Why Can’t Johnny Poop? (Pedcast)


Today were going to take a little detour from traditional pediatrics and discuss a unique view of a common pediatric condition, constipation. I’m going to introduce you to a thought I had many years ago about why children so frequently have trouble with the basic bodily function of defecation. You may be surprised to find out that constipation is an amazingly common symptom in children and one that pediatricians encounter frequently. I often am amazed at the myriad of ways a constipated child can present to their pediatrician: recurrent abdominal pain, excess gas and flatulence, bloating, heartburn, morning vomiting, hemorrhoids, rectal bleeding, toilet clogging large stools, and stool leakage, just to mention a few. But why so much constipation?  I hope to answer that question for you in today’s pedcast. I also want to share with you my personal theory of why abdominal complaints are so common in children, an explanation that involves evolutionary theory of all things.  I hope I have you curious with that comment so stay tune for this very interesting addition of Portable Practical Pediatrics.

Musical intro

Why do so many children have constipation?

For a child to have normal bowel movements, a number of things have to occur. The child needs to have a diet that is rich in fiber, they need to drink plenty of water, they need to be active physically, they need to have access to a place where they can comfortably use the potty, and they need to respond to the normal cues of defecation with the proper response… go to the bathroom! Unfortunately, many of these factors are just not available to a child in today’s world. Think about it, today’s kids often eat a mostly processed food diet that is very lacking in fiber and rich in constipating dairy. They sit in school all day and are not allowed to be physically active, their access to a bathroom is very limited and if they do get there, may not be inclined to defecate.  Additionally, they have great difficulty getting water since they often need permission to go to the place where they can drink water. Yes all these factors contribute to creating constipation but there are other factors as well. I’ve talked in previous pedcast about how intertwined emotions are with intestinal motility. Every primary care doctor, especially pediatricians learn to appreciate this relationship over time. You’re not paying attention as a pediatrician if you don’t notice that many constipated kids are unusually anxious. The link between anxiety and constipation is a very strong one.

One way to look at the link between anxiety and constipation

But why is there such a strong gut response to heightened emotions?  Why does anxiety translate into constipation? Is there a reason that this unconscious and presumably autonomic response has developed in children?  Could it actually be a useful, or even life saving thing? Well I have my theories about this phenomena that I am going to share with you right now.  If you think about where our ancestors came from, all the way back to when we were living in tribes, it was likely that our ancestors we’re nomadic. They moved around all the time and need to be ready to move in an instant. They moved in search of food, water, better weather, or when other tribes threatened them. If you were a child in one of these tribes, having the tribe move on without you meant something terrible was going to happen to you. If the tribe was moving and you had to stop to poop, that could literally mean the difference between life and death for you. I believe children living in these conditions developed a reflex to suppress pooping when they were anxious because of this very fact. I think the suppression of the defecation reflex, the shutting down of gastric motility, is wired very deeply into children as a survival mechanism. I believe this is the basis of the strong link between constipation and anxiety. If your child suffers from chronic or frequent constipation, understanding this is vital to helping them control this awful condition. Addressing their diet, water intake, access to a bathroom, and physical activity won’t alleviate their constipation reflex unless you also lower their anxiety.

How can parents help?

This is an interesting concept, don’t you think? Constipation may not just be an abnormal physiological state, but actually a useful survival reflex! Now I’ve got you thinking about constipation as a primal, primitive survival reflex with an emotional basis, and a sign of psychological stress.  You can see that this reflex actually developed for a reason and was very useful for children when they lived a tribal existence. Combined this innate reflex with the constipating modern lifestyle of most children today, and you get a generation of children who have difficulty with this basic bodily function… pooping.  So how do we help children who suffer from chronic or frequent constipation?  Well, first we try to relieve the factors that we can control like ensuring that they have a diet that’s rich in fiber, full of fruits and vegetables. Having your child drink plenty of water will also help. I have also learned that limiting dairy intake is a very important in eliminating constipation in some children.  Of course, making sure your children are physically active as much of the day as possible will help and don’t forget to make sure that they have access to a bathroom whenever they need it; a place where they feel comfortable. And of course, it is vital that you make every attempt to ease your child’s anxieties by being sensitive to their worries and trying to create an emotional environment where they feel secure and not threatened. Easily said but maybe not so easy to do, I know. Creating a healthy emotional environment has been the subject of some of my previous pedcasts https://www.docsmo.com/help-for-anxious-kids-pedcast/,  https://www.docsmo.com/helping-children-with-divorce-with-dr-john-simpson-pedcast/,  and will certainly be a topic of future pedcasts. Stay tune for these.


Well as always, thank you for joining me today. If you enjoy exploring pediatric topics with Portable Practical Pediatrics, please take a moment to write a review on iTunes or on my Facebook page www.facebook.com/DocSmo/. By doing so, you help others find my blog and increase the DocSmo.com audience. This is Dr. Paul Smolen, broadcasting from studio 1E in beautiful Charlotte, NC, hoping that you make haste, in helping your children with their bodily waste.  Until next time.


Edited by Dr. Monica Miller. Thanks Monica.