to go to A&e with my dd3 *pictures*

[littlemaemae]

My DD who is 3 has been having stomach/bowel problems for the last year. Diagnose as constipation. She can not pass a stool for weeks despite fantastic diet and laxatives and weeks is in severe pain most days. She is very petite and skinny but her stomach has swollen to look 9 months pregnant. Getting no where with doctors/hospital etc.
Aibu to think this is not how a heathy child's stomach should look.

It shouldn't be too bad if you are using the sodium pico sulphate and also movicol.... It will be the initial blockage ... Did they suggest suppositories ???
Well done !!!!

I think I would still go to A&E for now then follow the routine the continence nurse has suggest once dd is more comfortable.

The thing that made me totally lose it is I was crying DD was crying and she kept offering her a bloody sticker like it was going to make everything better! Poor woman probably just didn't know what to do for the best.
I will apologise to her.

She said movicol has to be prepared 1 sachet in 63ml of water then can be put into whatever, but if it is not made up like that then it loses effectiveness.
Just thought I would share that for those of you who are using with your dcs as I haven't been told that before, I've been told 100ml.

DD is asleep on sofa exhausted, puffy face, flakey skin, sore tummy.

Disimpactment is going to be really horrible for her, well us all.

The nurse has just rung me and said gp won't refer to gastro specialist, will refer back to our consultant to do it.
Who is on holiday at the moment.
I'm going to book to see another gp in the morning any bypass that. Not going to let him stand in the way and cost us precious time.

Glad you've got the referral and some proper help.

The clear out is the first thing. Movicol and sodium picosulphate have worked for us, but it takes time.

The stress on you all must be immense. Look after yourselves too.

Good luck.

Good for you! See, now you've found some courage, you'll soon see that it was there all along and you'll find it more and more. Keep going, you're doing wonderfully for her

We used to put movicol in milk as that was all he would drink!!! He could taste it though and stopped drinking milk... Hence the gastrostomy!!!

Someone mentioned earlier than an enema is more distressing than a movical regime - I was just wondering why that is? Would have thought an emema would be initially painful but provide more instant relief?

You can ask for a second opinion, but I really would take the offer of private healthcare costs from your in laws. They will feel great being able to help and she will be seen so much faster and by someone you choose. They can refer you back in to the NHS at any point but go and get an opinion at least.

Keep doing everything with the NHS too but get the private appointment.

I'd email practice manager with a complaint too.
Have you spoken to consultants secretary?

LittleMaeMae,your GP is an idiot.
Complain about him & don't drop it.

I seriously don't know why he is in the profession when he can clearly see a child suffering but not refer her even when a second doctor has already said he would recommended further investigations.

if you have the option of private - I'd grab it with both hands. you will be seen very quickly and they are unlikely to fob you off. I'd been trying to get referred to a gastro specialist via various GPs for literally years with no joy. private health insurance came with my new job and I had an appt within 2 days. its like night and day compared to the NHS!

for you and your DD

Just a nightmare

I'm no expert (although have had IBS myself). But surely giving her something that leads to an increase in water in the bowel is not going to help? Wouldn't it make her feel really uncomfortable? I've been through this in the past and it's horrid and makes you feel so awful and that's just after a few days of constipation.

This just all feels wrong; it sounds to me like she needs urgent medical help to get things moving and then tests and a regular regime. Also you said her appetite is really good so every day that goes by things will be getting worse (sorry, I know you know this).

Trust your instinct.

My DD prefers the movicol disimpaction regime as it's more gentle and apparently doesn't hurt.

The enema, goodness, horrible. It forces a large lump out of a small hole. Very painful. That's what they tried to do to her in a and e.

Nice guidelines.
Clinical management of idiopathic constipation in children and young people
© NICE 2016
Child or young person with idiopathic constipation
Faecal impaction present?
Disimpaction
Maintenance therapy
Diet and lifestyle
Digital rectal examination
Information, support and follow-up
Referral if no response to initial treatment
NoYes
Constipation
Disimpaction
Offer the following oral medication regimen:
Polyethylene glycol 3350 + electrolytes1 using an escalating dose regimen (see laxative recommended doses table) as the first-line treatment. Polyethylene glycol 3350 + electrolytes may be mixed with a cold drink.
Add a stimulant laxative if polyethylene glycol 3350 + electrolytes does not lead to disimpaction after 2 weeks.
Substitute a stimulant laxative singly or in combination with an osmotic laxative such as lactulose if polyethylene glycol 3350 + electrolytes is not tolerated.
Inform families that disimpaction treatment can initially increase symptoms of soiling and abdominal pain.
Do not use the following unless all oral medications have failed:
rectal medications (and only if the child or young person and their family consent)
sodium citrate enemas.
Do not use phosphate enemas unless under specialist supervision in hospital/health centre/clinic, and if all oral medications and sodium citrate enemas have failed.
Do not perform manual evacuation of the bowel under anaesthesia unless all oral and rectal medications have failed.
Review all children undergoing disimpaction within 1 week.

Poor thing!

Yesterday when I posted, I was trying to explain that it's a long plod to solve severe constipation in children and It can't be resolved overnight, so I didn't think a trip to A&E would resolve anything. However after the awful care you've recieved from your GP and the incontinence nurse I don't think you have any other choice!

I hope she is better very soon!

idiopathic constipation

idiopathic means 'without reason' but it's not clear yet if there isn't a reason behind it...

1At the time this pathway was created [January 2013], Movicol Paediatric Plain is the only macrogol licensed for children under 12 years that includes electrolytes. It does not have UK marketing authorisation for use in faecal impaction in children under 5 years, or for chronic constipation in children under 2 years. Informed consent should be obtained and documented. Movicol Paediatric Plain is the only macrogol licensed for children under 12 years that is also unflavoured.

I cannot believe it's still not sorted... Please just go to A&E! My child was in a similar situation. He was about 3 as well and suddenly started crying and crunching his belly. We were away in a different country and ended up at A&E. Dr said he had compacted poo and I didn't believe him as he'd just gone to the loo that morning. But dr insisted and had a gel suppository inserted. Had his nappy on and within 10min had masses of poo coming out.

I cannot imagine what your dd is going through. Please go to A&E and don't leave till she's admitted or given some proper med.

pathways.nice.org.uk/pathways/constipation

It also talks about red and amber flags. Please look at these.

keep pursuing. If you don't get anywhere tomorrow, straight to A&E. Or go tonight.

You're exactly right GreenMarkerPen. The NICE guidelines don't strictly apply in this case because this little girl doesn't have a diagnosis of idiopathic constipation. She doesn't have a diagnosis of all, because the GP refuses to refer.

OP, I'm genuinely wondering whether your previous MH problems means this GP won't listen to a word you say. It's very worrying.

I still think you're totally justified in going to A&E because you're being fobbed off at every turn. By all means disimpact with Movicol, but I genuinely think your DD needs some sort of intervention before disimpaction will even be possible.