Tips for managing constipation in a nearly three year old

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I am looking for some tips on how to deal with constipation in my nearly three year old dd. She has been potty trained for coming up to a year but was on and off constipated prior to that. She will have weeks of going regularly then one day of bad food which causes a painful stool and we are back to holding which in turn makes the stools harder and the vicious cycle starts.
Dd is with me most of the time and has a very healthy diet, plenty of fruit and vegetables- she’s not fussy with food when she’s regular.
The problem started a few weeks ago when she was ill we let her eat whatever she fancied and she was also not drinking enough.
She is refusing movicol, we got some glycerine suppositories which worked but really traumatised her.
So anyone got any great ideas what we can do to encourage her to become regular again.
Any great recipes? She isn’t in the frame of mind for smoothies at the moment and is refusing my homemade date cake, and my date based Nutella which she usually loves. She is also refusing to drink much water, I even bought fruit shoots but she is refusing those also. She likes milk a lot so I have been watering it down.
I feel like I’m at a dead end here.

Don’t forget lots of exercise to get things moving.

@AnotherVice I’m wondering if this is part of our problem her leg is in a cast. She is running around inside now but we can’t really get the cast wet outside. She is back doing her downward dogs and rolling around the floor though- definitely not sedentary but not as active as usual as riding her bike or scooter is tricky and we don’t want her getting knocked in the park.

Jelly is mostly water.

Sparkling water?

Cordial (ie proper fruit & sugar & citric acid).

Tea, like mummy. You can get decaff, or have rooibos with milk. She might enjoy the grown-up ritual with teapot etc. Or herbal teas: she might enjoy the zingier flavours like ginger or mint.

I wonder whether you can make up jelly with movicol. I don’t see why not. Just don’t confuse it with regular jelly that you may eat!

What do you mix the movicol with? We found that strong cordial was best for our dc. Also drinking it chilled, through a straw.

And bribery also has its place, especially if she doesn’t usually have sweets. A chocolate drop after every glass, for example. So we would put a small glass of movicol and a chocolate drop at the same time - immediate reward.

Will she eat prunes? 3-4 a day should help.

You could see if she'll take lactulose (can buy over the counter) - it works differently to movicol so they can be used together.

And if you think she needs a poo make her go for a try (if needed reward the attempt and remove any fun until she's had a try). If she likes stories/songs/favourite tv that could be offered while she's trying.

@Dilbertian jelly is a great idea thank you.
@User0ne i bought a pack of prunes in the supermarket today. I’m going to try and make them into a pudding as she won’t eat them alone.
She has just eaten a whole plate of peppers, cucumber and carrots so I am thinking it must be lack of water rather then diet as she eats so much veg and some fruit everyday. She’s one of those unicorn children who prefers broccoli to fruit.

Are you flavouring the movicol?

@Execrgybjkkbgdsxhutdc yes with either blackcurrant or peach squash or adding milk after it’s been mixed but she always tastes it. We have this problem with calpol too, she has spidey senses for medication.

I used to snip prunes into tiny, tiny pieces, stirred into porridge. Good luck - it’s a miserable phase. I hope things improve for her soon.

My little boy has to have movicol for constipation. I hide it in his milk. It dissolves fine and he has no idea it’s in there as he can’t taste it like in water. It works just fine and keeps him regular.

Make jelly with the movicol - I microwave one pack of cubes, and then separately mix 3 sachets with 180mls of water, and then combine with the melted cubes.

Cover the prunes in milk chocolate. Absolutely delicious. Hope you find what works.

Does anyone have any book recommendations for me to read to her about withholding her poo?
This is definitely the route of her problems. She had a good bowel movement yesterday and needed to again today but did the smallest poo and held the rest in.

Ground flax is really great to mix into things like applesauce, oatmeal, soups, etc. I think it is quite unnoticeable. Chia seed pudding is another winner over here.

Can you incorporate hydrated chia seeds into her diet?

Yes to chia and flaxseed I will put it on my shopping list along with jelly. We are using psyllium husk at the moment in porridge. I’m thinking I can switch to oat pancakes with flax eggs and chia seed jam. Is it possible to do too much and make things worse?

We have had a long standing problem with constipation with my ds age 5. We tried all the above and when we spoke with the nurse practitioner, she advised increasing fibre. Made sense So made home made breakfast bars with the oats, flax, chia etc. With a chocolate top.
In actual fact, this only added to the issue. The will to withhold and strength they find to do so has meant he became severely constipated. The fibre had only added extra bulk behind and already stretched bowel. Saw another practitioner after speaking with the children's bowel team via the health visitor and ERIC (look at their website...loads of great info) and he had to be on a disimpaction regime.
Unfortunately, the constipation seems to have caused a megacolon and now he has very little/no sensation of needing to poop, so still only produces small amounts frequently throughout the day as it's pressure and gravity releases it rather than him being able to push after getting the signals (the nerves are so stretched they don't send the signals). We are waiting to see the colorectal specialists.
Please don't wait too long before seeking medical support and perhaps trying disimpaction. And don't overdo the fibre.
Being constipated causes longer term issues in a reasonable short space of time. The psychological issues(connecting pain to pooping) however may take longer to resolve the longer she struggles.
It's a nightmare. My son is not potty trained because of this and is in reception, luckily the school are great and he has a care plan in place so I don't need to go to change him myself.
As for how to get her to have the movicol (and if you do need to disimpact, she'll be on a lot of it by the end point....son was on 12 sachets a day on top of required fluid), it can be mixed up and taken over the course of 12 or 24 hours (i think movicol is 12 and laxido is 24). Plain flavors are better to mix with juices, but the jelly idea from sounds fun too. Make into ice lollies maybe? Otherwise, bribary...chocolate buttons, small toys, trip to the park.

Random, but have you tried cutting out bananas? They can make some kids really constipated for some reason.

Will she eat dried apricots? Pears? They're both good for getting things moving

50/50 Fruit juice & water ice lollies.

Just to add that sounds like a great diet but sometimes too much fibre can make it harder for little tummies. My DC need a higher fat content to avoid constipation. The science behind it is the fat essentially greases up the system.

With that much fibre as well, the amount of water needed is huge. Psyllium husk and seeds swell in the stomach, so they need a lot of water drank at the same time unless they're presoaked.

Edited to add mine refuse movicol no matter how I serve. My GP recommended high dose lactulose syringed in. It's sweet and concentrated so easier to get them to take.

Thank you all for the great advice. I also read about the fat, we had salmon for dinner this evening. They often have Greek yoghurt too but I’m wary of too much dairy- it’s such a minefield. I will ask about lactulose I think she might for that.
Im really worried about stretching the bowel so would like to get her used to going regularly. I think it’s a case of won’t go rather than can’t go due to painful experiences in the past.

It’s the milk! Both of my kids suffered severe constipation. When they stopped the milk, the constipation stopped almost overnight (I’m exaggerating, but by day 5).

With my son, he stopped having milk when my daughter was born as he thought it was for babies, and we noticed it stopped. When my daughter moved on to cow’s milk, she started with the constipation. I hoped it would subside but it didn’t, so after 4-6 weeks, we switched to oat milk and again, it stopped.

Try cutting out the milk for a week to see if you notice a difference. I’ve seen soooo many others on the constipation pages I am on say the same thing.

(To add to that, the constipation was so severe that he was on daily Movicol, lactulose, and regular suppositories and still suffered with horrendous pain trying to pass a stool. So for it to stop so quickly was a miracle for us.)

Orange juice for mine definitely helped (once he was on movicol and give more regularly). He has a glass of juice every morning with breakfast and sometimes with dinner as well.
He was the same with being scared of pooing so he was on movicol to stop it getting worse and we just made him drink it, you can get chocolate flavour which might be worth a try?

Milk, even in small amount os so often the reason.

I don’t think the milk is a particular problem, I did cut dairy out completely for a couple of weeks last year.
She always seems to become regular when we are in a good routine and she has a lot of time at home with me alone, however at the moment DH has had annual leave and her sister is off school so she’s busier and therefore holding more. We need to get on top of that issue before she starts preschool in September though.