To insist on a referral or am I over reacting?

[Fcukthisshit]

My 2.5 year old Dd has suffered with severe constipation since she was tiny. I’ve been back and fourth to the GP with her numerous times and I feel like I’m being fobbed off with a prescription for laxatives. She has a good diet, with plenty of fibre and lots of exercise. An average day food wise looks like this:

Breakfast - baked beans and cheese on wholemeal toast and an orange.

Lunch - ham sandwich on wholemeal bread, a few crisps, cherry tomatoes and cucumber sticks, a biscuit and some grapes.

Tea: Bolognese made with beef, lentils and chopped veg, wholemeal pasta and cabbage

Snacks: lots of strawberries or blueberries (sometimes a punnet a day) a banana milkshake, an Ella’s kitchen prune pouch (Normal prunes are one of the few things that she won’t eat) and she has milk before bed.

We are currently using movicol but I feel like she shouldn’t need laxatives at all really with her diet. Yesterday, she hadn’t been for 4 days and she was in an awful lot of pain when she finally went. It’s horrible seeing her in so much pain.

The plan is to book another appointment with the GP and take a food diary, but WIBU to insist that they refer DD this time?

I’ve been putting off starting potty training for a while now as I don’t want to make things worse but she’s due to start nursery in August so I really need to get that cracked.

constipation is pretty common. many children are on movicol for year.

My Grandson had similar problems, and had a prolapsed bowel at one time. The thing that helped him in the end was dried figs. They don't look that appetising, so I went through the "Oh these are so delicious, really sweet! I don't think you'd like them because really they are for bigger boys and girls. " He ended up begging to try them, and soon got hooked. Now my husband uses them for the same reason. He says Lidls soft figs are the best.

Can I just say to a few posters that gluten intolerance doesn't show as constipation. I have it and have very loose bowels if I eat it.

Please don’t let her have unrestricted access to juice of any kind , no matter how dilute . Her teeth will suffer

Melon and cucumber also great for upping liquid intake. I agree with previous posters about upping fluids. Some great suggestions with funky cups and straws!

Jasper that is completely scaremongering. A beaker of sugar free squash at meal times will do no harm at all.

I didnt think children under five could have wholemeal bread. My dd (aged 2) on white as only bread i can take and throught her. If she can eat wholemeal ill get some today as i need to get more fibre into her. Please mn advise please.

I didnt think children under five could have wholemeal bread.
what on earth made you think this?

The treatment for constipation in children is Movicol, generally for a looooong time. Most children do not need any further tests.

The ERIC site has lots of helpful information:

www.eric.org.uk/Pages/Category/bowel-problems

Can you get her to drink fruit juice?

Whole pressed apple, pear and orange juices are great for getting things going... if you 50/50 it with water, you’ll up her water intake too...

Worth a try?

OP

Please don't give your child a gluten-free diet. There is no evidence that constipation is linked to gluten. Most people with it have loose bowels. It is very unwise to cut out food groups without professional advice.

You do need to consider she doesn't like the sensation of having a poo. A lot of children find it scary especially if they are quite old- as she is- and not potty trained.

(My DD was potty trained by a year. I'm not saying this to boast, but showing that an older child who soils nappies may be trying not to. So potty training might well help her and make her more regular.)

Consider that the lack of potty training might be the issue- she's holding back from having a poo.

Does she have 'leaking' my dd had constipation and overflow and it was fructose intolerance

I think intolerances can show as diarrhoea or constipation. I don’t think it’s a hard fast rule that your body will show something it struggles to process as diarrhoea necessarily. Similar to how some skin conditions are resolved through dietary changes but the suffer hadn’t considered foods as their bowels had never shown any problems.

I had a friend who had this. It's not uncommon for young toddlers to have constipation without any medical reason. It can also be self perpetuating as the DC get used to pain when they poo so they avoid pooing and exacerbate the issue. The only real solution in that case is to stick with the movicol until they forget about the pain (can take a year).

You should read this book too.

Thanks for the suggestions! She’s not mad on ice lollies but I will persevere with those especially as the weather gets warmer. I’ll definitely give fruit tea a go! I hadn’t thought of that one.

It’s interesting to read the laxative info from those of you who have been given information. I wasn’t given any info, just a rushed 2 mins with the GP each time I’ve been. I was worried that her digestion would become reliant on them, hence the hesitation to use them long term.

As per my pp that’s an example day - she does have lots of variety (porridge, salads, rice, soups etc etc) but I agree her diet is heavy on the fibre. I don’t intend on cutting out any food groups without medical advice.

My daughter suffered severe constipation due to a dairy intolerance. Definitely ask for a referral.

I don’t intend on cutting out any food groups without medical advice.

we didn't get any help whatsoever other then the paed telling us it might be worth leaving gluten out to see if things improve.

NHS is not great in that department. But given that gluten is not needed at all (doesn't provide vital nutrients), you have nothing to lose other than giving it a go. lots of GF alternatives available now which makes it pretty easy.

Have you got a stool softener..one of mine had this problem,lactalose or something

Making ice lollies is easy and fun. Perhaps if you let her help she would be more interested in eating them. I just use juice and add random fresh fruit. Today we put in mandarins chopped up and a bit of lemon, in apple juice. I use juice, as it’s a rare treat, but you could use dilute squash. Doesn’t work well with plain water.

Movicol is absolutely fine long term. My DS2 has been on it 15+ years and so have I..we simply have poor bowel function. The dose needs to be high enough to keep the poo soft and moving and it needs to be long term to help the bowel learn to move regularly.

Personally I find high fibre foods make things worse..too much bread, pasta simply makes me boated and completely bunged up so I prefer fruit and protein and green veg making up a larger part of my diet. And rice is the pits.

You do need plenty of fluid with movicol for it to work properly and just to get down her whatever she will drink. Sugar free squash is fine..you aren't handing her a 2l bottle of coke every day!

Can I just say to a few posters that gluten intolerance doesn't show as constipation. I have it and have very loose bowels if I eat it.

There is no evidence that constipation is linked to gluten. Most people with it have loose bowels. It is very unwise to cut out food groups without professional advice.

Not necessarily true. I have coeliac and my only symptom was constipation, which resolved with a gluten-free diet.
There's also no evidence that gluten is an essential food group that can't safely be cut out for a few weeks to see if things improve. As long as she's still getting carbs and fibre, I think it's quite sensible to trial a GF diet for a few weeks. You can have a very healthy, balanced GF diet that includes things like brown rice, potatoes / sweet potatoes, and GF oats, bread and pasta. If it improves, talk to your GP / a dietician about getting a formal diagnosis and further dietary advice; if it doesn't, You be ruled out a possible cause without doing any harm.

@Fcukthisshit
Part of having a regular bowel movement is training the body. This is where potty training comes in. It helps.
You need to sit her on the potty each day at the same time, and set the expectation. Don't make a fuss over it.

The more painful it is for her to pass a stool, the more she will resist doing so,

if she has always linked having a poo to pain, she will try to stop it.

This is what I think is going on rather than her diet- but lack of fluid does sound an issue.

*you've

@jinglinghellsbells if she goes for a poo every day, then she goes fine, as soon as she misses a day though, she does hold it in and I think that does contribute to the problem.

@cornettoninja - I have ulcerative colitis.