How to get a child to co-operate with a regular procedure that they hate?

[LifeIsGoodish]

I hope this is the right place to ask, as I expect that parents of children with SN are probably more experienced at this sort of situation than parents of children without health issues.

My 9yo needs to have regular Peristeen bowel washouts, but he is refusing point-blank. We managed a couple of weeks nightly, then gradually less and less often. He chose chocolate at a bribe, but doesn't care any more.

He needs the washouts. His overflowing is getting worse and worse. He denies the problem (he know that he has the problem, but denies the accidents, both to us and to himself).

How can I help him? How can I get him to cooperate? I understand that it is weird and briefly uncomfortable. I hate doing unpleasant things to my dc, but it will help in the long run - if only he'd let me help him.

[Hockeydude]

I would either try explaining from a health perspective (he will hear a lot of stuff about health at school, my dc certainly do) or I would offer him actual money. If neither work I'd ask him what would work for him. My 10yo has to attend appointments that he doesn't want to go to.

[LifeIsGoodish]

When we talk to the nurse he is honest about his dislike of the procedure, but agrees to do it.

When we talk about it when we are away from home - and therefore not doing the procedure - he agrees to do it; even comes up with times and bribes.

But when we are at home: no.

I cannot use force - I would hurt him. Besides, he is big and strong, I don't think I could force him.

The procedure would be best done every day for several weeks or months, eventually reducing to once or twice weekly, but it could continue for years. It takes minutes - we had got it down to 6 minutes (plus sitting on the loo time).

I was beginning to think about some form of talking therapy for him.

[Andro]

I understand that it is weird and briefly uncomfortable.

There's a good chance that this had gone beyond weird and briefly uncomfortable for him. Repetition of a procedure can have either of two effects; it either breeds indifference so that it becomes a none issue, or it does the exact opposite and breeds resistance to the point of hatred.

Having a professional do it might take the emotion out of the situation, otherwise some form of therapy may be the only option.

[Jasonandyawegunorts]

Did a medical professional tell you to do this nightly, because that's highly unusual?

[Jasonandyawegunorts]

If done correctly it should completely clear any build up from the bowel, which laxatives can not. doing this daily is completely wrong, It's normally recomended after a week of no defecation.

[LifeIsGoodish]

Jason, see my screenshot from the Peristeen website, and my photos from the instruction manuals.

[LifeIsGoodish]

The alternatives are stronger medication and/or disimpaction as an in-patient. I don't think there's any point to the latter, as he needs regular disimpaction. It's not a one-off thing.

[Jasonandyawegunorts]

Has medical professional told you to do this?

[Jasonandyawegunorts]

regardless of instruction manuals, which are aimed at adults, you are doing this to a child.

[LifeIsGoodish]

The manuals are from the children's kit. The Peristeen nurse who trained me on this, and the nurse who runs the constipation clinic both gave the same advice: daily for 2-4w, then we can try every other day. The sign that it is working will be a reduction in overflow leaks.

[Jasonandyawegunorts]

Okay, is that a yes then?

[LifeIsGoodish]

Yes

[LifeIsGoodish]

Have you experience with Peristeen, Jason?

[Jasonandyawegunorts]

Have you tried the standard treatment for this, oral laxatives until the point of a complete blowout?

[Jasonandyawegunorts]

Have you experience with Peristeen, Jason?

Not Peristeen, but i've had a enema as a child. I wouldn't want more than one a week.

have you?

[LifeIsGoodish]

Yes. We had some success with Movicol disimpactions, but after 6m or so they stopped being as effective. Nurse is suggesting Docusate disimpaction this summer holiday.

[Jasonandyawegunorts]

I'm also assuming you've done the mixture of a washout flowed by a long course of laxatives to shrink the bowel?

[LifeIsGoodish]

Yes, I have had enemas as a hold and as an adult. Frankly, the relief they gave me was worth the discomfort!

I am also not English, and have many times had medicines in suppository form, so I'm not in the least bit ewww about medical treatment using the bottom.

[Jasonandyawegunorts]

I'm not in the least bit ewww about medical treatment using the bottom.

Okay, this has nothing to do with anything on this thread. You child obviously does have a problem with it.

[LifeIsGoodish]

The bowel will take months or even years of being blockage-free to regain its tone. That's why the regular disimpactions are as important as the regular laxatives.

[Jasonandyawegunorts]

The bowel will take months or even years of being blockage-free to regain its tone. That's why the regular disimpactions are as important as the regular laxatives.

But this isn't true. There is no need to do this daily.

[LifeIsGoodish]

I'm not in the least bit ewww about medical treatment using the bottom.

Okay, this has nothing to do with anything on this thread. You child obviously does have a problem with it.

It does, because the instinctive reaction to putting things up the bum is ewww. Quite naturally. I want to make it clear that I am not transmitting any personal repulsion about it to my dc.