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Children's Hospital at Dartmouth Hitchcock (CHad)
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Bowel Management for Toddlers

During the toddler period (18-36 months), it is important to continue to have good stool consistency, have a stool at least every other day and introduce the concept of regular toileting to the child. Stools should be soft and formed (log shaped) by about 18 months of age.

The role of diet and toddler eating habits

To get the right stool consistency, continue to give your child high fiber foods, like fruits and vegetables, wheat bread and high fiber cereals. During the toddler period, it is normal for children to be "picky" eaters. Since your child will develop his or her likes from what you offer, teach your child to like healthy foods now by offering good choices. Here are some suggestions that may help.

  • If your child does not like a food, give small portions and praise your child for trying one or two bites.
  • Give your child lots of water and juices.
  • Limit milk to 16 ounces of low fat milk and limit other dairy products if they are constipating.
  • Offer fresh fruits for desserts and snacks.
  • At this age, special recipes such as psyllium jello squares or psyllium jello jigglers may be a fun way to provide fiber to the diet.
  • If diet alone does not keep your child's stool soft enough, Fruit-Eze, a commercial high fiber fruit paste, made of raisins, dates, prunes and prune juice may be helpful. It can be eaten alone, added to cereal or yogurt, or used as a spread on bread or toast. Store in the refrigerator. Use 1 teaspoon a day and adjust as needed. You can get samples by calling: (800) 243-1941.

The toddler should have a bowel movement at least every two days. If your toddler does not have a bowel movement, contact your health care provider for suggestions on how to treat this.

Developmental issues

Since children at this age learn by imitation, it is important to begin to expose the toddler to other family member's toileting habits. This means as parents, you need to bring your child to the bathroom so the child learns other family members have bowel movements in the toilet on a daily basis. This is especially important for the child who is not walking and unaware of others toileting habits.

Establishing a regular toileting time should be started. Observe your child to see if he or she gives signs, such as straining, to let you know when he or she is about to have a bowel movement. Keep a record of when your child has bowel movements and note if there is a pattern to it, such as after meals. Some children initially may need to use an oral medication, such as Senokot or a suppository to help train the bowel to empty at a scheduled time. Your health care provider will make recommendations if these are needed.

As the child shows interest, you may begin to introduce your child to the potty chair. As with all children, there is a wide variation of age as to when the child is ready for this. Generally, around age three is a good time to begin to encourage the child to sit on the potty, but do not force it. This is called scheduled toileting or habit training.

A few training tips

  1. Have the child sit on the potty in the bathroom for a few minutes.
  2. Choose a time when your child is likely to have a bowel movement, such as after dinner or any time you might predict he or she will have a bowel movement. Have your child sit on the potty the same time each day. Consistency is very important.
  3. Choose a comfortable, well supported potty chair that rests on the floor. The child's feet should be flat on the floor or on a stool with the knees higher than the buttocks, so the child can push.
  4. Help the child learn to push (bear down) by coughing, blowing a piece of paper off your hand or blowing a pinwheel.
  5. Make the time on the potty pleasant. Look at books, blow bubbles.
  6. Slowly increase the amount of time spent sitting on the potty to ten minutes.
  7. The initial goal is to get the child to sit on the potty. It is important to be positive and praise your child for sitting on the potty. Simple rewards such as a sticker may also be used. If the child does not have a bowel movement, encourage him or her to try again the next time.
  8. As your child develops a regular toileting time, he or she may begin to see some accident free days. It is especially important to work on developing this habit before your child begins school.

Weaning your child off the suppository

You may try weaning your child off the suppository once he or she is having regular bowel movements in the toilet. This is done by using the suppository every other day but still having your child sit on the toilet every day at the same time and encouraging your child to push. Continue to praise your child for having a bowel movement without the suppository. As the child becomes more successful, extend the toileting days without the use of the suppository. If you are using dietary fiber supplements or a stool softener, continue to use them.

If your child becomes constipated or goes more than two days without a soft log shaped stool, an enema may be given. The most commonly used enemas are pediatric Fleets enemas or homemade saline enemas made by adding one teaspoon of salt to one pint of water.

If severe constipation occurs, contact your health care provider.

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