baby withholding stools

  My 15 month child has had a sluggish digestive system since he was a few months old and as he grew older he had problems with painful constipation and hard stools.  I've managed to control it for the most part with diet.  At one year of age, after an episode of constipation he started to with hold his stools.  My doctor said to give him a lot of juice and keep the stools soft and eventually he won't be so afraid to "poop".  His stools have been soft for a couple of months and he still holds on to them and screams when the urge comes.  Will he just outgrow this or is there something else that I can do?

[HFHS.MD-HSW]

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Dear CJ:
I assume your child is otherwise healthy, stooled normally after birth, has been developing appropriately, and has a normal physical examination. Ineffectively or partially treated constipation, such as that which you describe in your toddler, can lead to significant problems related to toilet training in early childhood as well as socially disabling prolonged stool withholding and soiling in later childhood. Fortunately, the good news is that the application of available interventions promises a successful outcome. An appropriate goal is the comfortable and confident passage of stools at least a couple of times a week. For many toddlers, dietary manipulations suffice. Excessive milk should be avoided - a pint should be adequate at this age. Fiber content of the diet needs to be augmented by inclusion of fruits and vegetables. You probably have done this already. When this approach is insufficient, one must turn to other means. Any impaction must first be removed by judicious use of enemas. Oral lactulose can be exceedingly effective in a toddler. Pediatric glycerine suppositories may be occasionally useful. At times, cathartics such as senna have an ancillary role. Your pediatrician will be able to help you develop a plan to achieve appropriate stooling goals for your toddler. I would suggest discussing the matter further with him/her. I am very optimistic about the outcome of proper management.
This information is offered for educational purposes only. I hope it contributes to a useful discussion with your pediatrician and greater contentment in your household.
HFHS.MD.HSW
Key Words: constipation