I received a phone call today from a local nurse practitioner (NP) from a
family physician's office who has been seeing a 3 and a half year old
female child with intermittent (every 2 months) constipation. The child
continues to breastfeed ad lib (usually at night). The mother states that
the child receives a well balanced diet that includes 2 bottles (baby
bottles) of 2% milk daily. Mom states that she has "lots of milk".

The child was toilet trained at 3 years and this coincided with the first
incidence of constipation. The mother states that at about the same time
she  began to discuss weaning with her daughter, and that these discussions
are what usually appears to precipitate the "withholding of stool". The
child eventually has a BM with much discomfort and crying, continues to BF,
has normal BMs, until the next suggestion of weaning.

The NP asked me if the constipation might be caused by the amount of milk
the child is receiving. I told her that I didn't think that it was and that
certainly the breastmilk would not be causing the problem. I stated that
given the timing of the training , (at the same time as the suggestion of
withdrawing the breast), might be very threatening to the child. She may
relate the bowel movement to the withdrawl of the comfort of the breast,
and the withholding of the bowel movement to the reward of the breast when
the discomfort of the constipation is soothed at the breast. It appears
that when the threat of weaning is gone, the bowel movements return to
normal.

I would appreciate input for this problem, and any guidance you might have
for this mom.

TIA,

Bobbie