Dr Lauren Keller, DC

11/10/2025

I always ask how often people p**p and how the p**p looks. But guess what, those aren't very reliable! Not so fun fact, 64% of kids with constipation have bowel movements once every two days. Plus, 49% of constipated kids have a normal stool consistency. That's why it's equally important to look at other signs and symptoms of constipation:

🪀Fecal leaking, encoporesis, and p**p smears on underwear
🪀Lower abdominal pain -lower left side of abdomen or belly button pain
🪀Low back pain that comes and goes
🪀Urinary urgency or increased p*eing or leaking
🪀Bedwetting
🪀Straining/pushing for a bowel movement (it shouldn't take 10 minutes to push a p**p out and your face shouldn't be bright red from p**ping)
🪀Fluctuate between constipation and diarrhea
🪀Super skinny p**ps or frequent diarrhea
🪀Feel like they can't get all of the p**p out (incomplete evacuation)
🪀Nausea, bloating, stomach cramps
🪀Urge to go p**p shortly after p**ping

If your child (or you) experience any of these despite having a "normal" bowel movement, an appointment with your provider may be helpful!

🤓https://doi.org/10.1007/s00431-018-3243-6

11/09/2025

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11/07/2025

⚠️Trigger Warning ⚠️
🛑As always, this isn't medical advice. This is not a "should I give my child an e***a" post. That is up to YOUR provider (or your child's provider). This is for educational purposes only to show you how to make giving an e***a not cause trauma.

11/07/2025

⚠️Trigger Warning ⚠️
🛑As always, this isn't medical advice. That is up to YOUR provider (or your child's provider). This is for educational purposes only.

I frequently see parents AND providers asking how to incentive or reward a child that needs suppositories or e***as. And my answer is always the same, we don't. Instead we teach our kids about collaboration, working together to solve problems in a way that works for both of us and most importantly, we give them the space for consent. I highly recommend using collaboration over incentives. I love Dr Ross Greene's method that he covers in his book, The Explosive Child.

First, sit down and talk to your child (yes, even little kids). Say "I've noticed you have a hard time with the bathroom. What's up?" And listen. This isn't the time for parent insights, arguments or solutions. It's the time to help you better understand the child's perspective. A lot of times what parents/providers think are the issues and concerns aren't what the child is worried about. This is the time to better understand the child's concerns.

Next, talk to the child about your concerns. Be open and honest (in age appropriate talk). Talk about the current struggles you see with the child. "My concern is youe constipation. I see it affects you by causing . This isn't a time to be the authority figure and tell then what to do... it's the time for you to be open and honest about their concerns around the problem (constipation) so the child understands where you are coming from. You can also include that you are concerned that by not taking care of constipation now, it can cause more problems down the line like encoporesis, bedwetting, hemorrhoids, fissures. Sit down and let your child know WHY you want to do the suppository/e***a.

Finally, restate both your child's concerns and yours and end by stating "I wonder if there is a solution we can come up with that will address both of our concerns. I'd love for you to start." Give the child the space and time to come up with solutions. After a bit of time giving the child the space to comedown with solutions, you can also offer solutions. These solutions should be realistic and work for both people...otherwise they won't work.

And then you implement. If something isn't working, you go back to the discussion part to see if it brought something else up that needs to be addressed. Even if it doesn't work, it's still information to possible next steps.

As far as actual solutions/ideas that have worked in the past, I've had parents and kids that:
*start miralax only after school Friday with nothing planned so they aren't missing out on anything or afraid of p**ping in public (again, guided by provider)
*mix miralax with favorite drink or smoothie if taste/ texture is an issue.
*tell everyone else in the house that one specific bathroom is off limits during clean out and only they can use it
*the child gets to take a bath with bubbles (or glow sticks or homemade bath paint) before doing the e***a/suppository
*the child gets to insert the suppository/e***a (usually for kids 6+)
*the child only wants the e***a in the fetal position, or child's pose or happy baby or while curled up on their left side because those stretches help relax the pelvic floor
*the child gets to listen to their favorite music or eat their favorite food during or after the e***a/suppository
*co-regulation before, during and after (snuggle time before and after)
*some kids want complete privacy
*talk through all options of treatment- hospital clean out, e***a, suppository, miralax, etc and what those would look like. Is it possible they would do high dose miralax/magnesium clean out but not the e***a? Or they would consider a trial of miralax/magnesium and if it doesn't work then do the e***a?

There are almost always options that *may* work. If the first one you choose doesn't work out, try another. And don't hesitate to reach out to your provider for assistance in figuring out what options may be right for your child.

11/06/2025

Not gonna lie, I sometimes have to remind myself of this! 🤷‍♀️

11/06/2025

Yesterday we talked about interoception (the sense that recognizes your body's internal state) being one of the causes of constipation. Today, I want to look at it from a different lens.

First, I want to look at interoception and how it plays a role in our bodies. Think of a time that you are angry. I'm not talking frustrated, I mean seething with anger. Do you remember how that felt in your body? Maybe your hands and face felt like they were burning, maybe you felt like a heavy weight dropped into your chest. Or maybe you felt like your body was made of baking soda and someone just added vinegar and you're bubbling over about to explode. Those sensations you felt are what we call interoception. They are the physical sensations our body feels that we then label as an emotion, or the need to p*e or p**p.

So now let's look at interoception and the bathroom. When potty training, a lot of parents ask "do you need to p*e or p**p?" and while that's a valid question, it doesn't help the child understand what it FEELS like to need to p*e or p**p. We often bypass what it actually feels like to need to go p*e/p**p. And don't get me wrong, plenty of kids don't need this support as it comes naturally. However, this is about the kids that may struggle with those sensations because their sensations are either overwhelming and scary or the child has to pay more attention to even feel them.

If you're starting potty training, I recommend talking about the physical sensations your child might feel when they need to use the restroom. This can even start before potty training! If you notice a child starting to wiggle and do the potty dance you can ask them, "I see you're doing a little dance. What do you think your body is trying to tell you?" This also helps prevent the power struggle of you telling them they are doing the potty dance and they shout, "No I'm not" as it gives them the control to say what their body is feeling and telling them. If you know they always go p**p after they eat breakfast, you can do a check in and ask before and after eating, "What does your bottom feel like?". You can also start labeling YOUR sensations and connect the dots for your child. "Oh, I have a pressure in my butt. That 's my body telling me I'm going to have to p**p" or "I feel like I have a weight on my lower tummy, that's my body telling me I need to p*e soon." It helps

11/05/2025

Show of hands...who loves to p**p in public? Anyone? Anyone?? Nope...I didn't think so. There are so many stressors that come into play when it comes to public restrooms. Loud noises, unexpected toilet flushes that spray water on your b***y, dryers that sound like a jet is taking off, bright lights like you're staring on a Broadway show. That doesn't even begin to address the fact other people can hear you p*e and smell your p**p...and you can smell their p**p. It's no surprise that a lot of people don't love public restrooms. But there are also ways you can help support your child to feel more comfortable in public restrooms.

🌈Noise canceling headphones - this helps to minimize the loud noises
🌈 Sticky notes to put over the toilet sensor so it can't randomly flush (placing toilet paper over the sensor also works)
🌈 Essential oils - you can either carry a small bottle of essential oils or have a small container that has a cotton ball with essential oils on it. This can be beneficial because it not only masks the smell of p**p but if there's an oil you enjoy, it can also help you relax to be able to p**p. Fun fact....some hospitals even put a drop or two of peppermint oil in the toilet bowl to help the pelvic floor relax and allow a bowel movement. So if you NEED to go but need to relax, it's worth a try.
🌈 Sunglasses - this can help with the bright lights

We can't make the crowds go away, but we can help minimize and/or reduce the other stressors to hopefully make p**ping in public less stressful.

11/04/2025

There are three main reasons kids (and adults) don't feel the urge to p*e or p**p.

1. Constipation: Our bladder and re**um communicate with our brain to say "it's time to go" based off of pressure/stretch in those areas. A healthy 3 year old bladder tells the brain it needs to go with ~120ml of urine. When we are constipated, the brain learns that there is naturally more pressure on the bladder and re**um from the weight of the p**p. The brain is smart, and it adapts and learns that instead of signaling the need to go at 120mL it can wait until 150 or 200 or even 400mL. But when this happens the pressure can be too large and cause leaking or the brain basically goes from zero to sixty and doesn't give the brain warning signals it needs to go and the child has to go RIGHT NOW and they don't have time to get to the restroom.

2. Decreased interoception: Interoception is our 8th sense and is basically the radar detector for what's going on inside our body. It's what tells us when we are hungry, thirsty, recognizes pain or muscle tension, tells us we need to p*e & p**p and regulates body temperature. Children are still learning to connect the dots from what the body signals to what it means. As adults, we know when our cheeks get warm or our palms start getting sweaty that we are hot and need to cool down or drink water. If we start shivering, we know our body is cold and tells us we need more layers. Kids don't understand those connections YET. When it comes to the bathroom, they may not recognize that the warm sensation in their lower pelvis is a sign their bladder is full. Or that the heavy weight in the re**um is a sign they need to p**p. This comes with time and learning what their body's signals are telling them. Autistic and ADHD people often struggle with interoception. Just as some kids are tough and don't seem phased by pain while others seem distraught by a paper cut, the bathroom is no different! Some neurodivergent people recognize the simplest changes in their bowel and bladder. And others may not recognize those signals until they are super strong or it's too late and they already leak.

They have trained their body to not listen. This one is mostly adults. But when was the last time you knew you needed to use the restroom to p**p and you waited until it fit your schedule? Every time we do this with bowel movements, we can slowly change that pressure gauge so our body learns to adapt and be able to hold more p**p. We don't want to hold our p*e, p**p and farts (I'm talking about 30+ minuntes. It's 100% okay to hold it until you get to a restroom). We want to listen to our body when it whispers and respond to its needs so we don't have to wait until it screams.

11/03/2025

Do your kids normally mean mug the camera? Or someone is inevitably picking their nose? 🤷‍♀️ Carley is absolutely amazing at photographing kids so you get smiles and not snot captured. I can't wait for our family pictures with her. 💗

🎄Big News!🎅🏻
Family Mini's are back for the holiday season!

🎅🏻 NOVEMBER 22 - WILL HAVE A CHRISTMAS SWING AVAILABLE! ❄️

❄️Grab a spot before they're gone!
Check comments for available time slots.
Message me to book yours today!⛄️

11/03/2025

Think of a time that you felt sluggish and slow, like you're treading water and stuck peddling water out at sea with no boat or land in sight. Now, think of a time you felt anxious, overwhelmed, and felt like you're on a rollercoaster that can't slow down. Finally, think of a time that you felt relatively relaxed - you're grounded in yourself and the world, playful, happy, and can go with the flow.

If I were to ask you which of those times you felt like you could learn and thrive, I'm guessing it's the last one. And our kids are no different! We are all more open, curious, regulated and open to learning when we are in our Window of Tolerance.

The term Window of Tolerance was first coined by an amazing Professor of Psychiatry, Dr. Daniel Siegel. It's normally shown as a graph with highs (hyperarousal) and lows (hyparousal). When I saw The Regulated Classroom post it in the form of a rainbow, I was immediately in love with the visual. The rainbow has beauty, it's where growth happens and where we can thrive. It highlights that those states of hypo- and hyper-arousal aren't bad. While we don't want to be stuck in the storm, we need those states to see the rainbow/growth. It's okay to be anxious and restless or shut down, but the goal is to get back to the rainbow - where we feel calm, focused and grounded.

When it comes to the bathroom, we also move through these states. When we're stressed or hyper-aroused, it's common to fluctuate between constipation and diarrhea. If we're potty training, we might also see these kids withholding their p*e or p**p, hiding to use the restroom, or scared of the toilet. As adults, this might be the person who has a hypertonic pelvic floor, pelvic pain or p*e that sounds like a fire hose it comes out so fast.

When we're sluggish or depressed, it's common to be constipated as everything slows down. If they are potty training, they may seem like they don't care when they are wet/dirty. Or they may struggle to feel the urge to p*e/p**p and be labeled as "lazy" and it's important to note that those words are in quotes because they aren't lazy...they are struggling and need different support. As an adult, this might be the person who struggles to start the flow of urine or dribbles frequently.

Our goal is to help kids (and ourselves) grow that Window of Tolerance so they are regulated, relaxed, and able to function most effectively so they can thrive and learn to potty train. A lot of the things we talk about from breathing and sensory input to sleep, music and nutrition play a role in widening that Window of Tolerance to support the potty training experience.

11/01/2025

"Education through sensation" 💗

The body is not a machine that breaks down, it’s a living system that adapts to the environment in which we create for it.

Every muscle fiber, every layer of fascia, reorganizes itself based on the loads and messages it receives.
Pain, tightness, or fatigue aren’t malfunctions, it’s feedback about how safe your body feels, not only in movement but internally as well.

The more aware you become of your patterns. How you breathe, stand, move, and compensate, the more you can teach your tissues new ways to distribute tension and load.

Education through sensation.

Stay on the look out, we will be running some Holiday Specials this year once again! ✨