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While some kids get constipated because of underlying spinal-cord and other nerve problems, celiac disease, thyroid problems, and other uncommon conditions, most have a more mundane issue: They get caught up in a vicious cycle of having hard, painful bowel movements, which makes them less willing to voluntarily use the potty, which in turn makes them even more constipated. Before long, these poor toddlers have the equivalent of a brick sitting in their bowels. It's unclear what starts the whole cycle, though in 1998, the New England Journal of Medicine reported that up to 70 percent of pediatric constipation might be caused by an intolerance to cow's milk. (There's also an infamous case report of a 2-year-old who stopped using the potty and became horribly constipated after seeing a single television ad for a toilet cleaner, in which the toilet bowl turned into a chomping mouth.)
So we talked to Ryan's own pediatrician (a former colleague from my own residency) and agreed on a plan. Treating serious constipation is a two-step process. First, you have to clean house, so to speak, and start fresh. Second, a child needs long-term dietary and medical help to keep things moving and so it doesn't happen again. Though this sounds pretty easy, it turns out that even after they've been treated by a pediatrician for two months, 40 percent of kids are still constipated. Treating the problem, it turns out, is like losing weight: It takes a big initial step followed by long-term discipline in order to keep the problem away.