Maggie McKay (Host): How would you know if your child is constipated? What are the signs and how would you treat it? Today, we'll find out with Dr. Price Edwards, pediatric gastroenterologist at Lebonheur Children's Hospital.

Welcome to the Peds Pod by Le Bonheur Children's Hospital. I'm your host, Maggie MacKay. Thank you so much for joining us, Dr. Edwards.

Dr. Price Edwards: Thank you. Really glad to be here.

Host: So, let's just get right to it. What are the most common causes of constipation when it comes to kids?

Dr. Price Edwards: There can be various reasons that kids deal with constipation. You know, it's very common in both kids and adults. But for most, the stools just become too hard and/or painful. And that really makes having effective bowel movements difficult, which then can become an ongoing issue with patients not wanting to use the restroom or having fear around it, which can really slow down their ability to have bowel movements and cause ongoing issues.

Host: And at what age does constipation usually become an issue for kids?

Dr. Price Edwards: You know, it can happen at any age, but we do see very large bumps around when children are transitioning to more solid foods and around the time of toilet training, but we do see children of all ages present with new constipation.

Host: And when should parents be concerned about their child's bowel habits?

Dr. Price Edwards: While there are very strict definitions of constipation, there can be a lot of nuance in how kids can experience it. I would definitely talk to your pediatrician or a specialist if you're noticing your child seems to be in pain. If they're seeming to want to avoid going to the restroom, you're seeing blood in the stool, having poor weight gain or growth issues. Those are all different concerns that would be, I think, items that should be discussed with a physician.

Additionally, for infants, those that don't have a bowel movement within the first two days of life, or having large issues with bowel movements early in life, that always should be discussed with your pediatrician as well.

Host: Dr. Edwards, what role does hydration and diet play in preventing constipation? 

Dr. Price Edwards: Diet is definitely an important factor. We know that it feeds into our microbiome, and likely that has a role in how our gut health and stooling do happen. For most of the patients I see in clinic, small diet changes are not going to be enough to really get them back on track. But we know there are dietary factors. Certain items like soluble fibers like psyllium husk can be helpful. And there have even been some studies in adults showing that kiwifruit, prunes are as or more effective than medications for some patients.

Host: When our son was little, I remember the pediatrician saying, "Anything that starts with a P." Is that that accurate? I thought, "Wow..."

Dr. Price Edwards: Pears as well. That is true.

Host: Peaches?

Dr. Price Edwards: Really any stone fruit, but I think prunes, pears, and then kiwis are really the ones that have been studied the most that are known to make a big difference.

Host: So when is it time to see a doctor versus trying these at-home remedies?

Dr. Price Edwards: Most medications we use for constipation are over-the-counter. And so, families can use softeners and stimulants over-the-counter at home. I think that it really becomes an issue when you're having more daily symptoms. Those red flags I mentioned should always prompt a discussion with a pediatrician or a specialist.

If you're noticing fear or pain developing, I think intervening early is better just so you can avoid this becoming more retained habit and try and intervene on that sooner and not let more bad habits develop. I always recommend when they're using over-the-counter treatments to read them very carefully. There are some enemas, suppositories that should not be used in kids and just always pay attention to the warning labels and use them according to their instruction.

Host: So, what would you say are the safest treatments for constipation in young children?

Dr. Price Edwards: So, for those starting a medication, we typically start with a softener and that can include polyethylene glycol also known as MiraLAX, lactulose or magnesium. And really, all of these can be considered as a softener and these just soften bowel movements, try to make them easier to pass. And then often, if that alone isn't helping, we discuss adding a stimulant, which is going to help the colon squeeze to have more frequent more regular bowel movements.

So for a lot of patients that I see, we're talking about a combination of the two, and sometimes parents have tried one and feel very strongly about whether it worked or didn't, and there's always different options we can try and find the best fit for the patient based on what they've tried and how they're dealing with this.

Host: You mentioned MiraLAX. I once spoke with someone who said they give their children a little bit of MiraLAX in their juice or something every single day. Do you think that's necessary?

Dr. Price Edwards: Depending on the patient, you know, a little bit of softener can, for many, be all they need. And I think that's a really mild intervention. And for most patients, I think MiraLAX works much better or really any softener if you're using it daily, because it takes usually a few days to take effect. So, I think they're best used daily. And I think all parents worry about, "Am I forming a dependence or am I giving my child something that's going to make them develop a tolerance to these medicines?" And thankfully, the research has shown quite the opposite that really just finding a good combination of treatments-- medication or not-- to help regular bowel movements occur is going to be the best intervention to hopefully get off the medications later if we're able to.

Host: So, Dr. Edwards, if you could give parents one takeaway to help keep their child's digestion healthy and regular, what would it be?

Dr. Price Edwards: So, I think the one concern that parents always have is, you know, what is causing it? And I think that often consumes a lot of concern and worry and really makes parents think about, "Is there a blockage?" And thankfully, for most patients, we don't have to do large interventions or very invasive testing and some very simple medication or behavioral changes can be very effective. And I think that is the place to start.

And I always want to be very clear when talking to patients and families that this is a very invasive, debilitating, life-altering symptom. And I think families often feel very isolated because it can be stigmatizing and patients can be bullied if they're having accidents or soiling events. So, it's a really important topic and something I really do care a lot about treating because it is, I think, often not talked about enough, but still a very important topic.

Host: Well, thank you so much for sharing your expertise and making the time to be with us. This has been so educational and helpful. We really appreciate it

Dr. Price Edwards: It's been a pleasure. Thanks for having me, and I really appreciate the time.

Host: Thank you so much. To find out more, please visit lebonheur.org. That's Le Bonheur, L-E-B-O-N-H-E-U-R dot org. If you found this podcast helpful, please share it on your social channels and check out our entire podcast library for topics of interest to you. I'm Maggie McKay. Thanks for listening to the Peds Pod from Le Bonheur Children's Hospital.