Q&A with Dr. B

Q: I gave my son a recommended dose of Pedia-Lax based on his age. How long should I wait until I can give him the next dose if he has not had a bowel movement yet?

A: The maximum recommended dose that can be given per product differs based on the type of product and the age of your child. You should follow specific guidelines based on the product you are using. I recommend that you start with the lower end of the dosing range and increase the dose if there is no reaction after the reaction time listed on the carton. For example, if you are using Pedia-Lax Chewable Tablets and your child is 6 years old, you may use a starting dose of three tablets. If there is no bowel movement after 1/2 to 6 hours, you can give more tablets, remembering not to exceed the maximum daily dose of six tablets for children 6 to 11 years. Another example is that you should only give your child one sodium phosphates enema within a 24-hour period.

Product Age Starting Dose Reaction Time Maximum dose per day
Chewable Tablets Children 6 to 11 years 3-6 tablets 1/2œ to 6 hours 6 tablets or as directed by a doctor
Chewable Tablets Children 2 to 5 years 1-3 tablets 1/2œ to 6 hours 3 tablets or as directed by a doctor
Liquid Stool Softener Children 2 to 11 years 1-3 tablespoons mixed in 6-8 oz of milk or juice 12 to 72 hours 3 tablespoons or as directed by a doctor
Liquid Glycerin Suppositories Children 2 to 5 years 1 suppository Œ1/4 to 1 hour 1 suppository or as directed by a doctor
Glycerin Suppositories Children 2 to 5 years 1 suppository Œ1/4 to 1 hour 1 suppository or as directed by a doctor
Enema Children 5 to 11 years 1 bottle 1 to 5 minutes 1 bottle or as directed by a doctor
Enema Children 2 to under 5 years œ1/2 bottle 1 to 5 minutes œ1/2 bottle or as directed by a doctor

Please note: If your child doesn’t have a bowel movement within the reaction time after the maximum dose has been given, contact your pediatrician. Contact your pediatrician if your child doesn’t have a bowel movement after 30 minutes of giving the Pedia-Lax saline enema.

Q: My child recently started a new school and hasn’t gone to the bathroom in days. But she sometimes has loose stools in her pants. If she was constipated, she would not soil her pants, right?

A: Not necessarily. A child who suffers from constipation does not have the same control over their rectal muscles as an average child without these issues. She could have a very hard, large stool that is difficult to pass within her rectum and loose stool passes around the lodged stool. Constipation can present as loose stools and soiling in between periods of having no bowel movements. Furthermore, the fact that the child just started school could indicate anxiety about the new school, using a public bathroom, being separated from parents/caregivers, etc. These stressful situations could, and often do, cause constipation.

Q: We have used laxatives before, but they hardly worked. We stopped using them. Now the constipation has returned and we do not know what to use.

A: If a constipation remedy did not work, the correct dose was probably not used. Although the doses are recommended by age, some children may need to use more or less according to their condition. Your child’s pediatrician can best advise what’s right for your child. After the initial episode of constipation is resolved, changes in diet should be instituted to help maintain regularity. If constipation persists after changes in diet and dosing, you can try the remedy at the appropriate dose once again. All of these steps should be done under the supervision of a pediatrician.

Q: What fruits and vegetables are highest in fiber for my toddler?

A: Some fruits that are high in fiber are apricots, apples with skin, pears with skin, raspberries, strawberries, and blueberries. Some vegetables that are high in fiber are corn, spinach, and broccoli.

Q: By what age should children outgrow constipation?

A: The answer varies from child to child. As children grow older and their anatomy and diet change, they can certainly outgrow constipation (more specifically stool withholding and painful bowel movements that cause them to withhold). However, I have found that if a child’s diet consists mostly of carbohydrates and not much fiber and hydration, the child can easily slip back into becoming constipated. It is not uncommon for a child who had constipation issues in childhood to be prone to constipation as an adult. The best ways to manage constipation, at any age, are by diet first, then addition of stool softeners.

Q: My 4-year-old generally poops every five days or so – she’s been diagnosed with encopresis. In the day leading up to a large bowel movement, she will have several very, very small bowel movements; do you think this is voluntary? Meaning that she just doesn’t want to push and that’s what comes out before she can stop it? *Sorry to be graphic*

Q: My 4-year-old grandson has been toilet trained to pee, but he doesn’t ask to go to poop until he starts. He is diagnosed with “mega bowel,” a bowel that is constantly impacted with feces and is flaccid so he does not get a warning that he will have a bowel movement. Is there a cure for this condition as he is very embarrassed about this?

Q: My 2-year-old says her belly button hurts. Her doctor says she is constipated, but her poop doesn’t look like that’s the case.

A: What is being described is called soiling. Soiling is what happens when liquid feces leak out around hard, compacted stool. It can happen once or several times a day and is often confused with diarrhea. There is nothing a child can do to withhold soiling, and parents don’t often make the connection between what they think is diarrhea and what is actually constipation, making the right diagnosis difficult. It is a vicious cycle that starts with hard feces. When the child experiences the pain of passing a hard stool, they withhold the stool, which makes it bigger, harder, and more difficult to pass as days go by. The child will voluntarily withhold the stool until, literally, the rectal vault is filled with stool. Then smaller bowel movements or even diarrhea leak around the stool, since the child’s small anatomy cannot hold it any longer. The way to create a break in the cycle is to help create softer stools by increasing fiber in the child’s diet, keeping the child well hydrated, and using a stool softener like Pedia-Lax Liquid Stool Softener. Then maintain the child on a high-fiber diet with lots of fluids.

Q: My 3-month-old will be fussy for hours before she finally poops, and then she will be all smiles. This is pretty much a daily thing. I don’t want to give her juice until she’s a little older, though. So, is there something else I can try? She’s breast-fed and never eats formula.

A: If your child is uncomfortable on a daily basis, miserable, and her quality of life is affected, consider feeding her prune juice. Even as little as a 1/2 teaspoon a day, on a regular basis, will give her the relief she needs. But keep in mind, if her stool is already very soft, and she is slightly fussy, it may not be only constipation that is affecting her. In either case, in dealing with infants, it’s always best to consult your pediatrician.

Q: How much poo is too much for a 7-1/2-month-old? She’ll have a poopy diaper at each changing for at least three days at a time before they slow down a bit. I am currently trying to wean her from breast milk, so we are having to supplement as well. And she is also eating Stage 2 baby foods.

A: Although this seems like a lot of bowel movements, it still is within the normal amount for a breast-fed infant. If she is gaining weight and is not in any discomfort, just continue to feed and monitor her status as usual. If there is any change, especially weight loss or an increase in bowel movements, consult your physician.

Q: Why is my daughter’s poo just so foul-smelling? She’s 18 months old. And why is her poo always so bright neon green or sienna brown?

Q: When two of my children pass gas, it really smells awful. Why is this? They are both lactose-intolerant and I avoid all dairy with them. Also, they both tend to get constipated, and have to take stool softeners. But why the foul smell?

A: Foul-smelling bowel movements are very common in young children as they try new foods. So are the different colors and even the change in bowel-movement consistency. It is a result of different transition times for different types of foods through the child’s GI system. If your child is continuing to gain weight and thrive, this is normal. If there is any change or if this persists, it’s always wise to tell your pediatrician and see if anything needs to be checked.

Q: What causes IBS?

A: Doctors are not sure what causes IBS. One theory is that the muscles and nerves in the GI tract are extra-sensitive. This causes stronger-than-usual contractions after a meal, which leads to constipation and diarrhea, and the nerves firing off leads to pain and cramping.

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