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Everyday Holistic Pediatrics

Oh, Crap!

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Yes, crap! Why a blogpost about crap? As moms, we’re obsessed with our kids’ poops. From the moment they’re born, we’re charged with the order to keep track of every poop – when it happens, what it looks like, what it smells like, are they going too often, not often enough? As a pediatrician and a mom, I’m doubly obsessed with poop.

What do most kids tell me when I ask them what their poop looks like – after a giggle, or a look of shock or disgust, they say it looks “you know, normal.”  Hmmm…  OK, then, first things, first. What does normal poop look like? No, I’m not trying to gross you out. Seriously, which do you think is normal? Drum roll please…

BristolPooChart

Types 3, 4 and 5 are what normal, healthy poops should look like. Stool should be medium to light brown, smooth and soft, easy to pass, and sink under the water (no floaters here, please!).

What if your kids’ poop is more like Types 1 and 2? “Mama – it’s too hard, ouchy, my tummy hurts, I don’t wanna go!!!” Constipation is one of the most common complaints children have. The go-to advice you’ll hear from most pediatricians is “Drink more water!  Eat more fiber!” Been there, done that?

And what if your kid is already on MiraLAX (Polyethylene Glycol 3350), and your pediatrician has told you it’s safe to stay on this for years, indefinitely, like, forever  – what??? MiraLAX was actually never approved by the FDA for use in children under 17 years of age, and is not intended for use longer than 7 days (as written on its product label). So what’s the alternative?

There’s hope!

You CAN get your child to poop easily, on her own! You CAN heal his intestines from the inside out! When kids come to my office, I recommend several different things to help resolve their constipation once and for all, and not just put a bandaid on their symptoms.

RELAX & ROUTINE

by CHOReograPH, www.bigstockphoto.com

Relax… Not as easy as it sounds. Teach them mindfulness in their everyday moments. Why is relaxation so important to solve constipation? Ever heard of that term “anal-retentive”? Well, there’s a reason for it – yes, an actual physiological reason. When we’re stressed, our bodies go into fight-or-flight mode. Our sympathetic nervous system gets into high gear, causing our pupils to dilate and our muscles to tense up, including, yes, our anal sphincter muscle. The last thing we want to do when we’re running away from that saber-toothed tiger is have to stop and poop!

Do kids need help relaxing nowadays – YES! Which brings me to the next “R” – Routine. Kids are so “scheduled” and busy nowadays, that they literally may not have time to stop, drop, and poop! Help your kids stop and take the TIME to make pottying part of their daily routine. Ensure that they have time to relax and sit on the toilet for as long as it takes.

GET MOVING

by Wavebreak Media Ltd, www.bigstockphoto.com

Literally. Physical exercise gets those intestines moving. Most kids love to move – jumping, running, bouncing on a trampoline are all great ways to get that poop flowing. But please, remember – I am a pediatrician. Be sure to have a safety net around those trampolines! Make exercise a family affair – go on a daily after-dinner walk, take a bicycle ride or a long hike over the weekends. Let the whole family reap the benefits of being out in nature, moving your body, and spending quality together time!

WHAT GOES IN MUST COME OUT!

by AnnekaS, www.bigstockphoto.com

We’ve all heard about increasing fluids and fiber for constipation. Ideally you should drink about ½-1 ounce of water for every pound you weight. Your average 5 year-old who weighs 40 pounds should drink about 20-40 ounces of water per day. Huh? Most adults are lucky to get that much in. But it’s worth a try! Teach your kids that when they’re hydrated, their pee should be clear to pale yellow.

What about fiber? The American Heart Association recommends the following:

Recommended Fiber Intake                                    

Age Fiber (Grams)
1-3 years 19
4-8 years 25
9-13 years Female – 26
Male – 31
14-18 years Female – 26
Male – 38

 

That’s 5-10 medium size apples a day. There’s some truth to that old adage, “An apple a day, keeps the doctor away!”

But what if getting your child to drink this much water and eat this much fiber seems an illusory vision, only to be attained in your wildest my-kid-will-eat-anything dreams? Don’t despair!

Let’s focus on 2 dietary changes that in my experience as an integrative pediatrician and mom are the most helpful – one thing to DO, and one thing NOT to do…

MAGICAL, MYSTICAL MAGNESIUM !

Magnesium deficiency is widespread in children and adults. You know that annoying trouble you have unwinding and falling asleep, your short fuse and generally being way less patient than you wish you were, the muscle cramps you get after a short walk, headaches that make time with your kids not so fun, memory problems (it’s not just hormones?) and, oh yeah, poops that are too hard? Could those all be related to too little magnesium in your diet – uh huh! So how do you get you more?

To get more magnesium in your diet, focus on these delicious foods:

Food Serving size Magnesium (mg)
Dark leafy greens 1 cup cooked 157mg
Nuts and seeds (esp pumpkin) 1 ounce 150mg
Fish 3 ounces 82mg
Beans and lentils (esp soybeans) 1 cup cooked 148mg
Quinoa ¾ cup cooked 118mg
Brown rice 1 cup cooked 84mg
Avocadoes 1 avocado 58mg
Bananas 1 medium 32mg
Dried figs 1/2 cup 51mg
Dark chocolate 1 ounce 95mg

(For a more comprehensive list, see the World’s Healthiest Foods magnesium list.

Your child can also take a magnesium supplement. Natural Calm magnesium powder comes in a variety of flavors (organic sweet lemon is my personal favorite). Start at a low dose, maybe ½ tsp 1-2x/day, then gradually work up to what is called “bowel tolerance” – the point at which poops are soft and easy but not outright diarrhea. The types of magnesium that works best for softening poop are either magnesium citrate or magnesium oxide.

Once poops are soft and easy, gradually wean the magnesium supplementation off. Don’t be in a rush! If your child’s poops get hard again, then simply ramp back up and stay at that dose for as long as it takes. Your child didn’t get constipated overnight. It’s going to take some time for her digestive system to figure out how to get back on track.

Want more options? You got it!  How about a nice, relaxing epsom salt bath? Epsom salt is magnesium sulfate. Our skin is our largest organ, and anything that goes on the skin, will get absorbed into our body. Put ½-1 cup of epsom salt into your child’s bath, and watch them slowly unwind as all of their muscles start to relax. Dreamy, huh?  Oh, and I’m sure your kid never drinks bathwater like mine (eeeeuuuw!!!), but it’s totally fine if that does happen. Not a bath fan? Then try magnesium sulfate cream, or magnesium oil, rubbed to the bottom of your child’s feet at bedtime.

GOT MILK?

by yamix, www.bigstockphoto.com

The number one food culprit for constipation is cow dairy – milk, cheese, yogurt, ice cream, you name it. When our intestines are not optimally healthy, we are prone to developing food sensitivities to the foods we eat all the time – this is a phenomenon called increased intestinal permeability, or “leaky gut syndrome” This is not the tongue-swelling-can’t-breathe-scary kind of allergy. It’s a sensitivity, a delayed allergy, or whatever you want to call it.  And YES – dairy is often the problem.

So what to do – STOP eating dairy. What? No dairy? What is my child going to eat? Will they have to cut out dairy FOREVER? The great thing to know is that most food sensitivities are NOT forever.  The key is to eliminate the offending foods) for a minimum of 3 months, while supporting the gut lining with things like probiotics and fish oil.  This is a “Functional Medicine” approach to your child’s constipation, which will heal his gut from the inside out (for more information on how functional medicine can heal your child, see my blogpost What is Functional Medicine?

One of the most important steps toward beating constipation – REMOVE dairy.  It’s DOABLE. Instead of cow’s milk, try nut milks – coconut and almond are my kids’ faves. Almond and soy yogurt, coconut ice cream, Daiya vegan cheese to melt on pizza or mac and cheese – all great options. Typically within 2-3 weeks of dairy elimination, you and your child will feel relief at how much easier it is to pass that poop!

THE BUGS IN YOUR GUT

Kimchi - by Gutar photoghaphy, www.bigstockphoto.com

Did you know we have over a trillion bacteria living in our gut? There are more bacterial cells in our body than human cells. Sounds pretty important to make sure that only the healthiest bacteria inhabit our digestive tract, huh? When abnormal bacteria take hold in our gut, this is called gut “dysbiosis.” Symptoms of dysbiosis range from tummy aches, gas/burping, bloating, constipation and diarrhea to irritability, sleep disturbances, fatigue, weakened immune system, weight gain – you name it! Oh boy – the list could go on and on… What causes dysbiosis?  Improper diet, antibiotics, reflux medications, stomach flu, viral illnesses, even stress!

Regardless of the cause, dysbiosis CAN be healed, just like leaky gut. It’s back to that functional medicine approach. So how do we ensure “eubiosis” or a healthy balance of microbes in our child’s gut?

Ensuring that we have good bacteria called probiotics, in our gut, is the first step towards eubiosis. You may give your child a probiotic supplement. What I look for in a probiotic is a wide variety of probiotic species, and on the order of 10-25 billion cfu’s per serving. Read the label and make sure your child is getting an appropriate amount. Those yummy chewable kid probiotics that only has 1 million cfu’s – probably not gonna cut it.  Kids over 2 years of age get the very same probiotic as a adults.  Kids under 2 years of age should get infant probiotics.  This is one of my favorite probiotics.

Do you need a supplement to colonize your gut with the good guys?  Nope – fermented and cultured foods are all the rage. And for good reason. They are chock full of probiotics, digestive enzymes, vitamins, and minerals to help colonize our gut with healthy bugs and help our gut thrive.  Give some of these a try: real sauerkraut, real pickles (real ones, not Vlasic, please, which also contains Natural Flavors (read: MSG), Polysorbate 80, and Yellow 5), other fermented vegetables, kombucha, coconut or water kefir (avoid dairy), miso, kimchee, to name a few!  Go ahead and get cultured!

YOU WANT TO STICK A NEEDLE WHERE?

by Pascale Wowak Photography

Acupuncture? And kids? YES! You’re probably having visions of laying on the table for ½-hour as you doze off to Zen music, and you’re thinking, “My kid?  Yeah, right!” But with kids, you don’t keep the needle, er, “magic stick” in – it’s a quick in and out. The whole session might take 5 minutes. Kids respond beautifully to acupuncture. There are times in my office where I’ll do acupuncture on a kid for constipation, and literally, as we’re wrapping up, they’re running to the potty to poop!

LI 4 Acupressure Point

If acupuncture isn’t going to fly with your kid, then you can do acupressure to this very potent point for constipation. Large Intestine 4 (LI 4) is located on the top of the hand, in the webspace between your thumb and index finger. Put your thumb on the point, and your index finger on the palm side of your child’s hand. Squeeze your thumb and index together, make small circular motions with your thumb with firm but gentle pressure. Aim for several minutes or 100 circles, but know that the more constipated your child is, the more this point can be tender, so she may only tolerate brief sessions at first.

IT’S NOT OVER TILL IT’S OVER

www.pull-ups.com

www.pull-ups.com

By reading this blogpost, you’re well on your way to healing your child’s gut. It won’t be long before you and your child are doing the celebratory potty dance together. Happy dancing!

If you found this post useful, or know another awesome mama or papa who would, please SHARE it, sign up for my newsletter and follow me on Facebook!

47 Comments
  1. Hi Dr. Song! I’m so glad you posted a color visual poop chart, it really does make things clear and is very helpful. I also needed the reminder on Magnesium. Looking forward to your future posts!

    • Thanks, Kat! I’m having a blast, and I hope to provide value to mamas everywhere! Let me know if you would like me to write on any particular topics! 🙂

  2. What great information! The advice is very useful. I am looking forward to the next blog posting.

    • Thanks, Ann! It’s super fun! Let me know if there are any topics that you think I should write about next! 🙂

  3. Great blog, very insightful. A topic for you to consider is “lack of attention and focus” in school age kids.

    thanks!

    • Thanks, Indu! Will definitely have a blogpost on attention and focus, so be on the lookout!

      Take care,
      Elisa

  4. Dr. Song – So glad you are giving your wisdom and great manner of delivering information a larger audience. I will read it.

    Katherine

    • Thanks so much, Katherine! I love to write, and hope to be able to provide value to parents wherever they live! 🙂 Elisa

  5. Great post! Thanks for sharing and look forward to more 🙂

    • Thanks, Erin! Will definitely be sharing more! 🙂

  6. Would love a post about tooth decay Dr. Song, i think its a pressing issue on todays children and adults, spreading knowledge on how to cure tooth decay naturally would be a god send. Also, when you say nuts and grains and such you mean sprouted, possibly even fermented then sprouted first, right?

    • Hi Kristine! Thanks for your message! I will work on a post on tooth decay – it’s definitely an increasingly common concern! And sprouted and fermented grains and nuts are always ideal! 🙂

  7. Dr. Song, can I add epsom salt when giving bath to my 4 month old?

  8. Dr. Song, can I use epsom salt when giving bath to my 4 month old?

    • Hi Maria, you can, but I would just use a very little bit since you’re not using much water in the bath. Take care!

  9. Dr. Song, WOW! I’m not sure how your newsletter reached my inbox but today I’m discovering your articles and I am so thankful. My 10 yr old has been dealing with encopresis since he was 3 and now is in the full swing of ADHD symptoms. After sitting with his allopathic doctor for an hour the other day and basically getting fussed at for not wanting to go straight to stimulant meds or keep him on Miralax every day, I was questioning myself. Your articles are reaffirming to me that an integrative approach is possible and responsible. Thank you. This is so timely for me.

    • You’re so welcome! I’m so glad that you came across this info as well! 🙂

  10. When we lived in SE Asia, we found out that most families give their children fresh Papaya on a regular basis – whether just straight, or with lime juice, or in smoothies (without dairy). It worked wonders for our kids. I understand there’s something about Papaya enzymes where the fruit provides fibre and water to get things moving smoothly. We still use Papaya with our growing children as needed. Very grateful to have found this alternative…

    • Love that, Sarah! Will definitely include papaya in my next blogpost about constipation! Papaya enzymes are awesome for gut health, constipation, and even thinning mucous! 🙂

    • Love papaya enzymes, Sarah! Thanks so much for your tip!
      xo Elisa

  11. Love! I am glad you mentioned the Cheese we can get for dairy free…seen great results going dairy free with my 8yo but I’ve still have that lone bag of shredded cheddar for topping spaghetti and on pizzas!
    Also what is your fave probiotic? Link didn’t show up!
    Thank you! Thriving child has changed my whole world!

  12. Hi. I’m very interested in better understanding whether kids benefit from dairy foods or if these foods are detrimental to their health. By leaving these foods out of their diet does this increase their sensitivity bc they are not being exposed to dairy?

    I’m very confused about this topic. When I looked at replacing cows milk with nut milk I was disheartened by the other additives in the nut milk and didn’t want to just jump onto a new fad. I know I can make my own nut milk but I also need to be realistic about making the time to do this. Also, do I need to purchase activated nuts? So much to consider!
    Thanks so much for your wonderful blogs!
    Olivia

    • you’re so welcome! so, the issue of dairy is complicated. raw and cultured cow’s milk dairy can be awesome for some, but for others with dairy sensitvities, it can be inflaming. it really needs to be individualized. but like anything else, i don’t think any food should be consumed every single day. variety is the key to good health. i also don’t think “milk” is necessary. we don’t even have milk of any kind, animal or nut or seed, in our house. my kids don’t drink milk. they have occasional yogurt and cheese. best of luck!

  13. Great post! Thank you! How do I pin this post?

  14. Im wondering what to do if my child’s poop looks like #6 or #7 on occasionally? I’ve taken him to a Naturopath & know that he’s showing signs of food sensitivities. Grains, dairy & his body has a hard time processing out chemicals. I have him drinking unpasteurized, fresh goats milk. He’s an extremely picky eater. He has started eating bananas which may be contributing to the constipation. Any suggestions?

    • Make sure to also look at the underlying gut microbiome. A functional stool analysis can be very helpful. And sometimes even goat dairy can cause significant trouble, and eliminating ALL animal dairy (cow, goat, sheep, etc.) for a time can be helpful…

  15. Hi there

    Can you clarify big the magnesium in epsom salt baths actually helps to soften the stool? I’m having a hard time getting my drink natural calm, so I’m looking for other options. Can you also recommend any homeopathic remedies to help with constipation? Thank you so much! Marie

    • Almost everything is absorbed through the skin, so epsom salts, which are magnesium sulfate, will be absorbed through the skin and increase magnesium levels! There are so many homeopathic medicines for constipation, and it really depends on each child’s unique symptoms and reasons for constipation, but Nux vomica is helpful for constipation related to stress, and Bryonia for constipation that is super dry and hard. Best of luck!

  16. Thank you, love your blog and everything you do for us mamas! My son has the opposite problem and is typically in the 5, 6 and even 7 range. I have found so much information about constipation in kids but nothing for loose stool. Any resources or supplements your recommend? Thank you again

    • You’re so welcome! For looser stools, I would focus on probiotics, and try to find a functional medicine practitioner to look for underlying gut dysbiosis and food sensitivities!

  17. Thank you so much for all the helpful info!! My poor daughter has been on miralax for a year now – and I am desperate to get her off! She is 21 months. Question for you: is the dosage you listed for the magnesium an ok amount for her, even though she is only 21 months? Thanks for all the encouragement!

    • Magnesium can be dosed to “bowel tolerance” and that dosage will depend on each child. So watch how your daughter responds and adjust the dosage accordingly. Some little kids actually end up needing more than bigger kids!

  18. I read magnesium citrate could cause malabsorption issues and other dysbiosis issues. Is this true in a seven year old? Is this better than lactulose? Thanks for any help and your wonderful blog!!

    • Hi Katie – magnesium citrate shouldn’t cause malabsorption and dysbiosis, especially when used appropriately and hopefully the underlying cause of constipation discovered and healed so eventually you can go off of it. On the other hand, so many kids and adults have magnesium deficiency that I think most would benefit from some supplementation. I often prescribe for kids, even 7 year olds. And there are so many health benefits of magnesium that I do think it’s a better choice than lactulose. Best of luck!

  19. My 3yo struggles with encopresis. We are on a miralax/magnesium citrate routine and he was doing on until we got a stomach virus last week. Now he’s regressed to the point that he’s soiling his underwear about once an hour. I’m at my wit’s end. What do you suggest? I fully believe the initial encopresis was caused by a very high volume chocolate milk “diet” about a year ago

    • Hi Allison – I’m so sorry you and your son are going through this! I’m unable to give specific medical advice for your child, yes – dairy is a huge culprit for encopresis and hopefully you’ve but that out 100% as a trial. Acupuncture is also so helpful. And if you haven’t already, please do join the Thriving Child Community private Facebook group and post your question there, or find the answer already in the discussion. It’s an amazing resource of collective knowledge from holistic parents and practitioners dedicated to helping children thrive naturally – body, mind & spirit, and I try to get on regularly to answer general questions: https://www.facebook.com/groups/ThrivingChildSummit/
      Elisa

  20. I’m so grateful for this post!! MY son’s pediatrician led me here after my complaints that the pediatric GI wants my son the stay on miralax indefinitely for his constipation. I refused and she became a bit annoyed with me and said benefiber can work also. I tried to ask her about how to address the fire, not just the smoke, through diet and all she said was I am making this too hard on myself. Long story short, my frustration is calming after reading your blog posts and watching some of your videos. All the information I had previously read all dealt only with adults, so I am extremely thankful to have found your information about how to heal my children!

  21. Hi Dr. Song. Love all your posts and videos on here and fb. So glad dr. Uzelac recommended your work.

    Any tips for a long list of food sensitivities in terms of food choices or resources for recipes for kids…we’ve been dealing with our 3yo’s dysbiosis/leaky gut since birth (antibiotics off the bat, this can contribute to dysbiosis, correct?)

    Making food for a toddler on such a restricted diet for the next 3mos to 6mos is daunting, stressful, and burn out!! 🙁

    Thanks so much
    Linda

    • Linda – Dr. Uzelac is such an amazing food/recipe resource! She’s awesome! Ali Segersten’s book Nourishing Meals, and Special Diets for Special Kids are great resources as well! Good luck – I know it’s so challenging, but you’re doing amazing work for your little one! xo

  22. I just discovered your blog today, you’re an MD after my own heart! As an RN myself, I’m all for homeopathy that has been well researched so thank you! When can you start an infant on probiotics? I also wanted to mention that I’d love to see a blog post on food allergies as well as eczema. Thank you!

    • Hi Amber! Love that you’re a holistic RN! We need more of us! 🙂 I’m working on awesome new content so stay tuned! Food allergies and eczema are on my list! xo

  23. Thanks for a great post Dr. Song! You have the best advice! I would add that if eliminating dairy (casein) still doesn’t get your child going everyday, eliminate gluten as well. For many people gluten causes constipation. I wish I had known that years earlier!

    • you’re so right, Shannon! Dairy is the biggest culprit on constipation, but gluten is a close second! xo

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