Q&A:
What should I do about my 2 1/2-year-old's "oozy poop"?

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Answered by Loraine Stern M.D.

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"I adore children and being a pediatrician because of all the hugging and laughing that we do," say Loraine Stern, M.D.

Loraine Stern, M.D., clinical professor of pediatrics at U.C.L.A., has been in private pediatric practice for 35 years. Dr. Stern wrote for Woman's Day magazine from 1986 to 2005. She is a former editor of and contributor to Healthy Kids magazine. She has published two books on child care and has edited a book about pediatric nutrition for the American Academy of Pediatrics. A spokesperson for children and families, Dr. Stern has appeared on national networks and programs such as CNN, The Today Show, and Good Morning America.

Dr. Stern has two stepchildren but no animals or even green plants.

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Question

My son is 2 1/2. For about a year, he has had what appears to be diarrhea in that he constantly has some fecal material in his diaper. Yet every few days he goes through a period of straining and produces fairly solid stool. I know he is sensitive to milk. Could this cause the above symptoms, what I call "oozy poop"? The various doctors I have asked ignore me, but I don't know how I will begin toilet training if this is going on.

Answer

What you are describing may be a fairly common problem called "overflow incontinence." A large collection of firm stool blocks the passage of bowel movements, but some thinner bowel contents can slide on past and cause constant leakage or smearing. This is most often a problem in the toilet trained child who holds stool in an attempt to avoid using the toilet or soiling himself. Withholding stool causes large, firm bowel movements to form that are difficult and painful to pass, causing the child to withhold further. In your child's case, since you haven't started teaching him how to use the toilet, the problem may simply be the result of constipation. Most adults think constipation means not having a daily stool. Actually, it means the difficult passage of hard, painful bowel movements.You say this has been present for a year, and I would assume that it began at the time you discontinued formula or breastfeeding and introduced cow's milk. Although a lack of fiber and other dietary factors can contribute, cow's milk is notorious for causing constipation in some children. A trial of eliminating milk may help, but then you need to pay attention to his calcium needs. There are simple substitutes for cow's milk -- calcium-fortified orange or apple juice, for example, or rice- or soy- based drinks. Also, examine your child's diet: Is he eating enough high fiber foods such as whole grain bread, crackers and cereals, vegetables and fruits? To correct this problem, you need to talk to a pediatrician sympathetic to your predicament. In fact, since there is a slight chance that the "oozy poop" may be due to some other medical problem, I think consulting with a pediatrician is essential. Often we have a program of "cleaning out" the bowel for a short period of time using laxatives or stool softeners. Once the colon has been stretched by holding large amounts of stool, it needs to get back into normal tone and shape. Don't take it upon yourself to use any laxatives or enemas, however, as there can be dangers to small children with misuse.