Kids with low tone and sensory processing disorders are not the only children who struggle with constipation, but it is more common for them. The reasons are many: low abdominal and oral tone, less use of available musculature because they use compensatory sitting and standing (the schlump, the lean, the swayback) patterns, and even food choices that have less fiber. If you struggle to chew and swallow, you probably aren’t drinking enough and eating those fruits and veggies that have fiber. Sucking applesauce packets may get you Vitamin C, but it has pulverized all that fiber. Now add discomfort with the sensory experience: the smells, feelings, sounds of bathrooms and using the potty. It can all be too much!
Without fluids, fiber and intra-abdominal pressure to support peristalsis (the automatic contraction of the intestines), children with low tone are at a huge risk for constipation. And constipation makes pooping harder and even painful. Sensory overload makes kids agitated, distracted, and sometimes even aggressive. Not good for learning or letting it go into the toilet. Hence, resistance and even fear of pooping, and therefore more stress and withholding of stool. A really big problem, one that you may have to get your pediatrician’s assistance to solve.
It can change. Here is your secret weapon: your child’s occupational therapist. If you haven’t been involved in your child’s therapy before, this might be the time. Research has shown that sensory-based issues can contribute to toileting problems, and OTs are capable of evaluating all the sensory and motor-based contributors. While your pediatrician gives you recommendations on diet, laxatives and more, your OT can help your child stay in the alert-but-calm zone where digestion is relaxed, get better core stability to help push that poop along, and adapt the toileting experience for minimal sensory aversion and maximal sensory perception. Take a look at Low Tone and Toilet Training: How Your Child’s Therapists Can Help You and Low Tone and Toilet Training: The Importance of Dry Runs (Pun Totally Intended).
Update: Many of my clients have been successful with a creative combo approach: they use stool softeners, they limit refined carbs (sorry, Goldfish crackers are cheese plus refined carbs!), ensure lots of fluids and then add some tasty fiber. Prunes covered with chocolate have been popular, but beware the results of too much of a good thing! They use abdominal massage and make sure that their physical and occupational therapists are working those core stabilizers.
There are medications that improve gastric motility, but they aren’t always tolerated or even prescribed for small children. Pediatricians are very hesitant to be aggressive with a small child that could dehydrate in a few hours of diarrhea. Find a doctor that listens to you and is creative. My suggestion? Think outside the box and consider an osteopath. They are “real” doctors, but they have more training in alternative and manual treatment approaches.
Think constipation is only going to affect pooping? Wrong! Read Is Your Constipated Toddler Also Having Bladder Accidents? Here Are Three Possible Reasons Why to understand more about how this problem can contribute to other toilet training struggles.
My book, The Practical Guide to Toilet Training Your Child With Low Muscle Tone, is done and available at Your Therapy Source ( a terrific site for parents and therapists!), on Amazon as well as on my website, tranquil babies !! Just click on the “e-book” section, and start making progress with your child today!
I include detailed readiness checklists and a full explanation of how to train your child in all aspects of toilet training. You will know how to get the right equipment, what clothes to use so that dressing doesn’t derail your child’s best efforts, and how to deal with defiance and distress. And yes, constipation is addressed in more detail than in this blog post. It may turn out to be only one of the issues that you have to confront. Don’t worry, help has arrived!
If you want a hard copy, contact me through my site and request a mailing address for your payment.
As I say in my book: be prepared, be consistent, expect to practice, and be positive that you and your child can do this!
I just found your blog. My little guy was a 32.5 week preemie and I suspect he has low tone. He’s been constipated since birth. He only went twice a month and now that solids have come he can’t go at all and our peditrican won’t help much.
He’s turning 1 next week and still can’t sit solo so having early intervention come out next week to access him. He can’t get up on knees and his joints seems loose too. He will sit there popping his knee back and forth in and out of joint. He will lock his legs straight out that I can’t Bend them an other times they seem floppy.
Thanks for your article
Early intervention could make a huge difference for your son and for you too! Please ask your therapists lots of questions and consider whether a pediatric gastroenterologist could help you. And check out my Facebook page, where I posted a video on constipation made by a children’s hospital!