Abdominal Pain in a Toddler

6/27/2007

A two and a half year old boy came into my office today with a two day history of abdominal pain. He just began toilet training several weeks ago. He drinks regular cow’s milk and mom states that he has a daily bowel movement and thus she does not believe that he is “constipated”. A thorough exam reveals a belly that is soft throughout all regions however there are multiple areas of very hard stool felt in the lower part of the belly. I believe that the source of this child’s pain is the hard stools that I detected by examination.

The mom questioned how he could possibly have “backed up” stools if he voids daily. The answer lies in the normal bathroom habits of a young toddler. Often they have a quick bowel movement on initial sensation that they have to void and in haste they quickly finish up. Most toddlers have no time or desire to complete the next round of emptying that often follows the initial movement. It is for this reason that newly toilet trained toddlers often have residual stool that causes pain. With time the stool hardens and it becomes a vicious cycle of poor emptying and “back up”.

The second reason that toddlers often get constipated is excessive intake of cow’s milk which is a carbohydrate and can make stools hard. I advised mom to take several steps. The first was to use three consecutive days of a Children’s Fleet enema followed by a suppository. This will help stimulate the child to empty his bowels. At the same time, I asked her to decrease the milk intake as well as increase his water and fiber intake. If this fails, I would consider a natural laxative for several weeks until things are back to normal and the stools have passed.

I strongly advise that children or adults with constipation take a daily probiotic for a significant period of time, at least four-six weeks. Constipation is often a multi-factorial problem involving diet, bathroom habits, hydration and maintaining normal gut flora. Western diets that are low in natural fiber and high in processed foods create bad environments in the gut that do not allow healthy bacteria to thrive. These healthy bacteria are needed for normal immune function as well as to promote good quality stools. Probiotics help restore these healthy buggers that we desperately need. I also advocate the use of prebiotics like FOS(fructo-oligosaccharides) which are non-absorbable sugars that healthy gut bacteria thrive on. FOS does not increase blood sugar nor get absorbed into the blood stream.

      

There are no comments.