Baby 411 Blog

Poop 411

WARNING: Those with weak stomachs should not read this post! Or, at least not while they are eating.


Hi everyone,
I was on another Dr. Phil episode recently, but didn't get a chance to give everyone a head's up. The family I worked with on the show had two sons with a medical disorder called encopresis.

Encopresis is a problem that stems from a long history of constipation. Kids who have painful poops due to constipation will often start holding it in (in hopes of avoiding the pain). These kids, who are labelled "withholders", will have a self-fulfilling prophecy. Because they hold the poop in, it gets harder and harder, and ultimately, when the poop comes out--it really does hurt--obviously creating a vicious cycle.

At some point, these children actually lose the sensation to poop because the lower part of the intestine becomes so stretched out. And, new poop that is being formed will actually seep around the old poop that's been sitting there since last Christmas. Kids with this constipation problem may look like they have diarrhea because the poop leaks out and soils their underwear. As you might guess, the smell is overpowering!

Anyway, Dr Phil's message boards lit up regarding this topic with parents who were looking for some tips to help their own kids who suffer with encopresis. So, I thought I would post some comments here since some of you out in blog-land may also be going through this with your kids. We also cover this topic in-depth in Toddler 411.

Top Tips for Encopresis:

1. The Cleanout: With the help of your doc, get your child on a regimen to clean out all the old poop. It took months to get to this point, so it will take months to get it cleaned out. This usually involves taking mild laxatives (Miralax, which is now over the counter is one of my favorites), and a stool softener for several weeks. You may also need to clean out from below with suppositories or enemas depending on the age of the child and the severity of the problem.

2. Maintenance: Once your child is cleaned out, he may still need stool softeners to keep it soft and easy to come out (so he doesn';t go back to withholding).

3. FIBER: The long-term solution to constipation and encopresis is changing a child's dietary lifestyle. This also involves (often) changing the parents' diet too! The whole family has to participate to make this work. The goal for daily fiber intake starting at age 2 is AGE + 5= the number of grams per day. Once you're an adult, that number is about 25-30 grams per day. Fiber is what keeps the poop soft and moving.

4. Toilet sitting: Have your child sit on the toilet for 5-10 minutes after EVERY meal (including lunch at school). That;s the most likely time the bowels will move. Kids often avoid the bathroom at school and end up holding the poop in until they get home. Any time the poop is held and not eliminated, it will be harder in consistency (bad idea!)

For more info, check out Toddler 411 in bookstores nationwide.

Soy milk before a year of age

This post is a response to Tony regarding soy milk. The recommendation of the American Academy of Pediatrics is that babies under one year of age receive breast milk (preferably) or infant formula so that they receive the nutrients they need. While soy milk is a fine alternative to cow's milk after one year of age, it is not an acceptable alternative to breast or infant formula in kiddos under a year.

Hope that clarifies it for you. Thanks for writing in.

Question of the day: Is it ok to mix formula with cow's milk

Reader Amy F writes in today with question about mixing formula and cow's milk:

My daughter is 10 months old and breast fed. We started trying out cow's milk just recently. Knowing that it does not have all the needed nutrients as breast milk, I was wondering if I can add formula to milk for added nutrients? She will not take formula any other way.

Hi Amy,

Thanks for writing in. The American Academy of
Pediatrics nutrition committee does not recommend
replacing breast milk or formula with cow's milk under
one year of age---period.

The reason? Not only does cow's milk lack the proper
nutrients that breast/formula have but babies under
one year have difficulty digesting cow's milk in large
volumes. It's ok to use milk in prepared foods, or
offer yogurt or cheese under a year, but drinking 8oz
or more of cow's milk a day can result in severe
anemia. The milk irritates the gut, and causes the
baby's intestinal lining to break down.

For your baby with the discriminating palette, I'd
rather see you add a teaspoon or two of prune juice or
pear juice to the formula to sweeten it up or mix a
little expressed breast milk in it if you've got it.

Hope that helps explain the rationale here~
Best,
Dr B