Advice on constipation in a 16 month old despite laxatives

[GreenDogDot]

Looking for any advice please on constipation in a 16 month old, we’re really struggling!

I have tried to get a doctor to see her twice, both times I have been called back by a HCP. As she is passing something (no matter how small, hard and painful it was!) a few times a week they’re not fussed and just say that it’s safe to have laxative indefinitely and to make sure she drinks enough.

We have tried:

Lactulose - she’s been on the maximum dose for over two weeks. I thought we’d get to a point of having an explosion but no great effect.

A pouch of prunes a day - I think this has equal if not better effect that the laxative but not curing the problem.

Water - she drinks well, her water bottle is topped up regularly during the day because she’s finished it. Plus two big milk bottles before bed and on waking.

Food - she eats three good meals a day, typically porridge and banana, something like toast, scrambled eggs and yoghurt for lunch and curry/pasta/fish pie and fruit for dinner.

I don’t know what to do next after another hour of straining and screaming in pain this morning before she managed it. Is there another medical professional that she could see? Nutritionist? I’ve been looking at osteopaths in slight desperation!

My daughter had awful constipation due to CMPA. Despite eczema etc clearing, for months after coming off all dairy, the constipation continued as she had developed a fear of going from the pain so would withhold. Every few days after a warm bath she would go, but it was almost like watching a toddler give birth, absolutely traumatising & I truly feel your pain.

We found lactulose did nothing, if anything made it worse because she’d get frequent loose bits come out when straining but wouldn’t go properly. This caused really awful nappy rashes despite me changing her multiple times an hour & the pain of the nappy rashes made her withhold more.

We started giving a cup of prune juice first thing every morning and it was like a switch flipped overnight. If she likes prune pouches, will she drink that? You can find it on the long life fruit juice shelves in sainsburys, Tesco etc. It’s an acquired taste, I couldn’t drink it myself but she already liked the prune pouches. Anytime I ever see someone asking for advice re constipation I shout prunes from the rooftops 😅

You can also get them tinned, so maybe chopped up in her porridge etc?

I think so much of it is psychological, they develop a fear of going because they know it to be painful, so then they withhold and the visciois cycle continues. Prune juice is what broke the cycle for us, and honestly within a couple of days she was going normally and stopped withholding when she realised it wasn’t painful anymore.

Keeping well hydrated as well, especially in this heat is all the more so important for constipation. Juice/squash, jelly, ice lollies etc. All rules went out the window for us as DD was terrible for drinking water and it makes it much harder.

Good luck, it’s awful as a parent to watch ❤️

Thank you, I really appreciate that. It is awful, especially not being able to do anything other than hold her hand and rub her back.

I have tried tinned prunes and she wasn’t keen, texture rather than taste, I think but not prune juice so will grab some of that today.

Just some little tips from what you’re said OP, bananas can actually make constipation worse in toddlers. I would swap the banana for a fruit that will help soften things up, kiwi, pear, peaches for example.

Same with milk, “2 big bottles of milk” especially cows milk again can actually keep things too firm.

Sausages
Its the high fat content apparently

My kids them 2 x per week now

Thank you. I have read that ripe bananas are OK but green ones not. Worth a trial though. I’ve really tried with pears and kiwi but they literally seem to be the only fruit she won’t eat which is unfortunate!

I’d have a think about the milk too. Does she also have any of these symptoms?

Movicol worked for us. It works differently to normal laxatives, it’s a sort of gel that softens poo so it’s easier to get out. I always keep a box now in case DS (aged 4) has one of his bouts.

I have considered it but no skin issues at all, no vomiting or discomfort that I can tell. She does often have a cough or runny nose but she also started nursery this winter!

She was in NICU at birth with an infection and needed a huge amount of antibiotics which I think wiped out any gut biome that she had developed and we’ve been trying to catch up ever since. When EBF she once went 11 days without pooping! Still struggled once she was fully formula fed, it improved with the introduction of solids but has slowed up again at the moment.

I will look further into CMPA but my gut (ha) is that she has a slow, sluggish system that needs to develop, with any help I can give.

I would definitely try cutting out the banana and eggs and upping fruit and veg.