The background story: how we got to where we are
Chronic constipation in babies and young children is a painful road to be on---for the whole family.
My daughter cried practically non-stop her first three months. Everyone had armchair expert advice for this, and most called it colic. I tried the soothing music, routines, the elimination diet (great for losing that baby weight and for feeling light-headed! I say that very ironically because I do not believe it was healthy at all.), special holds and dances. Some of it might have worked for a minute but ultimately it was all to no avail.
She was only few months old when she was diagnosed with reflux. The pediatrician prescribed Zantac (liquid) and at first, we thought this was a Miracle...all problems solved. I could eat again, in a healthy way, she calmed down (was a new child really), and it was such an easy solution.
Then, the next problem began: constipation.
To define, constipation doesn't mean missing a day or two between bowel movements. In fact, the National Institutes of Health position about constipation says, "Constipation means that a person has three bowel movements or fewer in a week. The stool is hard and dry. Sometimes it is painful to pass. You may feel "draggy" and full.
Some people think they should have a bowel movement every day. That is not really true. There is no "right" number of bowel movements. Each person's body finds its own normal number of bowel movements. It depends on the food you eat, how much you exercise, and other things."
I wasn't worried so much about how frequently my exclusively breastfed baby had a bowel movement; I was worried about how she strained and cried when trying not to have the bowel movement. She would go for a few days, then her body would start the bowel movement and she'd fight it because it hurt so much.
After having watched my baby arch her back in tremendous pain with reflux, I wasted no time when she began squirming and struggling with bowel movements.
My pediatrician pooh-poohed me. "Not every baby goes every day," she said, which is true, but she missed my point that I was worried about the pain.
I asked, "Aren't those guidelines more for children who are eating food, or formula fed babies...those who have more complex nutrition to break down? Because everything I read about exclusively breastfed babies says they shouldn't get constipated like this. What else could be going on?"
She just shook her head and made a note in the chart. But I persisted and eventually she sent me to a pediatric gastroenterologist who asked many questions about how my baby slept, where she slept, and was much more interested in that than any of the GI issues. Finally he snapped his clipboard shut and said sternly, "Your baby's only problem is that you spoil her. Babies will cry. You have to learn to let her. Just let her cry; in a few days it will all sort out."
What? I didn't go to a GI specialist to hear about parenting technique!
A friend's words kept echoing in my head, "Of course all babies cry. But when my baby cries like that, something is wrong."
I went back to my pediatrician, practically in tears. I reported the horrific visit with the specialist. I begged for her to listen, and help.
"You can start giving her juice in a sippy cup," she told me, "That will solve it."
I decided if the doctors wouldn't help us, I'd do it myself. I also decided to change doctors.
I got on the Internet and began researching.
First, I checked into Zantac. I learned, through the manufacturer, that Zantac has been known to cause constipation in babies and young children. I was so excited! Solving one problem may have created, or exacerbated, another. So how did we handle that?
My new doctor, who believed me, prescribed Miralax. This is a non-habit forming, very gentle laxative.
Again, we experienced a miracle.
By this time, our daughter was eating food, and showed no aversions or pickiness. I had read, and heard from dietitians and nurses that often kids with digestive troubles have aversions to food. These can also be developed because babies and children are smart enough to link food to digestive pain.
I was grateful that our proactiveness had solved her painful constipation and prevented any food aversions.
With time though, we found it very hard to regulate, and we started wondering when our daughter wouldn't have to take two medications daily to have a decent quality of life.
Between her first and second birthday, we began weaning her off of the Zantac and trying to wean her off of the Miralax. We succeeded with the Zantac, but failed with the Miralax.
Our new doctor sent us to a different pediatric gastroenterologist. This one actually took us seriously. She had no questions about sleep, except as it related to the GI issues. She actually did a physical examination and checked for serious bowel disorders.
She was very comforting, and validating. She told us there was no major physiological problem, for which we were very grateful, but did say she believed our daughter did have a real problem. She said some children relate to sensation differently than others, and the sensation of a bowel movement could feel uncomfortably stimulating. The child tensed up and fought the sensation, thus the movement, and created a constipation cycle. Diet is a major culprit for creating uncomfortable bowel sensation, as is genetics and wiring. Medication that constipates can make it worse.
This made sense to me then and makes more and more sense with each passing year. My daughter is very sensitive in many areas, IBS and Crohn's Disease run in our family, and we had probably, inadvertently, facilitated a bad cycle.
The good GI specialist reviewed our journals for our daughter's diet. She saw some triggers---mainly dairy---but felt it was more important to keep our daughter eating, and use the Miralax to help with bowel movements.
For many reasons, we agreed. We stand behind that decision for that time, but as our daughter got older, we felt it was important to make a different decision.
Potty training, which our specialist had instructed us to not push, hit us unexpectedly when our daughter was two and a half, "Mom, I'm going to use the big potty now!" she announced to me one day.
Potty learning was a long process---the better part of nine months to be honest---but she was still not using the potty to poop. I finally determined she felt the urge too late; the Miralax made it so soft she didn't recognize the urge.
I kept trying to wean her from the Miralax, and the constipation would return with a vengeance. One time it was so bad, and she was in so much pain the doctor and I decided the best course was an enema. This is something I will never repeat if at all possible. That had to be, hands down, the worst parenting moment. Worse even than the two oxygen-tent ER visits for stridor. My daughter cried and cried in agony, and I could only hold her and cry with her on the inside.
I decided, right then, to not mess with the Miralax.
Then, my daughter was three and a half and I began doing more research about digestion. This was for her, me and my new baby, who I was determined would not go down this path. We skipped the weaning part and stopped Miralax cold turkey.
The plan, or rather, our successful plan
Here is our plan, which I am happy to say is working:
1. Cut Miralax. Substitute one teaspoonful (and this is our quantity that we arrived at through trial and error) of Benefiber. Eventually I'll cut this back to every other day, and then only when needed. My daughter is now old enough to tell me when she feels "full" in her bowels (oncoming constipation). After the enema---an experience she is as committed to avoiding as I am---she is happy to cooperate with me and let me know the state of her bowels.
2. Change diet. We are testing for food sensitivities. Strawberries are out, as is soy, and slowly but surely we are figuring out the rest. I'm encouraging high-fiber foods such as:
- Apples
Peaches
Broccoli
Carrots
Zucchini
Beans (black, kidney, back-eyed pea)
Whole grains only (bread, tortilla, etc.)
I avoid "added" fiber because in our experience it causes fermentation (result: gas) and that can lead to bowel pain, fighting movement and constipation.
I also make sure that we limit or avoid things likely to lead to constipation:
- Processed sugar (can cause a yeast imbalance which works against digestion)
Too many processed foods (which avoids high salt and casein)
High amounts of dairy
Binding foods, such as green bananas and white rice
4. Facilitate easy and healthy digestion. This involves digestive enzymes, and live and active cultures. The enzymes are mainly for her stomach. I'm currently adminstering them since we've changed diet and I think her body is going through a learning curve. Eventually I'll taper those to "as needed" once we identify foods that her body finds hard to digest. The cultures are mostly for her bowel.
It's important to do these carefully.
First, the probiotic delivers the live cultures. You need to make sure that they are delivered live to the colon. The bonus to the live beneficial bacteria is that they maximize nutritient absorption and usually boost the immune system. (My daughter has been frequently ill, with chronic ear infections, thus many antibiotics...but all of that is changing.)
Second, the prebiotic supports the probiotic. The fructooligosaccharides (FOs) and inulin, "food" for the beneficial bacteria enhance the growth of those bacteria, thus making them more likely to survive and do their job supporting colon health.
This may sound like substituting one medicine for another, but I don't see it that way. I am supporting my daughter's natural body functions rather than forcing them. This is treating and solving the problem, rather than just addressing the symptoms. I consider it more holistic, and expect, and see, side benefits (such as improved resistance to infections).
5. Go to the potty and have the bowel movement at first feeling rather than waiting. Initially, this required a lot of questioning and prompting. This to me is potty training: helping the child learn to listen to her body's cues.
The results, or rather, our success
My daughter has had at least one, often two, bowel movements a day. 100% on the potty. I think this is her normal and healthy pattern.
Note: I don't believe every person needs to have this exact pattern.
She hasn't had a single painful bowel movement since doing this plan, and overall seems to be doing better. She can feel the urge for a bowel movement, but it doesn't scare her or hurt her. She doesn't fight it.
She's so proud to be Potty Princess...that is, successfully using the toilet for all of her business.
The follow-up, or rather, success with number two
My second daughter has benefitted from our trials and learning. She began to show similar signs with reflux, gas and colic, and squirming with bowel movements.
She's exclusively breastfed. I immediately switched to one-sided nursing (4-6 hours). Her gas and green poops were almost completely eliminated.
I followed the above plan and the benefits went through my breastmilk to her. I also benefitted with fewer IBS flares (I think it would be none except the hormonal fluctuations from nursing make that difficult.)
Tip: My daughter can hold her urine all day. She's much too busy to take a break. I believe that this act of holding can tense up the entire abdomen, creating a negative effect (read:constipating) for the bowel. Therefore, I got her into the habit of potty breaks to prevent this.
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