Free printable · PDF
Pediatrician Discussion Checklist
Appointments are short and it's easy to walk out having forgotten the thing you most wanted to ask. This sheet gets everything on one page before you go in.
Letter-size PDF. Print at home or save to your phone.
Short answer
What is the Pediatrician Discussion Checklist?
The Pediatrician Discussion Checklist is a printable one-page sheet to fill in before an appointment about constipation, stool withholding, painful pooping or accidents. It walks through the current situation, the symptoms worth describing, what you have already tried, the questions parents most often wish they had asked, and a notes box for the visit itself.
What's on the sheet
- A 'current situation' box: how often your child poops, what it looks like, when this started
- Symptom checkboxes in plain language: straining, pain, blood, holding, accidents, tummy pain, appetite
- A 'what we've tried' section, so you don't repeat the same conversation
- Questions to ask, including about stool softeners, what to expect, and when to come back
- Space for notes and the plan you agree on
Get the Pediatrician Discussion Checklist by email
Enter your email and the download unlocks right here. You'll also get the rest of the free toolkit and a short series of calm next steps for constipation-driven.
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How to use it
Fill in the first three sections the evening before the visit, ideally with your poop log beside you.
Tick the questions you care most about and add your own. If you only get through two, make them the two that matter.
Describe what you see, not what you think it means. 'Hard pebbles twice a week, cries, hides behind the sofa' is more useful than 'he's constipated.'
Write the plan down in the notes box before you leave, including what would prompt you to call back.
Keep the sheet. At the next visit it shows what changed.
Free tool
Prepare for the pediatrician visit
Prefer to do it on your phone? The free online tool keeps the same information and makes a summary for your pediatrician.
Open the free toolNot sure which pattern fits?
Take the free 2-minute quiz. Eight questions, no child's name or birthdate needed, and a clear starting point at the end.
Questions parents ask
When to contact your child's pediatrician
Contact your child's pediatrician promptly if you notice any of these.
- No bowel movement for 5 or more days
- Blood in the stool or on the toilet paper
- Vomiting, fever, or a swollen or very painful belly
- Stool leaking or soiling in a child who was previously trained
- Weight loss, poor appetite, or a child who seems unwell
- Pain or distress that is getting worse rather than better
- Anything that worries you — you know your child best
Poop Peace is educational. It does not diagnose or treat. If you are worried about your child, contact their pediatrician or local emergency services.
Sources
This printable is informed by the following pediatric and children's bowel health resources.
- American Academy of Pediatrics — HealthyChildren.org. Constipation in Children(opens in a new tab)
- Journal of Pediatric Gastroenterology and Nutrition. Evaluation and Treatment of Functional Constipation in Infants and Children: Evidence-Based Recommendations From ESPGHAN and NASPGHAN(opens in a new tab) (2014)
- National Institute for Health and Care Excellence (UK). Constipation in children and young people: diagnosis and management (CG99)(opens in a new tab) (2010, Updated 2017)
The Calm Poop Plan
See how the Calm Poop Plan works alongside your pediatrician
For families who want the whole approach in one place — the modules, the scripts, the routine builder, and the pediatrician guide — rather than piecing it together from articles.
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