1yr old chronic constipation please help

[pinkcarpet]

Has anyone got any experience of what causes chronic constipation and how to treat it? DD is screaming and her whole body physically shaking when she goes to poo. Some days there's blood too. I broke down in tears earlier as i hate seeing her in so much pain. The GP hasn't been much help so far although we're going back again tomorrow.

We've been using lactulose for 2 months already and its done nothing. We've been using a steroid cream but that's also done nothing. I've been pureeing most of her food. She is eating mostly fruit and veg with some meat or fish and pasta or rice. We've tried excluding dairy too for the past week but its not made any difference.

I'm really hoping we can change her diet and it'll clear but i don't know what to change as she's already eating really basic purees. She still breastfeeds 3x day and I've tried giving her apple juice instead of water to see if that helps but its made no difference.

I'm wondering if it could be gluten causing her constipation? Anyone experienced this? Or maybe egg allergy?

www.eric.org.uk

Orange juice and not apple juice can help.
Have you used warm baths, massaged tummy and also cycle movements with her legs to assist at all?

Oh and lactlose requires water to work so she may need more than you realise. It works by being an insoluble sugar and soaks up water, mixes with stools to soften. If they're still really hard then maybe up water a little bit. Aware you have to be careful to not fill up tummy so then she's not eating.
Only other thing is purees break down the good fibre would whole fresh fruit or vegetables help more? I mean obviously cut up etc, especially something like cucumber which is mainly water, into finger food for her?

Sorry realised unsure of her age so please disregard if this is to soon for her if she's to young etc

She needs a referral to a specialist paediatric constipation nurse. I would be treating her with movicol rather than lactulous, but you’ll need to see your GP re the dosage.

I would also add some probiotics to her diet

Thanks, I'm trying to get her to drink more water as I know the lactulose works by drawing water into the bowel but she's only just turned 1 and still not great with a sippy cup. She is breastfeeding a lot still due to the pain I think. This morning there was a lot of fresh blood when she pooed so looks like she's got a fissure again. How do I get a referral to a specialist?

I've been giving her whole fresh fruit. I had to stop giving things like whole peas and sweetcorn as they were making it worse, just coming out completely undigested, which is why I've been pureeing. She's also losing weight and sleeping really badly at the moment and I'm not coping very well at the moment

Lactulose is an ineffective treatment for young children. NICE guidelines advise a macrogol e.g Movicol or Laxido.

Also don’t worry about food like sweet corn coming out undigested. That’s normal as it’s made of cellulose and doesn’t break down easily. But changes to diet won’t fix chronic constipation so I hope your GP doesn’t fob you off with that advice.

Sorry - didn’t mean to sound bossy in that last post - but I had two years of GPs telling me to get my dd to drink more water and eat pears etc. before I found out the correct treatment and was able to start tackling the constipation (by which time dd had severely stretched bowel which has taken years to get back to normal.

My DD had this, it's awful to see a child in so much pain, the only way it was cured was by her having a general anaesthetic and having an 'anal stretch ' which is pretty much what it sounds like , you then gave a window of opportunity for the fissure to heal - means tons of lactulose for about a month. It worked really well, insist on a referral as it will be getting worse and worse.

If she is actually losing weight at just turned 1, that is a good reason to ask your GP for a paediatrics referral. Hope you can get some more help soon. The resources on the ERIC website mentioned above are excellent and I have often seen them recommended, so have a read there too.

Much (but crucially not all) constipation in young children can start from stool withholding behaviour as they start to gain awareness of their bowels, then it starts to get hard and painful to pass so they hold on more and you've quickly got a problem. Diet and fluid intake plays some role too of course - so minor illness and drinking less can make it all a bit tougher.

Once you have hard stool causing tears and a fissure, then pain is a powerful preventer of passing it. A child needs enough medication to soften things enormously until this can heal, and then until a stretched rectum can relax back to normal.

I will say though, that when my eldest was trying to go down this road (some years back now!), the thing that eventually solved it for us was pureed tinned prunes. I think they just kept things moving enough to prevent the cycle restarting.

Very best wishes.

Thanks again. Its been really distressing for the past few days. I feel totally helpless seeing DD in so much pain. The lactulose has made the poos a bit softer but they are so big she can't pass them without screaming and shaking. Its really awful to watch

I’m sorry you’re & DD are going through this. My 2.5yo has had chronic constipation for about a year. When it first happened it was terrifying and the first doctor we saw told us to try prunes and apple juice as she didn’t want DD to get addicted to laxatives. Well that did shit all (pardon the pun) and I couldn’t bear to see her in so much pain so saw a different doctor who prescribed movicol. It’s made a world of difference. She’s still having some issues but we haven’t gone back to those awful days of screaming agony and rabbit pellet poos. I don’t know the answer longer term but definitely keep pushing the GP. Good luck!

It's horrible. My eldest was constipated from about 12-18 months. it was suspected she had a cows milk protein allergy/intolerance and to work out if this was the case we had to eliminate milk protein from her diet - after 6 weeks of no milk protein in diet at all her poos were normal. Reintroduced it and immediately back to being constipated. So that's what it was. We found it too restrictive to eliminate milk entirely so used to moderate how much she would have and give lactulose regularly. Keeping both in check made it manageable. ie keeping her to maybe one small portion of milk based foods each day. Drinking pure fruit juices and lots of grapes and pears and plums etc. She grew out of it and by 5 was pretty much normal. Now at almost 7 you'd never know the trauma that used to accompany going to the toilet! Hope you get it sorted.

Thanks @scarfattack I'm really really hoping we ha e the same result. We've eliminated milk for 7 days but its made no difference so far and if anything the last 2 days have been worse than before. Do you know how long it takes to see an improvement?

@pinkcarpet
It took us 6 weeks of milk protein elimination to see any results. It was gruelling! But it completely proved that was the issue because the problem came back when we reintroduced it. We found middle ground because whilst the constipation wasn't nice it was eased with daily lactulose and I didn't want to eliminate milk indefinitely because she was going through a bit of a fussy stage and milk and cheese were some of the select things she would eat. It's done her no harm and she doesn't even remember taking her 'poo medicine'!

You definitely need Movicol or Macrogol as an effective treatment. ERIC are a good place for advice, they have a helpline.

Hi, just a quick update for anyone who commented.. We've been given a Laxido prescription but its been very difficult to get DD to take enough of it, so its not really working yet. I think one of the underlying problems is that DD isn't eating and drinking enough. This morning she refused pretty much everything I offered, just ate 1 slice of banana and 2 teaspoons of porridge. I've tried favouring the Laxido with juice, cordial and even maple syrup but she just takes a tiny sip then pushes it away. I've tried a regular sippy cup, a softer spout, a straw, and an open cup but it makes no difference. Any tips on getting her to take more solids and drink more water?

Ice lollies? Jelly? Fruit & veg with high water content like watermelon and cucumber?

Hiya, more advice on this thread too:

www.mumsnet.com/Talk/potty_training/3552002-Withholding-disimpaction-chronic-constipation

Also, try the book - It's No Accident by Steve J Hodges. I cannot recommend it enough.

My daughter has been chronically constipated for three years - don't worry, we're an extreme case as the GPs failed diagnose and we didn't know it was a thing until it was too late (she's now five).

Cow's milk thickens poo - though scientists don't really know why and is a common cause of constipation, especially in young children. However, it can also simply be that they're not used having anything but that liquid poo come out of them as a baby and then suddenly it's firming up, it's unnerving and they don't know what to do with it - so they start to hold it. And then it becomes problematic.

DD was diagnosed as lactose intolerant when we started weaning back in the day. Turns out that was a misdiagnosis and she was actually allergic to cow's protein. So she'd been having lactose free products for three years, which also have been found to cause constipation. So her system is a complete mess.

My main advice (as I said on the other thread) is get yourself a referral to a specialist / gastroenterologist asap. GPs simply don't know enough about this issue in enough detail to make a difference. I wish we had got someone to take us seriously that there was a real problem sooner than we did and got that referral earlier. It would have made a world of difference to our's and DD's lives over the past three years. :'(

Good luck - you're not alone. Chronic constipation is actually quite common in children, it's just not widely talked about or known.

Thanks @AlphaMama I've managed to get a referral to a pediatric gastroenterologist but the first available appointment is not till July. We've been off dairy for 3 weeks now and DDs skin rashes and eczema have cleared up a lot so we'll carry on dairy free till the next HV appointment and see if we can get a referral to an allergy clinic too