First teeth, first steps, the terrible twos, and now toddler constipation. Toddler years are quite intense, filled with fun moments, frustrations, and sometimes transit problems.
In this article, we will leverage our foundational tools to deal with toddler constipation: nutrition, supplements, medicinal plants and a healthy lifestyle.
But we will also linger on one important event that may create psychological blockages in your toddler: potty training and the giving up of diapers.
This article builds upon the newborn constipation and baby constipation articles, for which we defined a good framework for our discussion. In a first step, you should review those two articles, since they introduce important concepts that still apply to older babies and toddlers.
So let’s dig into the meat of this discussion. Wait for nap-time, put the little one in bed, brew yourself a nice cup of tea, and read on...
In terms of nutrition, we already covered a lot of ground in the baby constipation article.
The same concept will apply for toddler constipation. The only difference is that instead of eating foods mashed, your child can start to share a meal that resembles what we eat, diced thinly of course.
Let us go through a refresher of the basic anti-constipation nutritional concepts.
We already discussed the fact that meals should be prepared from scratch. Do not get fooled into believing that Gerber or other industrial food companies have the interest of your toddler at heart. Using supermarket prepared food will deplete your child’s reserves of essential nutrients, vitamins and minerals.
Be also careful with the different labels, including the “organic” one. The industry has had plenty of time to bend the rules, lobby the lawmakers to relax some criteria, and get us to a place we could call “big industrial organic”. I am convinced that big industrial organic is only marginally better than regular supermarket food.
What makes a greater nutritional difference, in my opinion, is:
Grains are more and more problematic. Naturopathic practitioners like myself are seeing a rise in gluten intolerance. Even if the child doesn’t have a full-blown intolerance to gluten, he can to exhibit a gut sensitivity, without necessarily an acute inflammation, but with a low-level constant irritation, sometimes accompanied with toddler constipation.
Besides, we already saw in the foods that cause constipation article that gluten, when broken down by our gastrointestinal tract, releases opioids, opium-like substances called "exorphins". And opioids cause constipation, that is a well known fact. How much opioids is released from gluten and absorbed by our system is open to debate.
What is not open to debate is this: when you are trying to solve a chronic toddler constipation issue, you should eliminate all potential culprits.
To be on the safe side, remove all cereals and grains from her menus. They will get plenty of fibers from the fruits and vegetables you prepare them. Wheat seems to be particularly problematic in certain kids.
In the baby constipation article article, we covered specific vegetables that are flavorful and nutritive, to get your baby interested in her first solid food foray.
Now that your child has grown up, your should consider all vegetables, putting an emphasis on color and texture variations, from dark green leafs to deep orange roots. This variety ensures you give your toddler a wide array of vitamins, minerals and antioxidants.
But remember: nothing beats local seasonal vegetables. Gently steaming is always preferable to harsher forms of cooking.
Olive oil, lemon juice, a bit of crushed garlic (cooked) or onions, herbs and mild spices are all welcome addition to make the eating experience fun. Adults do not particularly appreciate bland foods, why should your toddler put up with a tasteless mash?
Try a variety of fruits, including: pears, peaches, apricot, raspberries, prunes, any type of dark berries which are rich in antioxidants, etc. Just like with vegetables, you can hopefully find a good array of local seasonal fruits where you live.
Here are the fruits you should avoid if you are dealing with toddler constipation:
Here are the fruits you should offer your child frequently if you are dealing with toddler constipation:
I am not a fan of fruit juices for toddlers in general, unless you have juiced the fruits yourself. If you are dealing with toddler constipation however, prune juice can be a savior.
Offer half a glass of prune juice to your toddler in the morning and see if it helps gets things moving. If not, try another half glass in the afternoon, and repeat the next days if necessary.
Once the toddler constipation crisis is averted, discontinue fruit juice.
Your toddler needs proteins and other nutrients provided by meat , fish and eggs. Please do not try to grow your toddler as a vegetarian, you will end-up stunting his or her growth.
You can refer to the “Baby Constipation” article for more information on healthy proteins for your child.
Good fats are essential to the development of your toddler. Please refer to the “Baby Constipation” article for more information on healthy fats. Use a liberal amount in your cooking.
If your are dealing with toddler constipation, try to give her a small teaspoon of olive oil for breakfast. The olive oil encourages the gallbladder to release a large amount of bile, which acts as our natural laxative.
The trick is finding the right way to sneak the olive oil into something she likes. Try to put it in half a juice of orange juice. It won’t mix very well, but the taste of the orange juice should mask the olive oil taste. Plus, the orange juice will have an additional laxative effect.
Another alternative is to put the olive oil in a small jar of pear or apricot sauce. The fruit sauce will also have an additional laxative effect.
More and more kids are developing intolerances to dairy products. In the foods that cause constipation article, we already saw that milk can be a major constipation trigger, backed up by scientific studies.
So if you are dealing with toddler constipation and if you want to play it safe, I recommend avoiding dairy products, particularly milk. Based on my observations, butter does not seem to present any problems, and contain essential fat-soluble vitamins (vitamins A, D and E). Cheese is somewhere in the middle and more dicey.
If you are certain that dairies is not a trigger for your toddler constipation case, I recommend that you at least buy non-homogenized milk, and cheese made from raw milk, since the homogenization process makes the dairies a lot less digestible.
We now need simple rules to mix those foods and create menus that won’t be turned down by your toddler. Having raised 3 kids myself, I have gone through a long trial and error process, and came up with the following.
Here is what I typically recommend to parents:
Fresh fruits are best kept for snacks.
Gentle medicinal plants like burdock root or dandelion root can be used to stimulate the liver and gallbladder to produce more bile, our natural laxative.
Is a toddler to young to take medicinal plants? It depends what plant.
I have used burdock and dandelion for toddler constipation with 3 year old and older kids, including my own, and I am very comfortable with those plants as long as you keep a low dosage.
Depending on the weight of your toddler, 5 to 7 drops of a fresh plant extract (also called tincture) twice a day is fine. I have been using the Herb Pharm brand for years in my naturopathic practice. Herb Pharm makes extracts of very high quality:
When I am facing a stubborn case of toddler constipation and when burdock or dandelion does not work, I may recommend yellow dock, 5 drops of a fresh plant extract twice a day. As explained in the yellow dock article, that plant provides a greater “kick” to the gallbladder. The plant extract can be found here:
I am against stronger, harsher laxatives like sena, cascara sagrada and buckthorn.
In previous articles (newborn and baby constipation), we have seen that a vaginal delivery inoculates the baby with good gut flora, which is essential for a good transit. Babies undergoing a C-section do not have that luck, and start off with a deficient flora.
In addition, your toddler may have taken antibiotics, due to ear infections or other conditions, which destroyed her gut flora.
Finally, an ongoing nutritional imbalance may create a condition called dysbiosis, an imbalance in the good gut flora vs. bad gut flora (too much of the latter, too little of the former). A lack of vegetables variety for instance may signify the gut flora of your toddler has not been fed well (fibers provided by fruits and vegetables act as food for the friendly bacteria).
If you suspect that your toddler does not have a good gut flora based on the 3 points above, you should consider a good quality probiotics supplementation. Probiotics should be taken for a period of 3 months in order to effectively repopulate the gut flora.
I particularly like the Udo's Choice brand:
Your toddler is experimenting with the world around her, and a lot of psychological changes are taking places. Psychological factors can, without a doubt, be a trigger for toddler constipation.
In my opinion, there are two key behaviors that your toddler will display when he is ready to start potty training.
First of all, he will be aware of his own defecation and urination process (in the diaper at this stage). He will he able to tell you that he is peeing for instance, or that he just peed in his diaper. The same applies to defecation, he will be pushing and while catching his breath tell you “me pooing”, or he will tell you after the fact. Or he may just point to the diaper to show you something happened in there.
Second, he will show an interest in the bathroom, the toilet, and most importantly you going to the toilets. He will want to know where you are going, what you are doing in there. You will need to show him how you sit down, that the poop goes into the hole, that you press here to flush the toilet and “bye bye poop”, that wash your hands afterwards, etc. You may have done this routine already with your toddler.
The important point is that you should be open to talking about this. There is nothing dirty about it (when you follow the basic hygienic steps). Walk him through the process several times, whenever he asks. If your toddler is a boy, ask the man in the house to take him to the toilet and show him how to pee.
Let us repeat those two critical points. Your toddler should be ready for potty training if:
What happens if you attempt potty training and he is showing no awareness or interest? He will probably not be able to tell you when he is ready to go, or he will not understand why you put him in that small room, and will grow restless and frustrated. This may lead to resistance, and toddler constipation down the line.
As parents, we are often unconscious of the multitude of pressure points that society is exerting on us. Potty training comes with all kinds of pressures. Society dictates that your little one needs to be “clean” as fast as possible.
Here are some pretty typical influencing factors:
Just be aware of those pushes, and ignore them. You may lose a few weeks up-front, but you will save months, if not years of frustration (and possibly toddler constipation) down the line.
Your toddler is not an “average”, she is not you when you were a kid, she is not the neighbors’ kid. She will evolve at her own pace, and you should be able to detect (as per the previous section) when she is ready for the potty-training journey. It may happen at 2½ years, at 3 years or later.
Sit down, relax and close your eyes as I tell you a little story.
It is about a very small mysterious place where adults go once in a while. They lock themselves in. They hide in there, making strange noises. They don’t like to talk about it. There is a weird looking object in the middle, cold to the touch, with a big hole in the middle. You are not supposed to touch it cause Mama said it is dirty. Pulling a lever makes a lot of noise and makes things disappear in the whole.
Alright, let’s stop here, I don’t want to give you nightmares tonight. You get the picture, I am attempting to describe toilets from a toddler point of view. They can be scary.
You need to demystify the toilets. Talk about it as any other room, answer questions, show them what happens there, laugh about the “big noise” and the flow of water when you flush. Put a piece of toilet paper, flush it out. When your toddler poops in her diaper, transfer the poop in the toilets (when possible) and show her how to flush it out.
Yes, these are all additional time consuming tasks. But again, it is better to invest a bit of energy now, up-front, than a lot of energy later dealing with toddler constipation.
Her own toilets
Buy one of those little plastic toilets. It will be her own. She can sit on it, decorate it, put stickers on it, place it by the big toilets to do just like mommy, etc. If the big toilets are a bit scary, the little toilets will be a lot less.
And lots of them for certain toddlers, I talk from experience. Every time an accident happens, you will pay with your own time. Removing the dirty underwear, giving a shower to your toddler, cleaning underwear, dressing him up again, etc.
I have lost it in a few instances. My favorite is: it's early morning and time to go, I need to drop the older kids to school, then drop the little one to daycare, then go to work. And at this point, right before getting into the car, an accident happens.
Needless to say, every overreaction is a few points lost in the journey to get your toddler independent. But using Stephen Covey’s metaphor, future deposits will make up for this one withdrawal from the “emotional bank account”.
So just repeat the following a hundred times: accidents will happen, I will stay calm most of the time, and I may lose it once in a while and this is OK!
There is nothing more frustrating than you spending all this time to make things right, and one outside person, say the preschool assistant, blowing it all away.
Things get dicey when an accident happens outside of the home, when your toddler is in the hands of another care provider. When you find out someone gave a hard time to your toddler because he pooped in his pants, talk to your toddler and let him know it is ok to have accidents once in a while.
But more importantly, gently confront the person who overreacted to ensure this does not happen again.
Let’s face it. Toddlers are very busy playing. And the toilet habit just gets in their ways. They will be tempted to hold it in till the last minute, sometimes skipping the urge altogether. In the long run, this sends a counterproductive message to their body, sometimes leading to toddler constipation.
Remind your toddler on a regular basis. When he wakes up from his nap. Before his afternoon snack. After his snack. When he comes back to day care. Before he goes to day care. Etc.
You will often see him in strange positions suggesting that he needs to go. Offer him to go to the toilets “horsey riding”, doing the airplane, race him to the toilets, whatever works for him. A little motivation to get him to go to the right place at the right time doesn’t hurt.
One of my boys loved power struggles. He made a special point to oppose any suggestions I gave him. So I had to change my style from nagging to casually talking about the toilets. It had to be when he decided, not when I decided.
I used the “oh I think I need to go to the toilets” trick in front of him, or asking my wife “do you need to go to the toilets”? That method worked well, with him running to the bathroom saying “no, I go”.
Learn to diffuse power struggles to go to the toilets. Casually suggest once in a while, and use tricks like the one I mentioned. You can also buy potty books, and grab one of those books once in a while, flip to a page, and read aloud how “little bear has gone to the toilets”. Whatever works to prevent toddler constipation!
Unfortunately, once toddler constipation has settled in, your daughter or son may go through a few painful defecation episodes. A vicious circle may start, with your toddler holding it in fear of pain, which further aggravates constipation.
In extreme case, this may lead to fecal impaction, a situation that may require a digital disimpaction, or (better for your child) an enema or oral laxatives (or both), administered in a medical facility.
But before you get to that point, there are hopefully some useful tools you can find in the next sections.
Make a big fuss about every successful poop in the toilet. Clap your hands, loudly sing a special poop song (you can make one up), race him from the toilets to whatever place he chooses once he is done pooping, praise him in front of family members, make him realize how fun it is to stay in clean underwear for a whole day, etc.
In one of the houses we lived in, there was a very long corridor leading to the toilets. One of my sons would call me when he was done, and I would run toward him in this long corridor. He would watch me coming toward him at full speed with a mixture of excitement and fright. Then I would gently crash into him and tickle him. It was our routine, and he loved it. Think fun rewards!
Before going to bed in the evening, praise him some more. Bedtime is a special moment for the mind, making a review of the whole day during this quiet period is usually constructive.
Here are some additional tools you can use to address mild toddler constipation:
Here are some additional tools you can use to address a more acute toddler constipation:
In cases of acute toddler constipation, talk to your doctor. He may prescribe Miralax, an oral laxative, to help him eliminate the plug. Miralax contains polyethylene glycol (PEG), a laxative that seems to be fairly well tolerated by children(1)(2)(3) and is widely used in different countries for acute toddler constipation situations.
It is particularly used when there is fecal impaction, with or without encopresis (encopresis is a situation where a hard fecal plug allows only liquid fecal matter to pass through, leading to leakage and soiling). PEG works by drawing water from the mucosa of the gut into the fecal matter, making stools softer.
I am all for natural solutions, but I know some exhausted parents have tried every possible way without success. In those cases, do not feel guilty about getting a prescription from your doctor. Your child needs to evacuate, and you have tried your best. Now let the doctor guide you.
Then, once you are out of this cycle, you can spend more time on natural constipation management and prevention.
There are tons of good potty books you can purchase from your favorite bookstore. They will reinforce good potty habits, and will make the process more fun. They also help your child keep in mind that they have to go once in a while, listen to the call of nature, which in itself does a lot to prevent toddler constipation.
I have used some of those books to remind them, in an indirect way, that now might be the time to give it a try. I would pick a book, pretend I was reading it aloud to myself, which would bring back the subject at the top of the child's mind.
I personally used "Once Upon a Potty" by Alona Frankel for my 3 boys, they loved that book!
In this article, we took a global view on toddler constipation. We started with our usual foundational tools – nutrition, supplements (probiotics) and medicinal plants. Those three, nutrition in particular, can make a huge difference in solving a chronic toddler constipation problem.
We also spent a fair amount of time discussing psychological factors, which can play a major role in toddler constipation. Toddler years are all about experimenting with the world, and the world can sometimes be a bit scary. Our job, as parents, is to make the world as safe as possible, especially during the potty training process, without preventing them from experimenting and sometimes making a few mistakes.
Finally, we reviewed a few additional tools you can try with your toddler. We ended up by saying that sometimes, nothing works. There is nothing wrong with going to the doctor and getting a prescription for a laxative that will get your toddler out of a painful vicious circle.
Once you get out of the crisis, then and only then you will be able to sit down, breathe, think clearly and come up with a constipation remedy toolkit that will prevent reoccurrence.
As usual, as a father of three and having gone through quite a few crises myself, my love goes to you. You will make it through!
(1) Pashankar DS, Bishop WP. "Efficacy and optimal dose of daily polyethylene glycol 3350 for treatment of constipation and encopresis in children". J Pediatr. 2001;139:428–32.
(2) Youssef NN, Peters JM, Henderson W, Shultz-Peters S, Lockhart DK, Di Lorenzo C. "Dose response of PEG 3350 for the treatment of childhood fecal impaction. J Pediatr. 2002;141:410–4.
(3) Dupont C, Leluyer B, Maamri N, Morali A, Joye JP, Fiorini JM, Abdelatif A, Baranes C, Benoît S, Benssoussan A, Boussioux JL, Boyer P, Brunet E, Delorme J, François-Cecchin S, Gottrand F, Grassart M, Hadji S, Kalidjian A, Languepin J, Leissler C, Lejay D, Livon D, Lopez JP, Mougenot JF, Risse JC, Rizk C, Roumaneix D, Schirrer J, Thoron B, Kalach N. "Double-blind randomized evaluation of clinical and biological tolerance of polyethylene glycol 4000 versus lactulose in constipated children". J Pediatr Gastroenterol Nutr. 2005 Nov;41(5):625-33.
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