constipation in 18mo, advice/help needed

[lucysmam]

my 18mo dd has been constipated pretty much all her little life, we've spoken to 3 different health visitors, every pharmacist locally and our gp for advice. the latest thing to be suggested is lactulose to help 'clear her system' but this is having little effect at all. Does anyone have any other ideas than plenty of fruit/veg which she is always munching, weetabix for brekky which she now has every day and plenty of fluids which she also has because all my gp keeps saying is keep giving her the lactulose which we have been for months and is not helping much.

She gets really tense when pooing and her entire body goes rigid and she screams, which is unpleasant for us/her and can't be nice for a complete stranger watching either but i don't really care about that.

I just don't know what else to do other than take her back to the doctor next week and demand that they do some tests of some kind, but what would i expect them to do.

TIA for any advice

You may not be giving her enough lactulose? As it is not a drug that goes into her system but a locally acting substance you can rack up the dose until it has the required effect!

The you need to work out what is a maintenance dose to keep her constantly soft so her anxiety about poo-ing disappears.

And at the same time work on the activity levles and diet and fluid intake.

This article (v basic) suggests longterm laxatives may be needed - and she might need a stimulant laxative as well as lactulose (osmotic).

www.patient.co.uk/showdoc/23069146/

Consider going back to the GP for a paediatirc referral?

thanks gagarin, will have a read of that after i've been in the shower. Not sure she could drink much more fluids though as she goes through at least a litre of water a day, plus 2 cups of milk with lunch/dinner. But I am going to start keeping a food diary again to keep track of what she's eaten & when she struggles most, see if I can work out what's causing it so thank-you

I didn't know you could adjust the dose yourself though, have been following dr's instructions about 1 5ml spoon with brekky/dinner.

Well - don't whizz it up too quickly or you'll give her the runs.

But for a good clear out I would think 5mls twice a day is a pretty pathetic dose!

Try 10 mls twice a day? It takes up to 2 days to work so don't increase it again until you've waited a while so let it work it's way through.

Also in our house ice cream usually works a treat so you could try that? I bet she'd be pleased .

And don't give her bananas as they can bung her up.

My DD has suffered with constipation for a long time now too, we have just been refered to a constipation clinic. Not sure what that is but at least they will offer support I am sure. May be worth asking about that for your DD? My DD is 23 m and does the same going rigid thing and holds it in which makes it worse as she then goes longer between poos its very difficult to watch She's been on lactulose for a year now and it sometimes helps but not sure over all. Having read this though I'm thinking she should have more. I have noticed that she gets worse after eating egg but loves it so I am jsut limiting it a bit.

the key thing is that any laxative should increase in dose until it works and then decrease in dose until the parents find a good maintenance level - and then stay on that dose until the bowel regains it's sensitivity.

Just using a blast of laxatives and then stopping doesn't help - it's the maintenance that helps until you and they can work out how to manage it by diet/fluid/exercise etc

My first had the same problem and it was really upsetting - she would hold on too which made the problem worse.

I did a whole host of stuff.

Dried prunes and apricots
Lactulose
Califig
Whopping when she pooed successfully
Reward chart for successfully going
Helping her by rubbing her back, getting her a book on the loo
Making sure she crouched when she wanted to go as it is much easier to poo, and when necessary hold her in position and explaining why I was doing it - to help her
I specifically told her why I was helping her and constantly repeated that holding on makes it hurt more.

She now has no problem and she will ask for prunes if she feels she needs a bit of help.

It is really distressing for them - bless

Good luck

Kiwifruit is really effective too (fruit or juice), my ds has had a lot of constipation. Does your dd have water with the lactulose - sorry if it has already been asked - apparently it doesn't work without it.

Sorry I know I am not the OP but what is it about water do they need to have it literally with the lactulose or just be drinking plenty of it?

gagarin ice cream? really? we've been sticking to what the dr said because she never said anything about increasing in order to help lo the last time we took her & said it wasn't helping, she just said stick to 5ml dose for the moment & try prune juice or something similar, so we have that in as well & dilute a cup daily.

used2bthin constipation clinic - something else not even mentioned by anyone we've been to! i'd love to know how we're meant to get help when nothing's offered!

mylittlemonsters she's not potty trained yet but was wondering if maybe that would help her rather than rigidly holding onto me or oh or mil while she either poos or skids. may try prunes rather than prune juice, she loves fruit so may be easier to get her to eat them than drink the juice

mylittlemonsters I have to hold DD into psition sometimes too or make her sit down in the bath as when she is really bad she will only stand rigidly to keep it in, its awaful for her. Good to hear that your DD is much better now, I look forward to being able to tak it through with my DD, bless her asking for prunes too very sensible!

water with it as in lactulose in the water Nina?

I'm going to try again with prune juice too lucysmam, I think I will syringe it into her as dd won't drink any juice I've tried orange too. She spits out prunes so syringing may be my only option. I think the constipation clinic is nurses who specialise in children with similar issues, they are keen on Movecol at ours apparently which encourages the bowel to move things through more quickly so that it doesn't build up a backlog I think (lovely). I'm not keen on the idea but getting desperate.

lovely thought!! I am going to make an appointment with gp and demand (in a very nice way of course) that they help me out more than they already have. Clinic sounds a good idea, even if just for support and nothing else so will ask about that.

I used to work in an old people's home & they used movecol there, and my dad was a nurse, he seems to think it's more of an old people thing but if it helps then would definately be worth asking about it

Am wondering now whether Nina meant that the lactulose had to be in water rather than given and then a drink of water like i have been doing?

I just give DD hers in a syringe with the rest of her meds so would be interested to know. She drinks loads of water though and eats lots of fruit and veg so should be ok I thought?

what kind of milk do you give her??

dd gets constipated if on sma. she's fine with cow and gate and aptimel.

dS1 now 3 1/2 has ahd major problems with constipation since he was 8 weeks old and hes under a constipation and soiling clinic at the hospital - the medication for the constipation, and the fact that his bowel has been stretched out of shape so many times means he quite often doesn't get the urge to do a poo as such, it just happens, which means we are struggling to train him for no 2s. He is on movicol which is doing the trick and keeping him soft and regular - before he would often go 10 days without a poo, and have leakage around the sides of a blockage - sorry tmi!!! I would definately go back to gp if lactulose not doing the trick, as speaking from experience the longer it goes on, the more severe the consequences can be.

AFAIK constipation clinics don't exist in all areas - some areas have specialist nurses, others just see the constipated dcs in normal paediatric outpts.

The movicol is a stimulant laxative and lactulose an osmotic laxative - they work in two different ways and can be given together.

And yes - ice cream worked a treat for my dd when she was younger!

well i went to bed last night without reading further . . .

elmo she's just had full fat cows milk since about 14mo but was on Nutriprem before that because she was sooo tiny.

Used2bthin mine eats plenty of fruit & veg too and almost always has a drink of water in her hand so wouldn't have thought that would make a difference to the lactulose working but anything's worth trying

katylou i will definately be taking her to the dr on tuesday after reading that, i was afraid of her being scared to poo & having further problems

gagarin thank-you for the info about lactulose, you seem to know what you're talking about!! have given her 10ml this morning with brekky and will do so for the bank holiday weekend & hopefully it will help better than the smaller dose. MIL is also picking ice cream up at Asda this afternoon for me, will give anything a go

so - has the earth moved?! Hope so.

You could try a stomach massage that is meant to help poo flow...

rub up the right side, then across the stomach under the ribcage, then pull your fingers from his back (below the kindey area) over the hip and down along the pelvis into the groin - 5 mins of this a few times a day could help to get it moving.

Prune juice can also be effective.

If you see your GP yous could ask for a supository (nasty but effective) my little one has Movicol which may help.

gagarin, pmsl! yeah it moved, with lots of huffing and puffing but is gradually getting better & less screamy. Dr couldn't fit her in until Monday so we're taking her back then to see about constipation clinic or something similar. Thanks for asking

Raine3, my lo wouldn't lie still long enough for massage. She hated it as a tiny baby too, would decide after a minute or 2 at baby massage class she's had enough n scream! Can't even get her to stay still for a clean nappy atm, she hates nappy changes so they're a real battle of wills. I might give it another go though, maybe after bath time when she's chilled out ready for bed time

Sorry ... I said his because mine is a boy ! ... good luck

Mine really suffered as a little one. Whenever there was a poo she got really distressed. We tried prune juice, lactulose, witholding bananas. The paedtrician told me I needed to "make" her drink more fluids - though you do that with a small baby she wasn't going to tell. With dd the problem was probably linked to weaning ( or at least coincided with it - noone committed to an opinion on this) and she grew out of it very quickly....

Raine3, she's very boyish anyways, makes no difference to me!

Portofino, she drinks loads of water every day (at least 7 cups) plus a cup of milk with dinner and lunch & a cuppa tea with brekky (don't ask, oh's idea)

I will just keep trying things as they're suggested and see what else the dr has to offer

Lucysmama - I have EXACTLY this problem with DS who was one last week. Having just come back from seeing a consultant paediatrician specialising in 'stomach' problems, this is his response:

Continue lactulose (was prescribed by GP) at dose of 2.5ml morning and 5ml evening.

Movicol - half a sachet every other day. This adds water to the stools and should make them easier to pass

An anaesthetic gel that is applied to the bottom regularly therefore stopping any discomfort caused by going to the toilet as the area is numb.

Add pro-biotic yogurt to the diet

Back to see him in two weeks. He looked for any anal fissures which you might need to get checked out but said that it is incredibly common and he must see at least 500 cases a year. nothing to worry about and the above steps should remove all the trauma (to the baby and parent !!). It's mainly a mental issue due to a bad experience passing stools at some point (my DS's problem started after a very bad teething episode) and they need to learn that it isn't going to be bad/painful when they relax and poo as normal.

HTH ?