When Management Becomes the Goal

I got an update from one of my families this week that I haven't stopped thinking about.

When we started working together at the beginning of June, their four-year-old daughter was withholding. She was taking Miralax multiple times a day, along with magnesium and a prebiotic powder, and she would sometimes leak pee. Her parents were doing what so many parents I meet are doing: everything they had been told to do to keep their child pooping.

And that's exactly where this gets interesting.

Because she was pooping.

If the only goal was to get poop out, you could argue that what they were doing was working. But her parents didn't come to me looking for another way to make their daughter poop. They wanted to know how to help her body eventually do this without needing so much help from them.

So that's what we've been working toward.

A little over two months later, they've been able to completely remove the magnesium and the prebiotic powder. They've begun gradually reducing the Miralax as appropriate for her care, and she's continuing to poop really well. Even when not at home, which is huge.

But the part of her mom's update that I loved most actually had very little to do with poop.

She told me it's been “so cool to see her come out of her shell.” She's talking so much more. She's more willing to help clean up. She's even becoming a daddy's girl, which Mom said is a big step because she used to want Mom to do everything for her.

We're seeing progress in the bathroom too. She still needs prompting and doesn't always want to go, so her parents are using a timer. But recently, Mom has been getting her settled with a book or drawing pad, leaving the room, and she's been going.

Are we finished?

No.

And that's important.

I don't need a perfect before-and-after story to know when we're moving in the right direction.

This is something I wish more families understood about childhood constipation: there is a difference between managing the problem and changing where you're headed.

Management isn't bad. Sometimes it's necessary. Relief matters. Medical care matters. Getting stool moving can absolutely be the first priority.

The problem is when management quietly becomes the goal.

A child starts taking something to help them poop. It works, so everyone keeps doing it. Maybe another thing gets added. Then another. Months become years, and as long as poop keeps coming out, we call it success.

But I think we need a better definition of success.

When I work with families, I'm not only asking, “Did your child poop today?”

I'm asking, “Are we getting closer to their body being able to do this independently?”

That's why I don't simply replace one product with another. We look at the conditions surrounding how that child's body functions every day—what they're eating and drinking, their rhythms, movement, environment, nervous system and bathroom patterns—and we make intentional changes based on what we're seeing.

Then we watch what the body does.

Because as the body becomes more capable, the goal should be to need less, not more.

That's what makes this little girl's progress so exciting. Two things her family previously relied on are gone. They're beginning to reduce another. She's continuing to poop well. She's starting to have some bathroom independence. And her mom is watching her little girl come out of her shell.

There's still work ahead.

But we're no longer asking only whether she pooped today.

We're changing where she's headed.

Keep building,

~ Nicole

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