Chronic constipation in 19 month old

[Marie12]

DS2 (19 months) has chronic constipation and was referred for a paediatric assessment by the health visitor. He is on 40mls of lactulose a day (which is a nightmare to give him because he hates taking it and I have to give him 4 spoons twice a day).

The nurse who came to do the assessment didn't examine him just filled in a load of paperwork and told me to continue with the lactulose but she said for the lactulose to work I have to get him to drink 3/4 beakers of juice/water a day. How on earth am I supposed to do that?

Does anyone have any similar experiences or advice to offer please? He witholds his poos everyday and really gets in a state about it and this in turn puts him off eating. We have been in this cycle for months and I just want to get it sorted out. He has a good varied diet (when he does eat!) and I thought he drank well but seemingly its not enough.....

I can't offer much advice other than to say that water and exercise are two of the best cures for constipation. If he's not drinking enough water, there's no way the poo will shift. He also needs to be moving around a lot. Is he active? Can you introduce more activity? Can you set up a reward chart / system with him for drinking water? And water is better than juice anyhow. 3/4 beakers of water isn't a huge amount, unless the beakers themselves are large. What's the amount in mls she's recommending he drink?

Plenty of encouragement to use the toilet regularly to try for a poo but without straining. Make toilet time fun so he can sit there for a good few minutes, have story time on the potty, let him see you using the toilet and talk openly about poo without making it a big issue.

I imagine if the lactulose doesn't work, they may investigate food intolerances such as dairy intolerance which can cause chronic constipation.

There are story books about poo that you could read together if things feel a bit taboo at the moment e.g. tinyurl.com/lm4xxw

sorry here's the link

A friend of mine had a similar time with her DD, and tried taking cow's milk right out of her diet, using goats milk and soya milk instead. Worth a try? Wouldn't have thought long-term lactulose use without any kind of diagnosis is a good idea.

I agree - the underlying cause of the constipation needs to be addressed rather than using lactulose as a long-term treatment. But lactulose might be enough to get things started for now, so see how things go.

My DS has had chronic constipation for as long as I can remember - he's now 20 months.

He was taking lactulose, but with little success and about 5 months ago was prescribed movicol which he now takes daily - one sachet per day in his drink each morning. He now has daily, regular bowel movements and doesn't spend all day straining like he used to. I used to have to manually help him to pass a poo when things got really bad but now I don't. The GP we now have is brilliant, really sympathetic and doesn't try to make out that we are giving our so with a really poor diet - as we have been dealing with this since DS was weaning his diet consists of fruit, veg, brown bread, rice etc - he has never eaten anything other than wholesome foods due to the issue.

The movicol isn't and can't be forever and the plan is to start reducing the dosage from next month - he currently takes one sachet in his first drink of the day, next month we will be reducing it to every other day and reviewing progress.

We have never really got a diagnosis for DS other than being told that this is incredibly common, some babies just have a slow bowel and that it does become a vicious circle in that they start to withold and then it becomes even more painful and then they continue to withold etc. Movicol is only prescribed to babies under 2 in exceptional circumstances and it's not the ideal solution as you are depending on medicine to get DS to do something which should be straightforward. From my reading there are issues in prolonged usage such as control issues etc so we are hoping to be off the stuff before we start potty training.

If the reason for the ongoing issue is witholding and the vicious circle this becomes then it may be worth trying this as it may stop the psychological issue that may be the cause of the problem so that you are able to 'reset' the behaviour as we are hoping to achieve.

I hope this helps, I really sympathise with you, if your situation is anything like ours your life can become one long battle of the bottom!

Maybe your best starting point is trying to find a GP who sympathises and takes your concerns seriously. It feels like it's been the key to us getting to this point and feeling positive about being able to help DS move on from here.

Good luck!

Thanks for all your replies. Unfortunately the GP I saw wasn't sympathetic, he didn't take it seriously at all and didn't seem to realise how hard it is to get such a young child to take so much medicine every day, hence me involving my health visitor who made the referral.

He's too young to understand a reward system, only just understanding basic commmands/requests, such as find your shoes! I am just trying to be really positive when he drinks from his beaker and praising him for doing so.

I have made the connection between cow's milk and constipation (despite GP telling me there wasn't one!) and I water down his milk now because he loves it at breakfast time and a big drink of it at bedtime too, so its hard to cut it out altogether. I tried the 'growing up' milk by cow and gate but he wouldn't drink it so might try soya milk instead.

Neither the GP nor the paediatric nurse were keen to prescribe movicol which is frustrating because its wonderful stuff (I use it myself)! He is pretty active. He doesn't sit still for one minute. If I'm in the house with him he is constantly walking around, up and down, he doesn't stop! I also encourage him to walk when we're out and he loves to play in the garden.

Mamibabi - just out of interest how do you get your DS to drink the movicol? Have you ever had any trouble getting him to take it?

Drinking it has never been a problem as we use juice to flavour it - it does taste a bit salty but the instructions tell you that you can do this and DS doesn't seem to notice the difference. He's usually finished it by mid morning and then he gets a fresh cup of squash/juice. Due to the problems he's had we long ago gave up on getting him to drink water - he just would't and it meant that he wasn't drinking enough which was probably contributing to his problems so we flavour his drinks with either juice or squash and make sure we brush his teeth regularly.

Thanks - coming round to that way of thinking myself. Having to resign myself to the fact he'll have to have juice instead of water!

Don't feel guilty - it's about getting a balance, you can't win them all!

Just wondering if you take movicol, have you recently stopped breastfeeding - the movicol you take may have been getting through the breastmilk, and he may have constipation due to withdrawal of this? Just a fleeting thought!

Keep badgering the doctors. try another one if they don't seem to listen. You know your child!

Have you considered switching to goat's milk instead of cow's? It tastes very similar, and it's totally natural not processed like soya milk. I give my DS goat's milk, goat's cheese and goat's yoghurt, all of which he loves. They sell it in most supermarkets. Slightly more expensive, but worth it if it makes a difference. You'd need to switch for about 2 weeks to notice a difference.

Thanks that's an interesting thought. I stopped breastfeeding him when he was 5 months though and he's now nearly 20 months. Mind you he's had this problem a long time and I put it down to switching from formula to cow's milk. I will get goats milk next time I go shopping - thank you coveredinsnot!

hello
i have just read over your posts. when i read mamibabi's post it sounded as if it had been written by me! we are going through the exact same with our DS (20months old).

DS has had problems with constipation since weaning and was recently prescribed the movicol. everytime we think we are getting somewhere with it and reduce the dose he goes back to square one. the poos harden up for some reason (even though we have him on a strict diet) and he goes back to holding them in.

I just wondered if you had managed to get a positive result in the last 6 months?

we are at the stage of seeking advice from dietician or private specialist to see if maybe a food intolerance is the cause ie. cows milk maybe? dont like the idea of giving DS the medication longterm without really identifying the actual cause.

Please tell me you have gotten somewhere with this???

I keep reading stories of children still being in nappies when they are ready to go to school...