Although diet, exercise and changes to routine can all play a role in constipation, situational factors also concern Dr Steve Hodges (the Paediatric Urologist who is all over the internet with articles like this one in the Huffington Post: “Don’t potty train your baby!”. You can read my response to Dr Hodges post here: Are there risks to ec / baby-led / early potty training? )
In this blog I’m going to look at situational causes of chronic constipation, give some tips on how to tackle them, and warn you of the child-led approach that can catch ec-ers out.
Social Skills vs Toilet Training
Dr Hodges says:
“Babies and toddlers simply don’t understand the importance of eliminating when nature calls. Knowing how to poop on the potty is not the same as responding to your body’s urges in a judicious manner.
Once kids learn to put off peeing and pooping, essentially the definition of toilet training, they tend to do so often and for as long as they can. Children — and I mean all children — don’t like to interrupt their lives to use the bathroom.”
This is the ‘laziness’ argument against potty training and I don’t like it.
I hear it from parents all the time “He’s too lazy to use the toilet so he… wees in his nappy at night / wets his pants every day at preschool / wees on the sofa when he watches tv”. It might make sense to an adult, but children aren’t mini adults, and this is passing the buck.
‘Laziness’ can be shorthand for habit and conditioning. It can also mask a situation over which a child has no control – if they can’t feel or don’t consciously recognise that they need the toilet (and the fact that it’s blatantly obvious to you doesn’t mean they’ve actually noticed themselves) – then ‘laziness’ doesn’t come into it.
However, when little children do recognise their body’s signals yet still don’t act on them are they really choosing ‘play over potty’ or has the decision become more complicated than that?
At home, with a potty close by, my toddlers would always use it.
Put them in a nursery or preschool setting where they had to ask to use the toilet – interrupt circle time, interrupt an adult conversation, decide which adult they should ask, ask far enough ahead of time to still make it – and (unsurprisingly) they weren’t so reliable.
What should be a very simple “oh, I need to do a wee, let’s deal with that” becomes a social minefield.
This doesn’t get much better as they get older. My kids frequently come out of school absolutely desperate for the toilet because there hasn’t been time to go during the day.
They’re not allowed to go unless they ask. To ask at lunchtime they need to find a dinner lady and then wait in a queue for a pass. That’s half their break time wasted so of course it’s going to be a deterrent. They’re not allowed to go to the toilet even if they’re walking right past them, because they need to clear it with a teacher first. They’re discouraged from going during lessons and are told to wait and ask again later.
Obstacles, obstacles, obstacles!
This is still happening at age 8 and I’m not the only parent who has to send my children back into school to use the loo before we can set off for home.
So what chance does your 15 month old have at nursery?
How to Avoid Chronic Constipation In the Toddler Years
Toddlers and preschoolers are very vulnerable to chronic constipation. It can develop silently (i.e. with no symptoms) and modern, busy lives are enough to put a child at risk.
So how can you keep constipation at bay?
The first thing is to recognise these 10 signs of chronic constipation. If you know what you’re looking for, you can nip this in the bud before it gets out of control.
The second thing you can do is to put systems in place to help your child to poo every single day.
I know the NHS website says it’s fine to poo every three days, and I know you know someone who poos every other day and has the most amazing gut health, but your rule of thumb should be: poo every single day.
Babies have a soft bowel and it’s easy to stretch. But as soon as it’s stretched, peristalsis doesn’t work properly, the nerves don’t work properly and you have a runaway problem.
If you ever get as far as a serious bowel clean out (and I hope you never will), you’ll be aiming for a poo every single day and you’ll have to be vigilant for months or years to prevent a relapse into stretched rectum territory. This is enough for me stand by ‘daily pooping’ as the ideal.
If you’re looking for websites to justify longer gaps between bowel movements, don’t worry, you’ll find them. But if you have an irregular pooper or a toddler with a pooping pattern that skips days watch for other warning signs and always keep daily poops in the back of your mind.
Setting Up For Success At Nursery and Preschool
Almost everyone who practices ec or early pottying worries about how their child will transition to nursery or daycare or the childminder.
Will the nursery understand? Will the childminder follow your recommendations? Will your child signal or sign or ask like he does at home?
These are natural concerns and can usually be laid to rest by talking to your caregivers and discussing how things work at home.
But unfortunately, even in the most enthusiastic and accommodating nurseries (and pre-schools!), things can go quietly wrong… and due to the nature of chronic constipation, the connection isn’t always obvious.
The bowel can hold three months worth of poo without you noticing a problem. Three Months!!
Now, every parent would notice if their child didn’t poo for three months! But that’s not how it happens. The bowel fills to capacity, little by little, over a much longer period of time. Probably six months or more. By the time you spot undeniable symptoms of chronic constipation it can be very difficult to pinpoint a cause.
The best way to prevent chronic constipation 6 months down the line, is to keep a close eye on your child’s toileting patterns when they start childcare – and to make things as easy as possible for them.
Try to ensure that your child:
- Knows who to ask when they need to use the potty. Be specific. It might be easier for you to say “ask any of your carers” but that leaves your child with a decision to make at the crucial moment. If at all possible, pick one. Even if this is done daily on arrival. Oh look, Jackie’s looking after you today! When you need to do a wee or a poo, find Jackie, ok?
- Knows how to ask to use the potty. Should they interrupt a conversation? Can they sign from across the room? Can they ask during dinner? If your child can talk, give them the exact sentence they need to say and get them to practice it with you. Say to Jackie “Jackie, I need to do a wee” and she’ll help you.
- Is familiar with the setting. Take them to the toilet when you arrive and before you leave. Let them get used to using the toilet with you there so that you both know the set-up.
This also means you’ll watch your child use the facilities and know if anything else is throwing them. Are the toilets too high? Can they reach the paper? Do they need to ask for help to wipe or will they be spotted and assisted? Are they worried about the doors?
Little things that are almost impossible to find out from end-of-day toddler round-ups but are immediately obvious if you’ve seen them for yourself.
If you’re pottying and your nursery / daycare isn’t well geared up for ec, bring in your own potty or adapter seat (the same model as you have at home). Help your child to use it in the nappy changing cupboard or wherever it’s going to live. Familiarise them with the set-up so that they know what to expect.
- Has time at the beginning and end of the day to poo at home!
This is vital and often overlooked.
A great many children don’t poo at their childcare setting (whether they’re out of nappies or not). Mornings at home can be terribly rushed and in the evening all time is precious. Your baby is delighted to see you but also exhausted; You’re tired too and know you need to crack on with the bedtime routine.
BUT – ask yourself every evening: “Did they poo today?”
If not you need to sit them on the potty and give them a chance!
Settle them on the pot by any means necessary. Start very low key and see how minimal you can make it, but if it takes 5 minutes of tech, that’s better than skipping the sit.
Let them sit for a while – long enough for the poo to come. And it will come if they can relax in a familiar position in a familiar setting.
Be aware that this is your job! Don’t think “Oh well, they’ll go in the morning.” Because maybe they won’t…
Where Ec-ers / Baby-led Pottiers Go Wrong
The trouble with advice like “make sure your child does a poo every day!” is that it doesn’t sit well with ec-ers. If you can feel your hackles rising, maybe you recognise this objection:
“I’ve taught her to listen to her own body. She always poos when she needs to. She obviously doesn’t need to poo now. I’m not going to force her!”
Engineering a potty op for your toddler at the end of the day is not ‘forcing’ her to poo against her will – that’s impossible. But you are creating the opportunity for her to relax and go. It’s fine for you to do that.
Or you might object to the routine-y-ness of it?
“I’m not going to impose a toileting regime! How can I say to my child “it’s time to sit on the potty” when he doesn’t need to go? It’s ridiculous! I would never take over like that. It’s his body. He gets to have control.”
I understand both the logic and the sentiment behind this reaction. But I’m afraid that you do need to instigate a toileting routine because if your child isn’t pooing every day of his own accord, it might not be because of decisions he’s making.
It might be down to the structure of your day.
If you want your child to have complete control over his own toileting needs, you have to put him in an environment where that is practical 24 hours a day. No classes, no shopping trips, no public transport, no car journeys, no childcare, no school runs with older siblings – nothing that happens by the clock in an adult world. Just total freedom and easy access to a pot.
If you impose an adult world and adult priorities on your toddler’s little life, then you have to step in if he gets caught up in it and doesn’t poo all day.
Don’t worry – it’s not as hard as you might think, and if you admit to yourself that something might have gone awry, you needn’t feel like you’re compromising your principles.
Unless your tot has pottering time, when they’re not rushed, not deeply engrossed in something and not falling over themselves to get time with you, you need to make time for that potty sit.
A calm sit-on-the-potty-with-a-book-before-bed can mean the difference between an empty bowel and the beginning of a build up.
(If your toddler is very resistant to sitting on the potty before bed, yet there has been no poo today… get creative! You need to get them relaxed on the pot and you need it to become part of your routine.)
Wait… Is This A ‘Regular’ Potty Pause, Or Is It Constipation?
If your child is skipping poos or has erratic timing or refuses the potty when you offer before bed, you might well be wondering…
And it’s a good question to ask – but unless you’re seeing the signs you’re probably ok.
I’ve written this blog to make you worry – because I want you to recognise this as a serious problem that might affect you. But that doesn’t mean that every blip you have on your ec-ing journey is a reason to panic
There are many other (more likely) reasons for your current dip on the roller coaster.
Teething, illness and developmental leaps (learning to crawl, stand, walk, jump with two feet, talk, start using grammar) can all make an ec’d baby or toddler suddenly unreliable.
Couple any of those with a drive for independence or a rebellion against your pottying style/schedule and you might decide you have a ‘potty pause’ on your hands.
But the symptoms of constipation are distinct from the everyday ups and downs of an ec-ing journey. Not every blip is a disaster waiting to happen.
Understanding constipation means you’ll notice when a blip starts to look more like a habit.
And then you’ll be ready to step in.
What About Regression? And Psychological Factors?
Yep, disruptions to family life can also align with a blip in pottying success.
But you do need to be careful with assigning cause and effect.
Any kind of upheaval can cause a child to be intensely occupied with other things and stop noticing (or reacting) when they need the toilet.
That said, it’s easy to overlook constipation – with it’s root 6 months in the past – if you think you have a psychological explanation for a backwards step.
For example, siblings are often born right around the time when constipation will begin to show. Is it a disruption to family life that’s caused your ‘relapse’ or is the cause lost in the memories of 6 months ago?
Bedwetting might be tied to the psychological stress of starting school but if you’re an average kind of household it’s far more likely to be the result of something physical: An exhaustion that means your child doesn’t wake when they normally would, or a mass of stool in the rectum that has been building for months… A small change in toileting habits due to the new school day, might mean that backed-up poop is now pressing on the bladder at night.
I’m not suggesting that constipation is the cause of all bedwetting or all daytime accidents in all children who were once potty trained (though Dr Hodges implies it pretty much is, and he treats kids with wetting problems day in day out). But it’s something you should rule out before looking for more complex causes. (With the help of your doctor of course. You won’t want to miss a UTI or diabetes by not seeking medical help.)
What If My Child Poops Every Day?
If you’re managing successful evening potty time, or your tot poops daily – willingly and easily of their own accord – then surely they can’t be constipated!
Well, actually….. they can be constipated, yes.
All it takes is for those daily poops to not quite clear all the stool from the bowel and you have the makings of a problem.
That’s why there are 10 signs that you should look for. Any one of them is worth keeping an eye on. If you start to see a few, or notice the more severe ones. it’s worth getting a doctor’s opinion.
Remember, irregular pooping isn’t a prerequisite for chronic constipation.
I hope this blog has given you some practical tips on how and why to encourage your toddler to poo every day.
Of course, a healthy diet is also important: lots of water, fresh fruits, knowing how well your child tolerates various foods… But here I’ve assumed that you’ve got that covered and are more likely to get caught out by getting caught up in the whirl of modern life or your desire ‘not to interfere’ with your child’s decisions about their own body.
As always, I’ll answer questions in the comments sections below (scroll down a bit)
– Born Ready Jenn.
P.S. Now read part three in the chronic constipation blog series: The mechanics of chronic constipation (and how to treat it).
P.P.S. There was also a part one: Are there risks to ec / baby-led / early potty training?