Terri Cassidy’s daughter’s first bout of constipation came during potty training when she was almost two-and-a-half. “In hindsight I think we made too much a big deal of it because she starting holding it in which led to her to becoming constipated,” says the Toronto mom. “We realized we had to step back a bit. She finally went in a diaper, but the pain she experienced put training back another month.”
Joanne Giornofelice, a mom of three from Hamilton, Ont., had the opposite problem with her daughter Oriana when the then-toddler experienced a nasty bout of the stomach flu suffering both diarrhea and vomiting. “We couldn’t get to the bathroom fast enough and it was coming out of both ends simultaneously,” remembers Giornofelice.
Your child may only be able to string a few words together but at some point he will have the verbal skills to say, “my tummy hurts.”

Here are three of the most common causes of stomach pain in toddlers and how you can help them through it.

Constipation

SYMPTOMS: Infrequent and hard bowel movements that are often accompanied by
stomach cramps.

CAUSES: “Children this age are trying to establish control over their body especially when they poop and when they don’t, so if they hold back, the stool can become large, hard and uncomfortable,” explains Dr. Bob Issenman, chief of pediatric gastroenterology and nutrition at McMaster Children’s Hospital in Hamilton, Ont., and past president of the Canadian Paediatric Society (CPS). Nutrition can also play a part. Milk is an important part of a child’s diet but it lacks fibre and if your child is consuming a lot of dairy, it can tend to be constipating, he says. The CPS suggests after 12 months of age, your child should not take more than three portions of milk products per day (one portion equals 1 cup milk, 3⁄4 cup of yogurt or 50 g of cheese).

WHAT YOU CAN DO: The best way to coach your child through the discomfort of constipation is to distract your little one and let their body work a little more naturally, says Dr. Issenman. “For some toddlers, drawing their attention to going to the potty can make the problem worse. Talking to them or playing music may help relax them,” he says. Offer your child foods that are high in fibre including fruits (yes, prunes) and vegetables. Another easy option is cereal with more than 4 g of fibre per serving. If your child is taking more than a day to pass a bowel movement, a little gentle help early is better than toughing it out, says Dr. Issenman. “It is reasonable to use gentle laxatives, but you want to avoid a situation where they are is being used on a consistent basis unless under the direction of a doctor.”

SEEK MEDICAL ATTENTION: If your child is really distressed, he is passing blood or if you see inflammation around the anus.

Diarrhea

SYMPTOMS: Increased bowel movements with watery or less formed stools.

CAUSES: Acute diarrhea may be the result of too much juice (“toddler’s diarrhea’), food poisoning or an infection for example by a virus (such as rotavirus), which is generally the most common cause in children. The symptoms can be very dramatic with your toddler passing large amounts of watery diarrhea over 24 hours. During the summer months, when families visit cottages and swim in lake and pond water, there is also the chance, although much less common, that your child has picked up a parasite e.g. giardia, says Dr. Issenman.

WHAT YOU CAN DO: Children with diarrhea need fluids to avoid dehydration. Oral rehydration solutions, available at drugstores, provide the exact amount of water, salts and sugars. It should be offered in frequent but small amounts. (The CPS recommends 6 to 8 tbsp every hour.) Do not chase diarrhea with sugary drinks or sports drinks that can make diarrhea worse. “Stay the course,” says Dr. Issenman. “Keep them on a normal balance of what you would feed them and provide extra fluids. Children will regulate themselves.” Stools may increase at first (one or two more each day) but it may take up to a week or longer for stools to become completely formed. Proper hand washing and safe food handling are also important ways to prevent the spread of germs that cause diarrhea.

SEEK MEDICAL ATTENTION: If she shows signs of dehydration including irritability, no tears, sunken eyes, tenting of the skin (if you give it a pinch and it’s very slow to recoil, maintaining the shape of a tent), dry mouth and tongue, lethargy and infrequent urination. Contact your doctor if your child has chronic diarrhea (more than two weeks) and is losing weight.

Vomiting

SYMPTOMS: Nausea and the forceful emptying of the stomach’s contents through the mouth or nose.

CAUSES: The sudden onset of vomiting is generally associated with a viral infection such as the stomach “flu’ (most commonly rotovirus or Norwalk type virus). In the summer, occasional vomiting may be associated with overeating and running around.

WHAT YOU CAN DO: Vomiting usually lasts 12 to 24 hours. It should be less frequent and forceful past 24 hours, says Dr. Issenman. “It may still be raining, but the storm has passed.” Again, Dr. Issenman suggests offering spoonfuls of oral rehydration solution when your toddler can keep something down. Gradually increase the amounts of clear fluids. After eight hours without vomiting, start her on her normal diet of solid food. He does not recommend anti-nausea medication as they may cause sedation.

SEEK MEDICAL ATTENTION: If your child is vomiting and shows signs of dehydration as described above, or is vomiting up blood.

CF senior editor Robin Stevenson has nursed her daughter through all three ailments above and expects to do so for many years to come.