Does the #SquattyPotty really work? The truth is that it’s not the specific “Squatty Potty” step-stool that helps, it’s being in a squatting position that helps (i.e. any step-stool that helps your child be in a squatting position while having a bowel movement would help). People in certain parts of the world continue stool in the squatted position. For example, in certain areas of Asia, you may frequently encounter squat toilets. While the below 3 minute video is very cheesy and quite odd, it does accurately show why being in a squatting position helps with stooling. It’s very difficult to hold your stool in, as children/toddlers often do – if you are in a squatting position. Check out this video to see why the squatting position allows a person to evacuate stool more efficiently. Happy watching (and try to focus on the medical illustration)!
The gastrointestinal tract is uniquely suited to digest all the different foods we eat to help our children grow and thrive. However, there are times when the body reacts to certain foods and cause discomfort.
A food allergy occurs when the body sees food as harmful and the immune system reacts to the allergens. When the response involves antibodies known as immunoglobulin E (IgE), symptoms such as hives, trouble breathing, or vomiting can appear quickly. Other times, non-IgE mediated allergies may cause symptoms such as abdominal pain or diarrhea that are delayed up to three days. The most common food allergens in children include milk, soy, egg, wheat, peanuts, tree nuts, fish, and shellfish.
A food intolerance or food sensitivity occurs when the body has trouble digesting certain foods, but the immune system is not involved. A common example is lactose intolerance where the intestinal enzymes cannot completely process the ingested milk sugar. Food intolerance can lead to similar symptoms as food allergies, but the reactions tend to be less severe.
In many cases, treatment of allergies and intolerances involves removing certain foods from the diet. However, overly restricting a child’s diet could have a negative impact on their nutrition and growth. In certain situations, medications may be useful as well. Your child’s pediatrician or pediatric gastroenterologist can help guide you through the diagnosis and treatment of these conditions.
One new diet trend that is becoming increasingly popular is the low-FODMAP diet. FODMAPs (Fermentable, Oligosaccharides, Disaccharides, Monosaccharides and Polyols) are foods that are poorly absorbed by the human intestine and are very easily digested by bacteria that normally line our gut. The bacteria feed on these sugars and sugar substitutes allowing them to grow out of control and produce and excessive amount of gas. The high-FODMAP foods can cause inflammation along your intestine, excessive gas, bloating and discomfort. A well-balanced, low-FODMAP diet is recommended for some children with chronic unexplained abdominal pain. Consult your pediatrician or pediatric gastroenterologist before instituting any restrictive diet such as low-FODMAP.
One of the most common questions we get in our office is, “How can I get my child to eat more healthy foods?” While there is no magic pill, we will be posting some of our favorite tips over the next few weeks. Keep in mind, this is just a phase, things will get easier!
Quick Tip #1: It is normal for small children are afraid of trying new things, including trying new foods (food neophobia). Reassurance does not always work. But… the more familiar they are with a food the more likely they will try it and like it. It may take several exposures to new foods before the child will accept them and eat them – sometimes as many as 15 attempts! Neophobia peaks at age two years old. It is less of a problem at three, four and five years old. Continue to offer your child to foods they don’t want to eat, but never force them to eat it.
Remember parents are responsible for providing healthful food that is appropriate for the age of the child. Children are responsible for how much they eat or if they eat at all.
Perry RA, Mallan KM, Koo J, Mauch CE, Daniels LA, Magarey AM. Food neophobia and its association with diet quality and weight in children aged 24 months: a cross sectional study. Int J Behav Nutr Phys Act. 2015 Feb 13;12:13. doi: 10.1186/s12966-015-0184-6. PubMed PMID: 25889280; PubMed Central PMCID: PMC4335451.
The Bristol Stool Chart is a great way to get an idea of how well your colon is working (or not working). Type 1-2, likely constipated. Type 3-4, ideal consistency.Type 7 is diarrhea. A stool log including frequency, Bristol type and associated symptoms will help you and your pediatric gastroenterologist arrive at a diagnosis and help treat your child.
1. Lewis SJ, Heaton KW. Stool form scale as a useful guide to intestinal transit time. Scand J Gastroenterol. 1997 Sep;32(9):920-4. PubMed PMID: 9299672.
2. Saad RJ, Rao SS, Koch KL, Kuo B, Parkman HP, McCallum RW, Sitrin MD, Wilding GE, Semler JR, Chey WD. Do stool form and frequency correlate with whole-gut and colonic transit? Results from a multicenter study in constipated individuals and healthy controls. Am J Gastroenterol. 2010 Feb;105(2):403-11. doi: 10.1038/ajg.2009.612. Epub 2009 Nov 3. PubMed PMID: 19888202.
3. Russo M, Martinelli M, Sciorio E, Botta C, Miele E, Vallone G, Staiano A. Stool consistency, but not frequency, correlates with total gastrointestinal transit time in children. J Pediatr. 2013 Jun;162(6):1188-92. doi: 10.1016/j.jpeds.2012.11.082. Epub 2013 Jan 11. PubMed PMID: 23312678.
Inadequate Hydration – Aside from losing fluids by using the bathroom, most children are very active and sweat quite a bit. These “insensible losses” force the colon to draw out more water from digested food leading to incredibly hard poops! Keeping them hydrated especially on warm days is important! Beginning in toddler-hood, kids should be getting about 1 liter a day minimum.
Stool Holding – Kids are some busy people! They are engaged in school, after-school activities, playing with friends, video games etc. Making the time for them to sit on the toilet is important. Toilets at schools are gross. “Toilet Time” at home is particularly important in toddlers and young children learning to develop healthy stooling habits. The colon is naturally squeezing 20-30 minutes after breakfast and dinner making these good times to encourage sitting.
Diet – Getting the right proportions of food can be challenging in early childhood. Kids are picky – and lets be honest, most parents don’t have time to plan an elaborate meal. The key to a balanced diet is allowing for adequate fiber in the form of whole grains, fruits or vegetables at least 5-9 servings per day. Some of my current favs: Mammachia Chia Squeeze (Chia is a great source of fiber and Omegas!), Brussels sprouts, and tangerines. www.choosemyplate.gov for more info!
Fiber – Fiber is good… too much fiber? Not so good. Insoluble fibers such as bran, lentils and green leafy vegetables work by breaking up stool. But too much can result in added bulk (i.e. basically making more poop). Soluble fiber such as oats, beans and oranges draw in water and soften stool. But too much can actually cause bloating/diarrhea/dehydration. For children 2-10 years old, the old adage is age + 5 = grams of fiber per day.
Milk-Protein Allergy and Other Food Allergies – Food protein intolerances (different from classic anaphylactic allergy) often result in abdominal pain, occasional nausea/vomiting and diarrhea. The constipation is secondary to the limited variety of foods available to those children suffering from allergies. Using food diaries and coming up with a comprehensive nutrition plan with your pediatrician or pediatric gastroenterologist is important to prevent vitamin deficiencies and constipation.
These area some less common but more insidious causes of constipation and cannot be missed! They include: celiac disease, IBS, thyroid disease, medication-related constipation, and anal fissures. If you worry that there may be an underlying reason for your child’s constipation that isn’t listed above, we are here to help!