We have a lot of potty talk around here. At dinner tonight, it started as the game of telephone where each person was supposed to keep the same first word and change the rest. The variants ran along these lines, “Poopy, patter, paw, paw!” And so it goes. I let the potty talk go on freely, hoping it will help everyone feel less inhibited with the actual act.

Humor is essential here as it’s a mighty serious subject and without some levity, I would have lost my mind a long time ago. This may be the hardest aspect so far in parenting Mia through her recovery from her stroke. It may be too much information for some of you but I am sharing it so it’s not such a taboo subject as I think that just makes it that much harder.

First the facts. Both of my girls struggled some with constipation as older infants and toddlers. Zoe learned relatively early to use the potty for both pee and poop, well before age 2.5. And, at around 2 years 8 months, she complained that the night time pullups were giving her a rash and went cold turkey.

Things with Mia have taken a different path. Her constipation was a bit more intractable. I asked her neurologists about it when she was 2. They denied any relationship between her stroke and digestive issues. This is interesting because among the families on the Hemi-Kids mailing list and Facebook group it is a frequent issue for kids who have had neurological injury early in life. Conventional treatment is to use Miralax but that’s not actually been demonstrated to be safe for children for years on end which is how it’s often used. I was uncomfortable going that route. So, as usual, I researched and experimented until I found my own way.

Last February when Mia was 2 years 8 months old, we were on vacation and she hadn’t pooped in a few days. When she finally did, we completely changed her diet to cut out most grains and dairy. She went 4 days in a row and spontaneously started to ask to pee on the potty. At the time, I thought this was our breakthrough and we’d be doing the elimination diet for a week or two more and then slowly reintroducing foods to figure out which ones to avoid. Here we are more than a year later.

The elimination diet was not the magic bullet. We tried an even more strict version of it with everything homemade from whole foods, absolutely no packaged or processed foods at all for a month. Try that. Completely impractical for me as a working single mom. We introduced probiotics. I started buying raw milk and fermenting my own kefir to make smoothies every morning. And, we started a behavior-based program called Soiling Solutions last June. It’s essentially a program to help Mia poop every single day. Thankfully, our new pediatrician is on board with this approach. At least she was last year when I shared a letter with her explaining it. We’ll see what she says at Mia’s four year well visit.

We schedule our “poopy time” to be right after dinner. The program consists of up to four rounds of this routine – sit on potty for 3 minutes, relax and play elsewhere for 10-12 minutes, repeat. On the best days, she goes on her own before the designated time. On the worst days, it takes an hour including a gentle inducer (glycerin suppository) after the second unsuccessful sit and occasionally a more harsh inducer (saline enema) after the fourth sit if she still hasn’t produced.

When we started this last June, it was pure torture for Mia, me, and Zoe. Zoe became the hero because in the early days we were having to do the full routine almost every day and since I was bad cop, Mia needed Zoe to comfort her. Now, it’s almost Pavlovian. We use kitchen timers for the 3 minute part and the 10 minute part. The girls watch a show on Netflix Instant in between the sits and Mia likes to pause the TV when she goes to sit. She still asks for Zoe to sing or hum to her if we have to do “bum bum blastoff” which is the name they coined for the suppository because it looks like a rocket ship, of course.

Even this protocol has not completely resolved the issues but it does ensure that Mia goes every day and that means she can be in underwear at school and all day, staying clean and dry which is hugely important for her self esteem.

She goes more often on her own initiation than she used to and I keep hoping that soon she’ll figure out she can go on her own all the time. But, in the meantime, we have a strict routine that we follow 6 nights a week. The one night I am out for the evening, our au pair asks Mia to sit and she occasionally poops for her. But, more often, she skips a day and then spontaneously initiates on her own sometime the following afternoon.

We’re gluten-free at home and a bit more flexible when out and about, but still really careful. I still make kefir from raw milk and send smoothies with Mia each morning. Zoe has a love hate relationship with these smoothies. I  like them. Mia has special gluten-free treats in the freezer at preschool so she can have something at times when others bring in birthday cupcakes. Her teacher checks with me regarding ingredients if they are doing a class baking project or taste test.

We ended the evening with another potty ditty, “Girls go to college to get more knowledge. Boys go to Jupiter to play with all the poop there.”