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Expert Q&A:
My 2-year-old daughter has had hard BMs for almost a year. What can I do to remedy them?

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Suzanne Dixon
Answered by Suzanne Dixon M.D., M.P.H.
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"There is nothing so amazing as the development of a child," says Suzanne Dixon, M.D., a behavioral and developmental pediatrician who was one of the founding members of the Pampers Parenting Network. "Every day is a new adventure when you have a child around you. I never get tired of learning from the children who have been a part of my life, professionally and personally."Suzanne Dixon, M.D., M.P.H., was born and raised in Minnesota and graduated from the University of Minnesota, School of Medicine. She did her pediatric training at Massachusetts General Hospital in Boston and then completed a fellowship in Child Development at Boston's Children's Hospital. Dr. Dixon joined the faculty at the University of California, San Diego, and did patient care, teaching, and research for 20 years. She ran a large newborn service, performed research in early child development, and was involved in many community outreach activities in maternal child health. Throughout her entire professional life she has maintained an interest in cross-cultural activities, living and working in many parts of the world, including Mexico, India, Kenya, Indonesia, and several countries from the former U.S.S.R. Dr. Dixon is the author of numerous research articles, review articles, and textbook chapters in pediatrics, child and family development, and public health. Her textbook, written with Dr. Martin Stein, Encounters With Children: Pediatric Behavior and Development, has become a classic in child health education and is in its fourth edition. She is Editor in Chief of the Journal of Developmental and Behavioral Pediatrics, an international journal of high standing in the professional world. She also has served as an associate editor for Infant Mental Health and currently reviews for several major pediatric journals. Dr. Dixon is a fellow of the American Academy of Pediatrics and served in national positions in that organization. She is a member of the Society for Pediatric Research, the Society for Research in Child Development, the American Public Health Association, and the Executive Council of the Society for Developmental and Behavioral Pediatrics. She serves as consultant to several national and international organizations and has received an award from Healthy Mothers, Healthy Babies.Dr. Dixon continues to lecture and consult worldwide on aspects of maternal, child, and family health. She practices behavioral and developmental pediatrics in Montana and works with local advocacy groups on education and women''s health. Dr. Dixon has been married for over 30 years and has three sons. She and her husband travel frequently, are outdoor enthusiasts, and enjoy being amateur anthropologists.
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Question


My 2-year-old daughter has had large, extremely hard BM's for about 11 months. Her pediatrician had me put her on mineral oil for 6 months, but the problem didn't clear up. I went to another pediatrician, who told me that she would have to be on it for 9 months before it cleared up. She will have been on the mineral oil for one year in August, and is still having the same problem. Her pediatrician thinks I am a nutcase, but the stools nearly always have blood on the outside, and she strains so much I am worried for her. Am I just paranoid, or is something else wrong?

Answer


The blood on the outside doesn't worry me as much as the length of time that this problem has been around. Those large hard stools are producing little cracks around the anal opening that bleed. These hurt and will lead to resistance to toileting if the problem isn't solved. Ask for a referral to a pediatric gastroenterologist, a child's specialist for problems related to the bowels. She or he can go through the whole story and determine whether more testing is needed and how to treat the problem. Get all her medical records sent ahead for review. Most moms turn into "nutcases" if they are constantly worried about a child. Get some specialized help for your daughter.
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