advice on constipated DD's diet (15mo)

[drivingmisscrazy]

We have a 15mo who (I think) eats pretty well, but she has had ongoing constipation - she withholds, poos about every other day. Things are better since we dropped her formula, but not better enough IYSWIM. She has 5ml of lactulose twice a day, plus plenty of water. Her diet looks roughly like this:

breakfast: weetabix with f/f milk and fruit (just swapped this for porridge)

mid-morning snack: banana, plus yogurt - sometimes an oatcake

lunch: egg, or beans, a little bread - plus avocado, tomatoes, cucumber. Fruit (grapes, pineapple, apple etc). SOmetimes pasta and pesto/leftovers

mid-afternoon: oatcake, dried apricot, dried apple ring

dinner: fish, chicken or sausage, plus sweet potato/potato, with vegetables (broccoli, beans, broad beans, peas etc), then fruit (blueberries etc etc ) again, yogurt if she hasn't had one earlier in the day

bedtime: 180ml full fat cow's milk

Is this a good diet? If so, why aren't her poos lovely and soft and easy to pass?

Oooo you could be me 5 years ago.

Ok. Our dietican says that dd had probably too much insoluble fibre, in relation to her relatively slow gut and the amount of fluid she drank.

Oats, whilst amazing if you have a low fibre diet, are actually very hgh in fibre if you have a balanced diet. Our advice from her was to replace the oats with wheat. So toast instead of heavy porridge. Wheatabix for a longer lasting meal. Her pov was that if they can have a midmorning snack, not to clog them up on porridge, give light toast so they have an appetite at 9.30am, then give a whole load of fluid and some breadsticks and hummous or something.
SHe also said that the gluten in the wheat would act as a gut stimulant, thus speeding up the action of the gut.

The stools are hard [and maybe large?], because they have been in there too long.

SHe may need movicol to move them through the bowel quicker, so they get less chance to dry out.

DD's paed then went on to say, basically, bugger her teeth and give her anything she will drink - apart from adult drinks like fizzy pop etc.
So his thoughts were that if she would drink 500 mls extra, all be it freashly pressed orange juice - so be it. Our choice obviously. We decided suffer her teeth might, but at least she wouldn't be constipated all her chldhood. SO that's what we do. We give mlk or something non acidic after she drinks it to help aleviate the acid, and never brush her teeth withing an hour of juice going in. She's 5 and her teeth are fine. Oh, and she drnks through a straw so her teeth aren't 'bathed' in the juice.

Fluid fluid fluid fluid. Can't have too much. You should aim for a litre, and it isn't easy.

We have learnt that black olives will produce a poo witing 24 hours.Give them in halves, and they come out in halves - it's like they pebbledash their way through!!!

Also steady on the banana, many dieticians feel this is has slow motility in the gut.

My other advice re: the possible use of movicol or some other - is to not let it go on and on. Act sooner rather than later.

The colon will grow to accomodate the size of stool it has too. So dd's stretched up to hold a poo my DH couldn't make in a week. The paed says realistically it will take as long for it to shrink as it did for it to stretch.
In dd's case the nerves from her colon stopped talking to her, and she has very little sensation of needing to go, until it is on it's way. Hence urge incontinence. Well, actually that has got better in this last year. I've seen her at 3 with a poo nearly hanging out and she has only just noticed!

SO my dd is looking at about 3 years of urgency, incontinence, soiling, piles, painful motions and so on. Also medication and all that entails.

That's because I ddn't persue it soon enough, we left it really till she was 3.

I don't meant o scaremonger, but honestly that is our experience of it. It can really impact on them when they are busy pre schoolers with no appetite and belly ache due to constipaton. ANd it's a circle of constipation = withholding = pain = withholding = constipation = bowel stretching = constipation and so on

So my tip is

Get referred to dietician
Get referred to paediatrician
Learn as much as you can about the gut and how the bowel functon, it makes it so much easier to micro manage at home.

Pay for one off consultations if this can't happen for any reason. In other words kick it's ass now before it kicks yours. Literally

Hi tree (this is stripey's dp actually!!). We took her to GP about 2-3 weeks ago precisely because we wanted to get on top of it sooner rather than later - it's been going on really since she was weaned. GP suggested dropping all formula, continuing with the lactulose and to go back in a month if things hadn't improved (one easy poo a day I think is what she's looking for). She'll then refer us on. Poos are less hard than they were, but just BIG and round and she struggles to pass them.

We try and get as much water into her as possible, but I'm sure it's nowhere near a litre - but maybe about 600ml (just guessing - cup of water with her three meals, offered regularly otherwise, plenty of delicious bath water ).

Thanks for this - we really want it substantially sorted before we potty train - it's already been quite a few months

Hi
having similar problems with dd. She has dirty nappy about 3-4 times a day. I thought this was normal. Should she only be having one a day?

Hello miss Nice to 'see' you. Hope my advice wasn't ott

600ml not too bad at all. When I said dd2 was having 400ml the detician went a bit pale. So think you are on a better track than we were with dd2. dread to think what dd1 had.

Olives. I'm telling ya. They are the way forward. And out.

fab posts treedelivery, my DS has similar issues, really helpful thanks.

DD age 4 has it, there is no quick fix, DD has been on Lactulose since November and still an ongoing problem, she is now on Senacot aswell, get a referral to the paed sooner rather than later, we have just had our appointment last week and things seem to be going in the right direction just because she has finally got the medication in the right balance, we weren't giving DD enough sena.

We are using Marvacol but struggling to find the right ammount once we clear a blockage!

Dr sears book recommends upping pears, plums and dates/prunes in the diet and cutting back on apples and pears. Certainly helped with DS1 when he was poo withholding. Make sure they have lots of fluids which helps too.

I'd drop the bananas and try kiwi fruit they have a laxative effect.

Here Here Coco!!!!!!
DS LOVES kiwi & they're soooo effective. (although DH is becoming wise to when he's had kiwi & likes to avoid those nappies!)
x

dd2 was a nightmare with constipation, had a fissure - all now healed thank goodness and i have to watch her diet she is generally ok.

lack of fluid is a big part if diet is good, so focus on that - i know you said she drinks water, but also add in an innocent smoothie, rice milk etc. something they will drink quite a lot of.

dd2 was much better when i stopped the weetabix and moved to cheerios i know i know, sugar, nestle, but it did seem better.

cut out bananas
limit yoghurt
i found lactulose just made her poo sticky, but maybe she wasn't drinking enough water when we were using it.
apple juice
broccoli
prune juice (Make into ice lollies if she doesn't like it, or mix with apple juice)

best of luck, it's hard, i felt my life was dominated by poo but you will get through, when her system matures.

and i do re-iterate what tree says about getting it sorted. we were on movicol for about a year, after the fissure, as the doctor really wanted to sort it and the lactulose wasn't doing it.

movicol is goooood.... and she came off it easily without any problem or lasting effects. but we had got into quite a bad cycle of withholding (interesting about the colon stretching that's probably what happened, sometimes her poos were so big they would block the loo when she finally did it).

this is all very very useful - thanks so much. She only has a very small amount of yogurt - she's not mad about fruit juices, but will keep trying those. I do offer her water pretty constantly over the course of the day. I don't think her problems are as bad as some of you have experienced, but her pooing is painful to her, and doesn't happen as frequently as it probably should. The overall message here is about fluids and bananas - she only has one small banana a day, but I'll try and substitute something else for it at snacktime. Best go - but many thanks

have dropped banana, gave kiwi today (quite liked...) generally trying to follow your advice. One thing that does make me think that it is about withholding behaviour is that she sometimes (like just now ) does a poo just as she's fallen asleep - a bit of grunting and it's done, because she is sleepy and not really conscious of what's happening until it's too late, IYSWIM. Anyhoo - onwards and upwards!

with dd2 i used to have to say "let's go to the park, go and do your poo and then we can go"
but she was a bit older than 15m, can't remember, more like 2.5 i think as she was out of nappies.

is she having a beaker/bottle of milk before bed? if so you can get a good cupful of water in to her by giving her 50:50 full fat milk:water (assuming she is eating well she won't miss the calories)

have just made new appointment to see GP - it hasn't been 4 weeks, more like 3, but removing the formula hasn't really made that much difference. She is still doing huge and painful poos I could cry for her, I really could. I'm also really confused about conflicting advice - more fibre, less fibre etc. She is now doing a poo almost every day, and without any real help from us, but it does cause her pain - and she clearly wants to go in the morning, but it's often the evening before the poo actually appears. It's just horrible and I don't know what to do next - she's otherwise healthy, happy - just a super little girl.

tree I think I overestimated how much water she drinks - but a litre seems like an awful lot - unless that includes water content in food, milk etc?? on a good day I might be able to get her to drink about 500ml. Wouldn't eat the black olives, though I did try. She drank some prune juice this morning, maybe about 30ml. She's really not keen on juice (perhaps picking up on the fact that I am not that keen to introduce it).

Hi there
Just want to add what worked (and is still working for us).My dd who's 3 developed a terrible problem about 1 year ago and wouldn't touch prunes or prune juice - horribly regular screaming pain, suppositories etc all tried but the one thing that has saved our sanity is linseed - it is a miracle food. What we currently do is water down her milk as she's not great about drinking in general but still loves her morning and night time bottle (can't get her to have it in anything but her bottle and tbh, I'm more interested in getting fluid in to her than any problem being caused by 3-4 mins of using a bottle twice a day). Also then at some meal of the day we put linseed into her food - we liquidise it so it's like powder, it's totally tasteless and she calls it her magic sprinkles and it is amazing, touch wood, we haven't had a single screaming incident of painful constipation since she started on it. One thing, the linseed absorbs water from the body I think to keep her poo soft so you do need to remember to give her water (which you're doing already anyway)
HTH

If your DC won't drink enough water (and who can blame them, water is for taking away instant thirst not really a "nice" drink) what about adding a bit of sugar-free squash or organic squash if you're concerned about additives. My DC will turn their noses up at plain water but will drink beakerfuls of water with a splash of apple juice added to it (hardly any, can barely taste it, just enough to give a bit of colour - it's pyschological!)

Also recommend papaya/pawpaw for constipation. It's expensive but a lovely tasting fruit.

Hi

Yes, the total fluids, so that's a relief Also she will get fluid from fresh fruit and veg too. So she's probably getting enough, you are doing well.

Listen, I have sobbed. Many times, for both of mine. It's horrid. You are right in thinking that you aren't as far down the line as we got. I think the big message is to not go there. We 'normalised' it, and it gradually got worse, and you hardly notice t happening.

She may need some movicol or similar really. If the diet is right, and the stool is hard, it is a motility issue. And that is a movicol type treatment, as it works higher up the bowel. Lactolose seems to work on the lower part, making the stool bulky & softer.
That's great, but with kids who have massive holding capacity and can withold a bomb, it almost adds fuel to the fire doesn't it? I think in general practice there is a tendancy to treat the symptom of constipation, rather than treating at the root cause.
It also doesn't take dc's long to develop the learnt response poo=pain=don't do poo. Then you have potty training and true withholding.

I honestly think that while fibre is vital in diets, the message is horrible confused.

I thnk children and adults living on crips and chips need lots more fibre. Lots of adults need more fibre.
Maybe Children whose parents are managing their diet, offering fruit and veg, providing balance and variation are probably getting plenty of fibre. It's almost like the 'more fibre' message is for someone else. I do wonder if my dd1 always got too much and generated mega poo as a result, triggering this whole cycle. Maybe too much oats and 'heavy' food. Who knows

If you can fund it or access it, a consultation with a paed dietician might be the business.

Other good ones are dried apricots, prunes and dates, simmered very very very slowly till they become molasses. Then sling it in whatever mush she will eat.
Also mango and papaya.

Maybe try tapanade on rice cake to introduce the concept of olives? May still have the effect too, I don't know if it's the olives, or the effect of a marble size ball flowing through her!

You can roughly gauge her gut motility by giving sweet corn one day and looking out for it. Nice!

Ooo and if you find her anus is sore, blather loads of vaseline or simlar on it. Really in there is you see what I mean. It wll help the poo flow nad hopefully help prevent any fissures or cracks. Not nice to think about but bleeding bottoms are very common sadly.

nteresting stuff about linseed. We put it in porridge. How much are you using janeausten?

interesting what you say about fibre tree, i think you have hit the nail on the head.

the one thing i used to use with great success are some glycerine pumps, but you can only get these in southern europe. you squirt the glycerine into their bum and within minutes the poo slides out with ease. why they don't sell them in UK i don't know, probably because we like to sort out constipation from the mouth down, rather than at the exit

on telling my friend about these she got some cooking glycerine in a syringe and squirted it in her dd's bum. within 8 seconds a giant poo slid out without any problem. this was after 3 days of her dd screaming and holding (she was desperate). i have never resorted to that, but if you know an italian or spaniard they can probably get you some or have some at home. (they are sold in all chemists, cost about 20p each). much better than a glycerine suppository which is pretty impossible/awful to try and get in to compacted poo.

I think the suggestion of cheerios is very good (alhtough I loathe them) or maybe something like raison wheats.

My DD suffered very badly & I blame myself - she ate wheat flakes for breakfast& wholemeal bread for her sandwiches - WAY too much dry fibre. Their digestive systems can not cope.

DD went on to have sodium docusate (sticky poo with lactulose) which I added to her milk.

Agree with getting as much liquid as possible, so the rocks organic squash is good for this. Also lots of wet fruit - lose the dried fruit - it needs water to swell up.

Mango is great, as is kwiw, pineapple,apples, NO bananas. Try to get a portion of this sort of fruit in at eevery meal.

Linseeds are fantastic - I took them (1 dsp) when I was suffering from pregnancy constipation. Grinding & soaking them with some water then adding to yogurts is also good.

I know what you mean, but this bit of your post did make me laugh

"DD went on to have sodium docusate (sticky poo with lactulose) which I added to her milk. "

I am sick of talking about poo, thinking about poo, trying to work out what to do about poo. So you think we should give her white bread? and no weetabix (but tree said weetabix! ). She likes pineapple, grapes, pears, blueberries, most citrus (tends to suck out juice and spit out skins), apples etc. Also tinned fruit (peaches, apricots), not mad about kiwi - drank prune juice yesterday, but not so much today.

She really doesn't much like juices, will try squash, I suppose. I wonder whether the water thing is partly about having been breastfed and therefore not really having drunk water at all until weaning? We really are doing our best with the water - constant offering. She will drink a decent bit with meals (a cup, maybe) but otherwise sips, slurps and then pours it over herself/the floor. She does like to drink bathwater though

Please ask for a referral to a peadiatricain, DD has had the most god awful 5 months a it now seems to be going in the right direction.