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?

I think with the greatest respect to all of you and deep gratitude for your support and advice that I will try and get her referred - I just feel that I'm making series of stabs in the dark (try prunes! try exotic fruits! cheerios! with linseed!) and whilst everything you all say makes sense, the fact of the matter is that nothing seems to work. And I totally appreciate that these things worked for you.

She may not be gulping water all day long, but neither of us can spend every minute of every day hovering over her with a cup either.

Our person-in-the-know said wheat over oats, as wheat would stimulate the gut. Apparently it can almost give you the squirts, like with Chrones and Coeliacs and other things I know nothing of.

Bathwater. Could we get some prune juice into that???? I'd be fully up for it if I thought it would work.

I bet she's getting enough fluid. I honestly think it's slow motility and immature guts.

My whole life revolved around poo. Still does. DD1's teachers look at me like I'm bonkers when she says 'Mummy I did a poo at school' and I swing to look at the class teacher with narrowed eyes.

Me:Did you see it?
Teacher: ..er....
Me : What length would you say it was?
Teacher: ...er....our policy on toilets is...
Me: Yes but can you tell me if it was thinker than, say, a black pudding?
Teacher: ....is that children go by them...
Me: Was it smooth or knobbly?
Teacher: .....selves and therefore I didn't....
Me: Was the smell of standard poo or was very strong?
Teacher:....see dd1 go to the loo.....

Teacher calls social services.

let us know what GP says. Try not to get fobbed off with 'increase diet and fluids' A food diary is a great thing. For them to look at and for you to wave at them if they try to fob you off.

she's a good GP and took us seriously last time, but not keen to intervene if the solution was as simple as removing the formula. Which was fair enough. Think I will start food diary. Yup, the Bristol poo chart.

Since we are discussing it, poo is better colour since got rid of formula - generally smooth, but bulky and heavy IYSWIM. I think she has a sore bum and withholds because she usually tries to go every morning after breakfast, but stops. So methinks movicol for a couple of weeks of soft easy pooing so that she breaks that association (this is what happened around xmas when she had ABs for very minor ear infection = was almost worth it )

Tree you've been a tower of strength, as usual - not sure why DP doesn't post so much these days. Will prod her and ask

Our Gp has been great too, but with the greatest repsect to her, we have found things so much more positive since we have seen the paediatrician.

sorry 5 go mad, keep x-posting with you. Have to have GP here to do referral - I think she will - might as well get the thing started as I don't know how long it might take to get an appointment

Aw bless you. Big waves to DP. Good you have a sensible GP too.

Vaseline around her anus might help with soreness. Really work it into the anus so the cracks get lubricated. Nice!

We got referred in January about the 26th and got our appointment last week. keep on at them as our delay was due to one paed going/another turing up and our referral being lost in the wasteland.

don't live in UK - which might mean better, probably means much, much, much worse

oh and tree PMSL at the teacher/poo conversation

Good luck, I have to go to bed but will keep an eye on this thread.

yes, whole life becomes obsessed with poo. I remember giving DD too much lactulose & when she pooed it went everywhere, like a bit frothy melted ice-cream-unfortunately we were changing the nappy in GAP & we stank the whole place out.

Ref the wholemeal bread- we make our own & I use a mix of wholemeal + white. Sometimes using spelt flour & white. Do you remember mighty white ? something like that would be better, at this stage, than wholemeal. It'[s just too dry for littlies.

I bet your DD will love Rocks organic. My DD's get it rarely & are always so excited. Just a tiny drop will make a difference. Also see if you can get her to drink half a cup before eating, that way you know what she is about to eat will have liquid sloshing around with it.

We paid for a paedatrician - waste of time - more helpful info on this thread. Oh yes, good diet he said, it's just one of those things, but the sodium docusate should help.

loving the sun I make my own bread too, usually 50:50 wholemeal and white. However, no changes we've made to her diet have made one iota of difference, so for now I'd rather she was constipated with a varied diet, than constipated with a limited one IYSWIM. Prune juice now rejected out of hand, so we are giving her 50:50 milk and water (having taken her off her mid-morning bottle) - might try that before bed. Took her beloved bananas away (lalas, lol) and now we have gone 2 days without poo instead of one. You can see why I am confused. I don't think it's her diet, I think she has learned that pooing hurts and withholds, and we have to get her poo soft enough for long enough for that association to be broken.

yes, you're right - pooing does hurt. My DD used to stand squeeze her legs together to stop the poo coming out .

I can understand where you are coming from, but with all these fruits & veg, she will be getting a varied diet. You do give her pasta I assume ?

IIRC you can't get sodium docusate until age 2.

And you're absolutely right about getting the poo soft.

I feel for you & DD, I really do.

the doctor told me (when we were trying first time with lactulose) that i had to get the poo to the consistency of tarka-dhal...

then once it was that liquid and dd had no choice but to do it, we would then throttle back and get it more solid, break the pattern/association/memory that it hurts.

but as i said before, we didn't solve it til we got her on to movicol.

it makes the bowel contract and bulks the stool, they have no choice but to pass it when it is ready. it is wonder-stuff.

Also wanted to add that if anyone is feeding their DC with follow on formula, the amount of iron can be constipating - this was another problem with my DD.

Although she was still breastfeeding, she had follow-on formula from about a year & I feel this was a significant factor.

gosh I wish my D would eat like that!

I agree with comments re reducing bananas & increasing vitamin C rich fruits.

You could try replacing cows milk with goats milk.

quick update - house full of visitors. GP very harassed and appointments all muddled up, so we had to wait an hour and a half . On the credit side she referred us without any quibbles to a paediatrician who specialises in constipation (what a job!) -it should be a couple of weeks. Wondering about dairy too - but she was sitting around in her vest today and you could just see her pulling her muscles in ALL THE TIME. GP also waived the consultation fee (€60) in the light of the long wait we'd had (missed her snack, her nap, day all messed up). Have to go and cook unscheduled dinner for 6

Best of luck.

oh wow great - we'll all be waiting with baited breath clenched buttocks to see what s/he says

tree, a he, called Alf...not sure whether this inspires confidence or not.

Alf?

@@@@@@@@@@@@tumbleweed@@@@@@@@@@@@@@@@@

d'you know him tree? ha ha

Hi little message just to let you know that there is light at the end of the tunnel. My 3.5 yr old suffered from chronic constipation ever since he was weaned. We were told to give him plenty of fibre and massive doses of lactulose with plenty of fluids. This never worked as he just lost all control of his bowels- which seemed to increase his fear of going for a poo. After much despair we were referred to a specialist who immediately cut down the lactulose and started him on docusate sodium. This had an amazing effect on him as it gave him enough control of his bowels to do a poo without him being able to hold on to it. Before this it was either diarrhoea (from too much lactulose) or witholding for days on end until he lost the energy to fight it.

We learnt that diet wise he needed plenty of water, pears, and soft bananas and yoghurt in moderation. More than anything it was a behavioural issue. To get rid of the fear we had to make sure that we were at home at certain times of the day as this was the only time/place that he felt comfortable enough to go. We learnt to not make it an issue (even though it becomes your one and only mission in life) and ignore him and give him privacy.

When it was time for potty training, the consultant referred us to a dietician who gave my ds a little talk, books etc on poo and amazingly managed to rid him of his fear completely. He is now fully potty trained and even though he still takes docusate regularly, is perfectly happy/comfortable going for a poo.

His diet is much better as a result, as he now has enough space in his tummy to eat!

good luck - dont despair you will get there.