Following graduation from college, I spent four years in medical school, then three years in a pediatric residency. This was long before medical student and resident work hours were restricted, so I spent up to 100 hours each week for many years learning medicine – specifically pediatric medicine. I’ve spent the rest of my life practicing to get it right. After all the time, effort and expense, what have I spent most of my professional time doing? Talking about poop: too much, not enough, too hard, too loose—you name it, some mom, dad or grandma has worried about it, and I’ve discussed it.

What’s normal and what’s not? Normal stools are easy to pass without pain and are passed somewhere between one to three times daily and up to once every three days – a pretty broad range. Healthy bowel habits start early in life. Teach your child not to hold stool in. There’s a difficult balance while toilet-training between holding long enough to get to the potty, but not holding so long as to develop constipation. Children sometimes ignore the urge to go because they’re busy playing. Encourage your child to go when he feels the urge. It’s important to recognize we’re most likely to have a bowel movement after eating, so have your child relax and be prepared to go 30 minutes after meals. Try to avoid words like ‘dirty’ or ‘stinky,’ which have negative connotations and may discourage your child from going.

Constipation means bowel movements are less often than usual or that the stools are harder, more difficult or painful to pass than usual. Constipation can be caused by a diet too low in fiber or too full of dairy, fear of having a bowel movement, inadequate physical activity, and occasionally, by medications.

Feed your child a healthy diet. Be sure he eats fruits, vegetables, grains and dairy daily, and drinks more water than juice. A high-fiber diet incorporates fruits, vegetables and whole grains. Too much milk can cause a sensation of fullness and bloating, and may depress the appetite for other necessary food items. Sometimes constipation can become a self-perpetuating problem. A child is constipated, has a painful movement, tries to avoid the pain by holding stool and gets more constipated. If you think this is occurring—or think your child is constipated—don’t use laxatives unless your doctor has advised you to do so.

Diarrhea is the opposite of constipation, is defined as stools which are too frequent, watery or mushy. It can be caused by viral, or more rarely, bacterial infections, as well as by dietary indiscretions. Diarrhea caused by infection often is associated with systemic symptoms such as fever, crampy abdominal pain, nausea, vomiting, loss of appetite, and rarely, blood in the stool. Diarrhea can lead to dehydration, so continue to offer your child liquids and bland foods. Contact your doctor if:

• You notice bloody or black tarry-appearing stools.

• Your child suddenly stops having stools at all after having loose ones.

• Your child often has constipation but now has loose, watery stools.

• Your child has watery diarrhea and is younger than 6 months of age, has a fever or has signs of dehydration.

Signs of dehydration include extreme thirst, lack of tears, less urination, dry skin, dry mouth, fast heart rate and decreased activity.

There are many things to worry about when raising your children. But if you feed them a good diet, keep them physically active and teach them to wash their hands well and often, poop should not be one of them.

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