Children may avoid defecation, “withholding” as pediatricians call it, to try to control their environment. Stressors include a new sibling or school, toilet training, moving homes, unfamiliar bathrooms. Stools that hurt to pass can also lead to withholding.
For children who might be afraid to go to the bathroom, distractions can help. Have them blow bubbles to steady their breathing or read a book, suggested Katherine Lamparyk, a psychologist at Cleveland Clinic Children’s Hospital Center. Establishing a routine for them to sit on the toilet for 5 to 10 minutes at the same time daily, like after meals, is also recommended.
Most constipation in children can be improved with diet, practice and routine, but it can also be caused by structural problems in the colon, thyroid disorders and food allergies.
Though they might be harder to get children to take, other stool softeners exist that do not include polyethylene glycol (PEG is the active ingredient in Miralax and its generic equivalents), like milk of magnesia, lactulose and mineral oil.
Some children can have hard stools sitting in their colon that will show up on an X-ray. They need months of stool softening to let their “body learn how to feel the urge to poop again,” said Dr. Wendy Sue Swanson of the Everett Clinic in Mill Creek, Wash.
If your child is on Miralax or a PEG generic, check in with your doctor every three months to ask about cutting dosages, and increase roughage in the diet, Dr. Swanson said. She added that some parents are reluctant to give up laxatives. “Constipation is awful for kids, it’s humiliating, awful and painful,” she added. “People are scared to go back to that place.”