Only Drinks Milk

Dear Lisa,

My 3 year old has chronic constipation along with stool withholding on top of that he refuses to eat food he lives off milk. What can I do? Respectfully,

“Mrs. M”

Dear “Mrs. M”,

Your son’s constipation is very likely related to his diet. Children need fiber in their diet in order to maintain a normal stool pattern and prevent constipation. Foods such as fruits, vegetables and grains add roughage to the diet. Excessive amounts of milk can also cause a child to become constipated. (1)

Milk alone does not provide the appropriate amount of nutrients necessary for a child’s growth and development. In particular, cow’s milk is a poor source of iron, containing only 0.5mg to 1.5 mg iron per liter.(2) In addition, drinking excessive amounts of cow’s milk can lead to blood loss through the intestines. Children over 6 months old who drink more than 1 quart of cow’s milk per day are at risk for developing Iron Deficiency Anemia.(2)

When a child is constipated he experiences straining and pain when ta bowel movement is passed. Children remember and fear this pain and as a result attempt to hold in their stool to avoid it. When a child holds in his stool, water in the stool is pulled out into the body, leaving a harder, more difficult to pass bowel movement. The longer the child holds in the stool, the harder the bowel movement becomes and a vicious cycle begins. Stool withholding can develop into a chronic problem and lead to complications.

Besides the nutritional value of eating food, young children also need to eat food in order to promote speech development. Biting, chewing and moving food around in the mouth helps develop the muscles and coordination that are necessary for speech. Drinking alone does not help develop the muscles in the mouth, jaw and throat that are responsible for the production of clear speech.

The many benefits of eating solid food should outweigh any concerns you may have about your son’s behavior when you attempt to give him solid foods. It is very normal for children to confront any change in their routine with frustration and acting out. Therefore, his refusal to eat and his acting out behavior should not persuade you to give in to him. Transitioning your son to a diet consisting of solid food is necessary at this time.

At first, the transistion may be difficult and emotionally challenging, but you should be reassured that most children adjust to change in approximately 2 weeks time. During this two week transition period it is important to stay firm in your decision and not give in to your son's pleading or crying. This may be very difficult to do because this behavior does have the potential to wear a mother down. Just remember that the body has a natural instinct, need and desire to eat. When your child is hungry he will eat something.

It should be helpful to know that it is healthier for your child to eat food rather than continue with his present diet consisting only of cow’s milk. When a child drinks milk continually throughout the day, he does not develop hunger or the desire to eat solid food. Therefore it is necessary to take away the milk. If he is drinking from a bottle, it is a good idea to just throw all of his bottles away so that you will not be tempted to give them back to him. You can give him sips of water in the mean time and frequently offer different types of solid food. Your son will initially protest, but when he gets hungry he will eat.

I have some practical suggestions that I hope will help this transition go a little smoother. One suggestion is to have your son stay at an Aunt’s or Grandparent’s house for a couple of days. Have his aunt or Grandma tell your son that there is no more milk and instead, offer other types of solid food. They should offer him foods with different temperatures, textures , shapes and and flavors. Mostly likely he will protest less when he is staying with relatives. Once it is determined which foods he eats at his relative’s house, then you will know what type of solids to offer him when he returns home.

Another suggestion is to have your son visit a friend or neighbor’s with older children and have your son watch them eat. Children learn from each other and many times they like to copy the actions of other kids. It is more likely that your son will eat food if he sees other children eating it.

You can also bring your son with you to the market and ask him to pick out something that he wants to eat. You may be surprised what he picks out. There may be a type of food that he saw an adult eat that he would like to try. Lastly, and probably most importantly, have your son sit down with the rest of the family for meals. Watching other family members eat sets a good example for your son. Parents that eat healthy food with a big smile on their face give their child the message that eating is good. Children learn eating behaviors from their parents, and what better way to teach them than to eat a big plate of fruits and vegetables.

I wish you luck.

If You are interested in reading other Pediatric Advice Stories covering topics discussed:

Constipation

Treating Constipation

Stool Withholding

Bottle Weaning

Picky Eater

Anemia

Childhood Nutritional Requirements

References:
(1)Schwartz M, Charney E, Curry T, Ludwig S. Pediatric Primary Care. A Problem Oriented Approach. 2nd Ed. Littleton, Mass:Year Book Medical Publishers, Inc. 1990:179.
(2)Betz C, Hunsberger M, Wright S. Family-Centered Nursing Care of Children. 2nd ed. Philadelphia, PA:W.B.Saunders Company. 1994: 1406.

Lisa-ann Kelly R.N., P.N.P.,C.
Certified Pediatric Nurse Practitioner

Pediatric Advice About Childhood Growth and Development