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.

@Doubtoftheordinary

Gluten is not a food group anyway! It's a component of some cereals. But most people who omit gluten have to omit wheat and other cereals. This can reduce calcium and B vitamins.

I have been gluten free for over 25 years.

She's having way too much wholemeal. Try to stick wheat to two servings, with one being white flour and the other being wholemeal. Also increase fluid intake, that includes from fruit and veg which are full of water too.

Op Based on your latest post you need to start potty training. It can't do any harm as long as you do not make an issue of it and cause more emotional distress. She is quite old to be in nappies.

I wasn’t given any info, just a rushed 2 mins with the GP each time I’ve been.

Ditto! But when I was referred to the Community Nursing Constipation Clinic the narrative changed completely. They explained about the distended bowel, how leakage of runny poo is a symptom of constipation, about proper, effective use of different laxatives. They also agreed with my observations of the effects of wheat on my dc, whereas the GP was constantly over-ruling me and insisting on more wheat fibre.

Do not cut out any food groups. Instead add more variety.

And for those who are saying that food intolerances manifest in diarrhoea, not constipation, this belief is one reason many people suffer undiagnosed for years. Constipation is a known atypical reaction to food intolerance.

@JinglingHellsBells

On what planet is 2.5 old to be in nappies?

If she isn’t going then up the movicol. We vary between 1-2 sachets a day with my DS depending on how much he goes. The ERIC website is a useful source of information and you can also phone them.

I will echo the above - stick with Movicol but adjust dose if necessary. DD was on it until she was 3 and it's much better than the pain. She's 12 and completely normal BMs for years now!

Beans and legumes like lentils can be a bit of an irritant to some people - it may be counter intuitive but I'd do some research (trial and error?!) to see if she struggling with the amount and type of high fibre food too and see if that helps. We did see a nutritionist with DD & it was a long time ago but vaguely remember a conversation along these lines.

Definitely agree re fluids. DS who is just three has 3-4 Movicol sachets a day, but if we can get more fluids in this can be reduced to 2. Grapes, strawberries, melon, lollies and milkshakes are our go to fluids when he won’t drink eg if he’s got a sore throat.
ERIC is excellent.

Stop the banana milkshake! Bananas bind and can contribute to constipation!

JinglingHellsBells Sun 26-May-19 10:03:54
@Jellyslice
Coeliac tends to show as diarrhoea not constipation.

As Jellyslice already pointed out, coeliac can present atypically. The frequency of coeliac disease in children with chronic constipation is higher than in the general population.

(Doctor speaking)

Just to reiterate loud and clear that constipation absolutely CAN be a presentation (and a fairly typical one) of coeliac disease in children...

bangs gavel

Rule of thumb is that once the constipation is resolved and the child poos regularly and comfortably, they will be on movicol for at least as long as they were constipated. It takes that long for the bowel to regain muscle tone and shrink back to its proper size.

Cross post

Also, we have noticed that teething and stress will mean he’s more likely to need more Movicol (he didn’t go for almost 17 days when we adopted him and had an impaction 😟).

I’d really try and get her fluids up by giving her sugar free squash. Mine love Vimto over any other drink. It’s better than putting her on medication, surely?

My dd used to suffer but once I potty trained her it cleared up a lot. I think she didnt like pooing in her nappy.

To reinforce what others have said, chronic constipation is the reason our son has been referred for coeliac testing.

Just a thought, but are you making the movicol up properly? You can’t use less water than 62.5 per sachet because of how it works and it really does rely on your DD drinking, which is difficult. I’m sure my DS doesn’t drink enough. We make the movicol up then add some squash to hide the taste.

Try removing the banana milkshake - I know lots of people who can't tolerate bananas.

Plus try adding an egg or two to her diet.

Just a thought.

really struggle to get her to drink water, so I’m giving her very weak sugar free squash (on suggestion of the health visitor) which she drinks a reasonable amount of but I agree, probably not enough - I do remind her to drink a lot.

Water won’t solve it. It will help, especially if she is on movicol as it needs fluid to work, but it won’t solve it. With that diet, you should be getting plenty of movement. We have exactly the same problem with DD and even if she drinks more water, it doesn’t really help. DD will have a couple of cartons of fresh orange juice a day and can easily go 5 days without poo.

Push for a referral.

@fcukthisshit, that’s a tough diagnosis, hope you’re okay at the moment?

Do you have regular check-ups? I just wondered if you could pick up some constipation info next time you’re there.

Other ways to get fluids in to her, things like ice poles, or watery fruit like melon, cucumber etc.

The charity Eric are excellent and have a hotline that you can call for advice.

It would be strongly advisable to reduce the amount of fibre in your child's diet. Toddler digestive systems cannot handle the amount of fibre your child is receiving and it is likely to be the cause of constipation.

www.nhs.uk/conditions/pregnancy-and-baby/baby-food-questions/

Do not give only wholegrain or high-fibre foods before your child is 5 years old.

My son suffered terribly with this when he was younger and still does to some extend even now aged 7. He has been known to go a week without a BM and when he eventually goes, well the things he produces can only be described as monstrous!!

I've found it's something that has improved as he's gotten older and often the lack of him going was down to habit rather than medical issues. As in he would put it off because he was too busy playing and so on. Maybe try and establish a set time daily for her to sit on the loo even if she doesn't feel like she wants to go? Her diet sounds good but plenty of fluids will also help.

It's really worrying especially if it causes pain but I have heard it's pretty normal in young children