<p><span style="font-size:14px;"><span style="font-family:arial,helvetica,sans-serif;"><strong>Contents</strong></span></span></p>

<p><em><span style="font-size:14px;"><span style="font-family:arial,helvetica,sans-serif;">What causes constipation in a child?</span></span></em></p>

<p><em><span style="font-size:14px;"><span style="font-family:arial,helvetica,sans-serif;">Symptoms of Constipation</span></span></em></p>

<p><em><span style="font-size:14px;"><span style="font-family:arial,helvetica,sans-serif;">Is this just a phase?</span></span></em></p>

<p><em><span style="font-size:14px;"><span style="font-family:arial,helvetica,sans-serif;">How should I start toilet training my child for bowel movements?</span></span></em></p>

<p><em><span style="font-size:14px;"><span style="font-family:arial,helvetica,sans-serif;">Toileting Diary</span></span></em></p>

<p>&nbsp;</p>

<h2><span style="font-size:14px;"><span style="font-family:arial,helvetica,sans-serif;"><a id="What causes constipation in a child?" name="What causes constipation in a child?">What causes constipation in a child?</a></span></span></h2>

<p><span style="font-size:14px;"><span style="font-family:arial,helvetica,sans-serif;">Constipation may occur if your child is not eating enough high-fiber foods, drinking enough fluids or getting enough exercise. In many children, a cause for constipation cannot be found. Painful bowel movements may cause a child to begin resisting the urge to have a bowel movement. Not having a bowel movement when the urge occurs can lead to constipation. Your child could be scared of being alone in the bathroom or scared of the toilet. Some children just don&#39;t want to stop playing to go to the bathroom.</span></span></p>

<p><span style="font-size:14px;"><span style="font-family:arial,helvetica,sans-serif;">An illness that leads to poor food intake, physical inactivity or&nbsp;<a href="https://medlineplus.gov/ency/article/003090.htm">fever</a>&nbsp;can also result in constipation and stool soiling. This problem can remain even after the illness goes away.</span></span></p>

<p>&nbsp;</p>

<h2><span style="font-size:14px;"><span style="font-family:arial,helvetica,sans-serif;"><a id="Symptoms of Constipation:" name="Symptoms of Constipation:">Symptoms of Constipation:</a></span></span></h2>

<ul>
	<li>
	<p><span style="font-size:14px;"><span style="font-family:arial,helvetica,sans-serif;">Extreme straining during a bowel movement</span></span></p>
	</li>
	<li>
	<p><span style="font-size:14px;"><span style="font-family:arial,helvetica,sans-serif;"><a href="http://www.zdrav.kz/en/node/9903">Abdominal pain</a>&nbsp;and bloating</span></span></p>
	</li>
	<li>
	<p><span style="font-size:14px;"><span style="font-family:arial,helvetica,sans-serif;">Crankiness</span></span></p>
	</li>
	<li>
	<p><span style="font-size:14px;"><span style="font-family:arial,helvetica,sans-serif;">Tiredness</span></span></p>
	</li>
	<li>
	<p><span style="font-size:14px;"><span style="font-family:arial,helvetica,sans-serif;">Loss of appetite between bowel movements</span></span></p>
	</li>
	<li>
	<p><span style="font-size:14px;"><span style="font-family:arial,helvetica,sans-serif;">Wetting during the day or night</span></span></p>
	</li>
	<li>
	<p><span style="font-size:14px;"><span style="font-family:arial,helvetica,sans-serif;">Extreme reluctance to use the toilet</span></span></p>
	</li>
</ul>

<p>&nbsp;</p>

<h2><span style="font-size:14px;"><span style="font-family:arial,helvetica,sans-serif;"><a id="Is this just a phase?" name="Is this just a phase?">Is this just a phase?</a></span></span></h2>

<p><span style="font-size:14px;"><span style="font-family:arial,helvetica,sans-serif;">It&#39;s possible that your child is going through &quot;a phase.&quot; Your child may not have the skills yet to use the toilet. But, if your child keeps soiling after about 3 months of being able to use the toilet to urinate, it&#39;s probably time for him or her to learn to use the toilet for bowel movements. Your doctor can offer advice.</span></span></p>

<p>&nbsp;</p>

<h2><span style="font-size:14px;"><span style="font-family:arial,helvetica,sans-serif;"><a id="How should I start toilet training my child for bowel movements?" name="How should I start toilet training my child for bowel movements?">How should I start toilet training my child for bowel movements?</a></span></span></h2>

<p><span style="font-size:14px;"><span style="font-family:arial,helvetica,sans-serif;"><strong>1. Keep a toilet diary.</strong><br />
Keep a &quot;diary&quot; showing when, where and what kind of bowel movements your child has. It will help you and your doctor see patterns in your child&#39;s bathroom habits. Try to keep a toilet diary for at least 1 week before going on to step 2. If your child is in day care, ask the teacher to help you look for patterns in your child&#39;s toilet behavior. At the end of this handout there&#39;s a sample toilet diary you can print out and use to help you.</span></span></p>

<p><span style="font-size:14px;"><span style="font-family:arial,helvetica,sans-serif;"><strong>2. Teach your child to sit on the toilet.</strong><br />
Play in the bathroom with your child to show him or her that the bathroom is not a bad place. Allow your child to sit on the toilet with pants on for a few minutes at a time. It may be helpful to have a foot stool so your child can rest his or her feet. Allow your child to have his or her favorite books, dolls or small toys during bathroom time.</span></span></p>

<p><span style="font-size:14px;"><span style="font-family:arial,helvetica,sans-serif;">Read to, play with and talk to your child when you&#39;re in the bathroom together. Don&#39;t expect--or ask--your child to have a bowel movement on the toilet yet. Remember, he or she is still getting used to the idea of sitting on a toilet. Start with a very short amount of time (about 30 seconds) and slowly work up to 5 minutes. A kitchen timer can be the signal for the end of &quot;bathroom fun.&quot; Move to step 3 once your child is sitting on the toilet 3 to 5 times a day, for 5 minutes each time.</span></span></p>

<p><span style="font-size:14px;"><span style="font-family:arial,helvetica,sans-serif;"><strong>3. Make sure your child&#39;s bowel movements are soft and well-formed.</strong><br />
It helps if you give your child less dairy food and more high-fiber foods. If your doctor says it&#39;s okay, you may be able to give your child fiber supplements for a short time. Ask your family doctor about diet changes.</span></span></p>

<p><span style="font-size:14px;"><span style="font-family:arial,helvetica,sans-serif;">At first, your child may have more soiling accidents. Have your child help clean up messes, but don&#39;t yell or punish your child for soiling. Being angry with your child when he or she soils only makes toilet training harder. Try to stay calm and relaxed when your child soils, so he or she won&#39;t feel bad.</span></span></p>

<p>&nbsp;</p>

<p><span style="font-size:14px;"><span style="font-family:arial,helvetica,sans-serif;"><strong>4. Have set times for sitting on the toilet.</strong><br />
Once your child is having healthy bowel movements and is used to sitting on the toilet, start having him or her sit on the toilet at regular times during the day. Time the sits to start about 10 to 20 minutes after each meal and during times when your child usually has a bowel movement. You&#39;ll be able to tell these times from the toileting diary. Your child should sit on the toilet at least 3 to 5 times per day, for about 5 minutes each time.</span></span></p>

<p><span style="font-size:14px;"><span style="font-family:arial,helvetica,sans-serif;"><strong>5. Reward bowel movements in the toilet.</strong><br />
The first time your child has a bowel movement in the toilet, give him or her a reward. Good rewards are stars on a chart or fun activities. At first, give a reward after every bowel movement in the toilet. Later, give the reward after every few bowel movements. Pretty soon your child will be trained. Then you can stop giving rewards.</span></span></p>

<p><span style="font-size:14px;"><span style="font-family:arial,helvetica,sans-serif;">Next, teach your child to know when it&#39;s time to go to the toilet. Teach your child to tell you, instead of waiting for you to ask. Young children should tell a parent before they use the bathroom, in case they need help.</span></span></p>

<p><span style="font-size:14px;"><span style="font-family:arial,helvetica,sans-serif;">What is the treatment for stool soiling caused by constipation?</span></span></p>

<p><span style="font-size:14px;"><span style="font-family:arial,helvetica,sans-serif;">If your child doesn&#39;t have a bowel movement for 3 or 4 days in a row, you should call your doctor. He or she will probably want to remove the stool that has collected in the lower bowel. Your doctor can do this in the office by giving your child an enema or a suppository. It is also possible that your doctor may have you give your child high doses of laxatives to remove the stool.</span></span></p>

<p><span style="font-size:14px;"><span style="font-family:arial,helvetica,sans-serif;">After the stool has been removed, it is important to be sure that your child can have bowel movements easily. Easy bowel movements will help prevent another large collection of stool. Treatment may include changing your child&#39;s diet to include more fluids and fiber-rich foods, having your child sit on the toilet several times a day and giving your child laxatives every day to help soften the stools.</span></span></p>

<p>&nbsp;</p>

<h2><span style="font-size:14px;"><span style="font-family:arial,helvetica,sans-serif;"><a id="Toileting Diary" name="Toileting Diary">Toileting Diary</a></span></span></h2>

<table border="1" cellpadding="0" cellspacing="0" width="100%">
	<tbody>
		<tr>
			<td>
			<p><span style="font-size:14px;"><span style="font-family:arial,helvetica,sans-serif;"><strong>Day/date</strong></span></span></p>
			</td>
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			<p><span style="font-size:14px;"><span style="font-family:arial,helvetica,sans-serif;"><strong>Time</strong></span></span></p>
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			</td>
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			</td>
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			</td>
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			<p><span style="font-size:14px;"><span style="font-family:arial,helvetica,sans-serif;"><strong>Time</strong></span></span></p>
			</td>
		</tr>
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			<td>
			<p><span style="font-size:14px;"><span style="font-family:arial,helvetica,sans-serif;">Mon/22</span></span></p>
			</td>
			<td>
			<p><span style="font-size:14px;"><span style="font-family:arial,helvetica,sans-serif;">9:00<br />
			BMB, UB</span></span></p>
			</td>
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			<p><span style="font-size:14px;"><span style="font-family:arial,helvetica,sans-serif;">12:00<br />
			PS, UT</span></span></p>
			</td>
			<td>
			<p><span style="font-size:14px;"><span style="font-family:arial,helvetica,sans-serif;">14:00</span></span></p>

			<p><span style="font-size:14px;"><span style="font-family:arial,helvetica,sans-serif;">BMP, UP</span></span></p>
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<p><span style="font-size:14px;"><span style="font-family:arial,helvetica,sans-serif;"><strong>Directions:</strong>&nbsp;When your child has a bowel movement or urinates:</span></span></p>

<p><span style="font-size:14px;"><span style="font-family:arial,helvetica,sans-serif;">Put day of week and date in the first column.</span></span></p>

<p><span style="font-size:14px;"><span style="font-family:arial,helvetica,sans-serif;">Put time of day in &quot;Time&quot; column.</span></span></p>

<p><span style="font-size:14px;"><span style="font-family:arial,helvetica,sans-serif;">Add the code to the &quot;Time&quot; column.</span></span></p>

<p><span style="font-size:14px;"><span style="font-family:arial,helvetica,sans-serif;">Continue each day.</span></span></p>

<p><span style="font-size:14px;"><span style="font-family:arial,helvetica,sans-serif;"><strong>Codes:</strong></span></span></p>

<p><span style="font-size:14px;"><span style="font-family:arial,helvetica,sans-serif;">BMT=bowel movement in toilet<br />
BMP=bowel movement in pants<br />
BMB=bowel movement in bed<br />
PS=practice sits<br />
UT=urinates in toilet<br />
UP=urinates in pants<br />
UB=urinates in bed</span></span></p>

<p>&nbsp;</p>

<p><span style="font-size:14px;"><span style="font-family:arial,helvetica,sans-serif;"><strong>Source:</strong>&nbsp;<a href="http://familydoctor.org/familydoctor/en/kids/toileting/stool-soiling-and-constipation-in-children.html">http://familydoctor.org/familydoctor/en/kids/toileting/stool-soiling-and-constipation-in-children.html</a></span></span></p>
