Doctor Betti Dr. Betti Hertzberg Ressler is a Board Certified Pediatrician on staff at Miami Children's Hospital. Dr. Hertzberg developed the toilet training video "Let's Go Potty." She is the co-author of "The Doctor's Book of Home Remedies for Children." Constipation in babies Question: My one-year old twins have had terrible problems with constipation for several months. I've tried everything -- karo syrup, kale, prunes, pineapple, extra water -- yet, they continue to have hard, very painful stools every other week or so. Just when we find something that seems to work, the constipation returns. I've talked to my pediatrician, my homeopathic counselor, my friends. Should I take them off of milk and diary products or be concerned that something may be wrong? Help! - Ellen Answer: Dear Ellen, In the majority of children with true constipation, the cause is usually dietary. You said that the twins have been constipated for several months. I'm assuming that all was well before that. Was there introduction to new food when it all began? The digestive system, especially in young children is sensitive to introduction of new food items. Sounds like you tried quite a few remedies. You said they worked for a while, but the problem returned. Having this problem every other week would make me think that there is something in the diet or environment. Getting back to the diet. Are the twins getting enough fiber and fluid intake? This needs to be on a regular basis. Sometimes when we see that something works, we go back to the original habits and the problem recurs. Keep a diary of the foods that are eaten. Sometimes we can pinpoint a specific food that is the cause. Too much of a certain food (milk or diary) can slow down the digestive system. If you take away all of the diary products, calcium must be replaced in the diet. There are supplements available. Be careful in using laxatives routinely. The child can become dependent on them and unable to have a bowel movement without them. An occasional glycerin suppository may be used. Constipation should be taken seriously when pain is present or when blood is found. There are times when a child will withhold stools, leading to constipation. This can occur with any change in their environment (major or minor). Toilet training is an example. This is a great way for a child to assert control and let you know who the boss is! Hereditary factors also play a role. If there is a family history of a similar problem, the greater chance of this happening in the child. Remember that too much of any one food can be responsible for irregular bowel habits. Continue working with your pediatrician. Try to make mealtime fun. See if you can speak with a dietitian. Advice on how to make foods attractive and healthy would help. Dr. Betti Also see: What is the cause of ITP and is there anything that can prevent it from recurring? Can a pediatrician comfortably prescribe and manage ADHD medication or is it better suited to a psychiatrist? Ask Dr. Betti your questions This information is not intended to be a substitute for visiting your pediatrician. If you or your child has specific concerns, you should see your doctor for a diagnosis and treatment.