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Fecal impaction - 3 year old - HELP!(3 Posts)
Some background history - DD is 3.5 and has high functioning/mild cerebral palsy that has always mainly affected feeding and pooping. Due to contributing factors (gag/swallow problems from birth with drinking and eating) plus food allergies (milk, soy, peanut) and an extremely strong personality (from me I assume) she is a monkey when it comes to getting anything into her or out of her and due to constant bowel movements since birth (in excess of 10 a day) she isn't toilet trained and has a lot of aversions.
About a year ago and when we assumed that her allergies were under control her paediatrician started her on movicol plain because they thought all of the reluctancy to poop (early stage stool holding) and subsequent loose stools were over-flow. For a year (until this August 2011) she varied from 1 to 2 sachets a day. Her bowel movements remained what I would call porridge splats (sorry for TMI) and she still clamped her legs together and resisted but this was 'normal for DD'. In May 2011 she started to vomit at night, just once and always within 2 hours of going to bed. We tried the usual avoiding food before bed and propping her (she had been a refluxy baby) but it got worse so her GP started her on Ranitidine (Zantac)...it worked. No more vomit or gagging or hiccups. In August 2011 we had a routine allergy appointment (that we had all but given up with due to them no longer getting positive patch or blood tests anymore). Anyway, we saw a new registra who asked if anyone had ever x-rayed her stomach, we said no, they did it = loading and distended rectum. They started her on a 7 day movicol impaction plan which increased to 6 sachets a day to "clear her out" and in true NHS style, arranged a follow up appointment to ensure the impaction had gone, in...November! This is when everything went to pot. Loss of appetite, even more lethargy, increased distress with passing a stool (which should have been soft), increased stomach noise etc On top of that, a nasty UTI that some 5 weeks later she is still on antibiotics for because, as we found out yesterday, her impaction is so bad it is restricting her urethra and bladder)...following cultures in lab, we now have the RIGHT antibiotic for that.
Yesterday, Monday, we ended up in A&E which a child who couldn't poop. She has never been the best pusher as her hemiplegia impacts on her tone but really, she was trying. Follow up xray and she has full fecal impaction which on xray shows her bunged up to almost under her nipples. So now not just rectum but colon etc too. 4 hours of screaming, tears and vomit later and they were able to administer an enema which gave her one nappy of over flow poo (like gravy) and the plan is to increase to 8 movicol sachets a day for up to two weeks and get an urgent referall to the paediatric gastro team at Great Ormond Street as both me and my Mum, have ulcerative colitis and they think my DD may have this too...explaining all the issues she's ever had with bowel motions.
Now, I'm happy to go down the route of 8 movicols a day (even though if you've ever given a child one, you know how hard this is) and of course up water intake, fruit and veggies and finish UTI antibiotics. But my question is (and sorry about the long rant): what more can I do? I understand my DD's needs are complex and I wouldn't go against anything the hospital have said but what fruit juice can I give her to help? Some say apple and some say orange? Flax seed oil? Her diet is limited because of allergy and aversions but I'll try/do anything to get this impaction shifted as the next stage is surgery and a manual excavation and God knows I do not want that. As it is I am stumped on how she managed to fecally impact while ON two movicol a day to prevent just that? Any thoughts? On further research I've found that Ranitidine is a constipator and have decided to stop this...maybe the night vomiting was due to constipation anyway? Have you dealt with the less than desirable side effects of Ranitidine? If you've got ANY ideas on how to help shift this impaction, to aid the movicol - please share it with me. I'll stop at nothing to avoid surgery
Thank you for reading and letting me vent. My heart is breaking for my baby
Constipation can definitely make you vomit so they are likely linked. There are alternatives to ranitidine if she still has symptoms now you've stopped it.
Kiwi juice is the best fruit juice for constipation I've found - used in hospital in nz but not a patch on movicol tbh.
The paed plain version is flavourless and can stick it in squash if that helps her drink it
We used to stick movicol in slightly strong squash, and make it a challenge to drink before we'd counted to 5.
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