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.

Dental dilemmas: Too much or too little fluoride?

Fluoride has been a controversial subject ever since communities began adding fluoride to their water supplies (about 50 years ago). Advocates point to the benefits of fluoride in reducing cavities. Critics have concerns about bone cancer and enamel fluorosis (streaking of the enamel due to excessive fluoride intake).

The latest fuel to the debate is a statement from the American Dental Association. The ADA responded to the National Research Council's assessment that infants being fed formula preparations mixed with water (i.e. powder or liquid concentrate) may be getting too much fluoride.

Here's what the ADA recommendations boil down to:
1) There has never been a recommendation to offer fluoride supplements in babies UNDER six months of age. Babies under six months of age who are fed liquid concentrate or powder formula prepared with tap water that is high in fluoride may be getting too much of a good thing.


2) Each community water supplier assesses naturally occurring fluoride levels, and decides whether or not to add fluoride to its supply. It's important to find out how much is in your own tap water (the ideal, as ADA says is 0.7-1.2 ppm)


3) If your baby is breastfed, this is not an issue. If your baby is eating ready-to-feed formula, it is also not an issue.


4) If your baby is formula fed and you are using powdered or liquid concentrate that needs to be reconstituted, use either bottled water that does NOT add fluoride or use your tap water if the fluoride levels in it are not excessive.


5) And, if you have tap water with little to no fluoride or well water, and your baby is OVER six months of age, you may need to actually give your baby a fluoride supplement. Check with your pediatrician/dentist for their recommendations.

For more information, see the ADA's FAQ page for parents at www.ada.org/public/topics/fluoride/infantsformula_faq.asp

A cure for colic?

A recent study published in this month's journal, Pediatrics, looked at yet another possible 'cure' for colic....probiotics. Probiotics are 'good germs' that can benefit people by improving intestinal function as explained by health web site PDRHealth.

As most parents know, colic is excessive crying for about 3 hours a day, starting at 3 weeks of age and lasting until 3 months of life. (It's also known to reduce the number of children a parent will decide to have). Although it has been studied for years, no one really knows what causes it, or what fixes it (other than time).

This latest study compared 90 exclusively breastfed babies with colic. Half received over the counter gas drops (simethicone) and the other half got 1 capsule a day of a probiotic containing the germ Lactobacillus reuteri. The results? Pretty darn impressive...The gas drops group saw a 7% reduction in crying. The probiotics group had a 95% reduction in crying. Babies who cried 2-3 hours a day were crying less than an hour after one month of treatment.

Are we ready to recommend probiotics to every baby? No. This was a relatively small study and more research is needed to confirm the findings and prove safety. But, this may be a reasonable way to reduce the misery of colic (and certainly less expensive than hiring a babysitter every night for 2 months!)

For more information on this research, check out Dr. Brown's appearance on ABC News Now.