the answer that you're looking for, but I would not give a tablet unless it's like a dire situation. And I would make sure that my eyes are right there. And when you give the tablet, I would say, you can watch one show or you can play one game. And then I'm going to be taking it back from you. So they have to know that you're in control of it and they have to know the boundary upfront, right? I mean, just think of it like if you were in their shoes, you're watching your favorite show, you love it so much, and then all of a sudden at the point that you're really enjoying it, your husband walks over and turns off the TV.

21:49Oh, I would be so mad. I would be so mad. But if I knew going in, I'm only going to get to watch this one show or I'm only going to get to play this one game, the meltdown is less. And that's not saying that there's not going to be a meltdown because there are two and they've just been watching a show that is meant to addict their brains. Hold steady. Hold the course. Do not give in. Do not give in. That is my greatest advice. When you give in, you're teaching them a few things, one of which is telling them if you scream and cry loud enough, I will give you it back. So you're just rewarding the bad behavior.

22:28If you stand firm and you're nope, I told you one show, you watched the show, they will understand that your words matter, your boundaries matter, and you're not a pushover. Like that is very gentle. That's not bad parenting. That's just parenting. So hold firm, hold firm, which I understand is hard. And then only hold the screens for really special activities. And I do understand that screens are a tool, right? if you're working from home, you might really need some screen time. And I want to release you of some of that guilt because I know you're trying your best. We're all trying our best and you're doing what you need to do.

23:07But I would just choose something like putting the screen as far away from them as possible. So putting something actually on the TV as opposed to in their little hands where they hold the phone or they hold the tablet two inches away from their face and choosing the least stimulating show. Hopefully all of that helped and I didn't come off too strong because I really am passionate about that. So I hope that was helpful. Thanks for writing in and thanks for your kind words. If you're looking for advice, email me at learningtomompodcast.mommail at gmail.com with the subject line mom mail and then keep your ears open because we might just answer it in an upcoming episode.

23:47What are just some things that we need to make sure are just regular part of our lifestyle to prevent constipation from occurring in the first place. Fiber is a huge one. We need fiber in foods, essentially. Now, some kiddos based off of preference, textural issues, a whole host of things can sort of limit the ability to get sort of fiber into toddlers. But the great thing about toddlers is most toddlers love fruit. and fruit is a great sort of fiber source so sometimes people feel like oh my gosh I you know yeah and hydration yes hydration was gonna be the next one uh hydration water hot take on my end I don't think most toddlers need cow milk and I would say in the kids that I see with constipation the very first thing I ask is how much cow milk are they drinking every day I don't think nobody he can have dairy.

24:45But I think it's weird that all of a sudden the day a child turned 12 months, now they're required to drink multiple glasses a day of dairy milk, whereas, you know, at 11 and a half months, supposedly their gut can't handle any milk. But as soon as they turn 12 months, it's like they have to have milk. Milk's a great protein source. It's a great fat source. What I see in toddlers is the first thing that I do with a kid that has constipation is cut out dairy, which is a bummer. Dairy is delicious. And it's in everything. It's in everything. And it doesn't have to be like trace dairy. It doesn't necessarily have to be butter, but like definitely cow milk, oftentimes like yogurt, cheese sticks, etc.

25:30That's like the first thing I experiment with. That's not going to solve it for everybody. But I would say 30 to 40 percent of the time, like that's it. I think water is pretty much all that kids need to be drinking. There's certainly reasons to get other drinks in there. You know, there's a lot of different reasons that we interact with food. Some of it's sort of nutritive, some of it's fun, some of it's cultural, right? So we might be doing different drinks, but when it comes to just like, what do kids need as a fluid? It's water. And the sooner we can get them drinking water and defaulting to water is their beverage of choice, sort of the better.

26:09And the water is going to help with the hydration. Movement's another big piece. Most toddlers are pretty wiggly though. You know, older kids, sometimes we have to talk about like, hey, when we exercise, when we move around, that is what sort of stimulates the gut. But most toddlers are partying pretty hard. So we don't have to worry about movement as much for that age group. And then, yeah, thinking about foods that have prebiotics, fermented foods, potentially probiotics, those can all be helpful as well. Okay. That was so helpful. And now I want to ask the question that I think everyone is wanting to get to, and that is you have a child who's constipated, has not pooped in days.

26:55What are we doing from a natural standpoint? Yes. And here's what I say, you know, my number one priority is kids having regular, non-painful, non-stressful bowel movements. So for example, there's a, there's what we would want in that category is usually like a stool softener or a bowel stimulant. If what works best for that family in a short-term scenario is like a Miralax, I think that's fine to use as a short-term solution, right? So I don't want to say, you know, oh, we can only use our non-pharmaceutical tools to support regular bowel movements when our first priority is pooping daily, soft, non-stressful poops.

27:41What I mean by non-stressful is the kid isn't withholding, they're not crying, they're not going to the corner, they're not having to do like different body positions to get their stools out. They're just like, hey, I'm pooping on the potty, I'm pooping on my diaper. It's no big deal. It's a part of my day, right? So my first step is whatever gets us there is fine with me. If it is Miralax, fine. Most of the families that come to see me are looking for like a alternative to that. And we've got like a number of tools that could be helpful there. Magnesium is sort of the big one, right? Magnesium acts as a stool softener.

28:18We can only absorb so much magnesium when we take it orally. The rest stays in our intestinal tract. It draws water into the intestinal tract and makes a softer stool, right? So it is a stool softener, essentially. That's really safe to use. So are you taking magnesium capsules and putting them in applesauce? There's magnesium gummies, right? There's magnesium gummies, there's magnesium drops, there's magnesium powder. I do think it has to be oral, right? People will be like, oh, could you do a magnesium oil? Could you do an Epsom salt bath? I think those are helpful for different reasons, but it's not necessarily going to trigger like a softer stool.

28:57It's not acting like an osmotic laxative, which is essentially a laxative that makes the stool softer so we can pass it. So when we are in what I would call like an acute scenario, which is like, hey, we haven't pooped in a while. Kids are complaining of tummy aches. They're bloated. They've had a history of harder stools. we basically want to make the stool soft enough that when they have a bowel movement, one, it's hard for them to hold it in because it's sort of too soft. And two, it's not painful. So again, we're erring on the side of softer stool. I would rather use whatever stool softener of choice we kind of pick.

29:39Magnesium is what I sort of use the most and push it. You know, it can be a fine line, we don't want to, especially, you know, oftentimes I'm like, hey, if we're introducing a stool softener, maybe it's on a Friday where we're going to be home for a couple of days and we're not sending our kiddo to childcare to have, you know, 10 bowel movements in a day. But yeah, it's whatever our stool softener of choice is. I tend to use magnesium the most. The other thing to consider is some kids do need to do what's called like a bowel prep or a bowel clean out. Those kids who have been constipated for a long time, we're kind of, this is like a different story.