Childrens constipation- is there anything I haven't tried?

[reup]

I have an almost 3 year old who is severely constipated and I have tried a number of things and wanted to see if there was anything I hadn't thought of. He is also witholding on purpose cos he knows how painful it is.

He is an awfuly fussy eater and barely eats any fruit and veg. He also dislikes fruit juice and smoothies (although will sometimes have baby fruit purees.) Just before anyone mentions it I never give him alternatives for his meal and he probably does not eat an evening meal 85% of the time.

I give him veg and I hide it in sauces too. He will eat it hidden in tomato sauce on a homemade pizza but will often scrape it off pasta!

He has raisins, fruit purees, porridge, all bran, bran flakes, wholeweat or granary bread, wholeweat pasta, baked beans.

I have tried adding linseeds. He has been on 10ml of lactulose a day for months to no affect. He started on movicol 5 days ago and he only just poo-ed today but there is loads more in there. He won't drink the movicol and as he doesn't like juices I have dissolved it in water and then added some milk so he will drink it.

I am putting off toilet training because of it. Am going back to drs after xmas to see if we should up the lactulose dose or get some laterantive to movicol.

He is so much pain and gets spectacularly bad tempered with it. It is just dominating my life at the moment.

If there is anything that anyone else has tried I would love to know! I bought up the whole dried fruit section in a supermarket teh other day and the only thing he liked was the yoghurt covered fruit flakes. Didn't help and they are probably as crap as eating a bag of sweets!

keep going with the movicol it doesnt matter what drink you put it in as long as he takes it.

I would stop the lactulose while he is on movicol. if he is starting to have movement keep movicol going so as he gets a regular pattern going. He should also start to feel emptier and that should increase his appetite.

The other important thing is to get him to drink plenty. If he drinks water keep going with that. it helps to soften the stools.

He does seem to have a lot of fibre in his diet. Although some fibre is important you dont want to bulk him up further and it can cause cramps.
Have you tried the health visitor? They are ussually better than gps at constipation.
hth.

When DD was younger I used to give Syrup of Figs now and again.

Thanks. Yes he does have a lot of fibre. I wondered if it was too much. He only really likes carbs to eat. Has hardly any protein except baked beans anc cheese. Will keep on with movicol. But I had such high hopes that it would make him poo more frequently straight away. (I knew he would have to be on if for a while to make his bowel shrink back to a more normal size)

Constipation is not fun. Especially for such a little one.

It seems to me that you've done extremely will, given that he's a fussy eater. Personally I would cut out the bran flakes and cut down on the wholewheat. Wheat bran can be quite irritating for the gut, and can acutaly make some people's bowels worse rather than better.

Could you get him to eat more oats? Oat fibre is very good for the bowels, and moves things along far more gently than wheat fibre. Porridge, oatcakes, flapjacks are all good sources, plus you can use quick-cook porridge oats in cake recipes (just replace 1/4 or so of the flour with the equibalent weight of oats). You can also get bread which has oats added.

Get a bit of olive oil into him every day, whether by cooking with it or by adding a teaspoonful of it to his food. Olive oil also helps keep things moving quite gently.

Have you tried figs or prunes? Both effective. Prunes can be so effective that I ration them for my dc!

My mum swears by a glass of water and a piece of fruit first thing in the morning, before any other breakfast, as a cure for constipation.

Does he eat much red meat? I found that surprisingly constipating for ds1, and his constipation eased as soon as I cut down his meat intake and wheat intake, and upped his oats. (Sounds like a horse )

Tummy massage? Clockwise from groin up and over top of belly to groin.

Lots of exercise that includes large leg movements, like swimming, climbing, cycling?

Cranial osteopathy?

All these things help babies - I don't see why they shouldn't help older children.

HTH

I tried a sort something called califig which had syrup of figs in it over the counter but it didn't do anything dramatic, even when I gave him a double dose.

It was calfig.

My 14 month old DD is on 20ml of lactulose (10ml twice a day) plus 2.5ml of Dulcolax in the evening. Its been three weeks at these dosage levels and she's finally pooing daily.

The Califig made not a jot of difference for her.

I have IBS and bran and fibre make me constipated.

There is only one thing that will be guaranteed to work. My dd was constipated for nearly 2 years at a similar age to your ds and we tried everything you mentioned plus a few more things besides. The magic cure is glycerine suppositories. Not nice to administer but they work every single time (ie cause a bowel movement to occur within minutes) and also make the bowel movement soft so it can be passed easily (my dd's constipation was in conjunction with an anal fissure).

Thanks for that. He has porridge or oatibix most days (he has all bran or bran flakes occasionally). Have tried figs and prunes and he wasn't keen. I made a really nice prune sauce for chicken this evening and it wasn't touched.

He doesn't really eat any meat, the odd chicken nugget (once a fortnight or so).

My oler son was similar but loved prunes which saved him. I wish organix still did that baby prune porridge.

He won't eat any fruit except bananas and baby fruit purees. I may try and get one in him first thing as he is very hungry then as he usually hasn't eaten since the previous lunchtime.

I wonder if I made some sort of prune or fig cake he would eat it as he loves any sort of cake or biscuit. I remember an old friend having a lovely choclate fig cake that you could not tell had figs in it.

How is Ducolax given? is it like a medicine or somethign to dissolve.

We were given gycerine supposotories but I think either the dr or chemist made a mistake and we have the ones for under ones! We put on in and nothing happened (except he farted) and the next one he pushed out. They are probably too small!

Coco shreddies are also very high in fibre (a HV recommended them to me once and all my fussy eaters liked them)

A spoonful of honey first thng in the morning.

he likes honey!

Dulcolax is an orange flavoured liquid. Its pretty sweet - like lactulose and DD laps them both up.

I'd talk to the GP about increasing the lactulose dose and ask about a bowel stuimulant. The lcatulose makes the poo softer but my GP was pretty insistant that a stimulant was needed as well to move things along. (The GP's little boy also had constipation which is why I'm trusting her on this one!)

It is horrible when they get so stressed about pooing. We've struggled for 4 months until this new regime. Hope you can get it sorted out.

Thank you everyone so much for replying.

I have some new ideas now and just googled a couple of cake recipes with figs and prunes. Not the most healthy things ever but that means he is more likely to eat them!

My DS has also been horribly constipated but he is younger than your DS. It started when he stopped wanting to BF. We got started on Movicol as soon as he was diagnosed and it worked within a couple of days. He has been on it for months now and the only way I make sure he has the full dose is to put it in his morning milk. A couple of other things - we have had some great support from the hospital who have community nurses - one of which specialises in constipation. Might be worth asking if you have that sort of support locally. We have found that bananas really make him worse so we limit them to occasional which is a bit of a shame as its one of the fruits he would eat sackloads of ! He has prunes most days but to be honest I have not noticed a huge difference. The biggest tip we have had is to make sure he drinks enough fluid. I have noticed he gets a bit constipated when he has had a cold or teething so at the first sign of him straining to poo I up his dose to 1.5 sachets daily. I don't know what dose of Movicol your DS is on but he might need a few sachets to get him cleared out to start with and maybe with some glycerine suppositories to help out too.
Good luck

Bananas are NOT good for constipation. About the only fruit to be minimised or avoided.
Also not too much dairy stuff - obviously need some in the diet but not masses of milk drinks etc (I had to limit DD to one pint per day and cut out bananas).
The Movicol is good stuff but takes a few days to work (and you may have to alter the dose) so before you change everything too much, give this a chance.

Liquid intake is very important - what about squash drinks of some sort if he wont have juice.

HTH

Cut down on wheat as much as you can and don't overdo cows dairy (maybe just at one meal), use olive oil & other good fats (not marge), good proteins (eg in soup/caserole liquid rather than a steak). He might also need probiotics if he eats mainly carbs to rebalance gut bacteria. Stay clear of bran and such, its a marketing ploy, it leaches nutrients and the "slow release" idea is a total con-it slows the gut down to nought.
Another good food is beetroot/b. juice, best cooked/in salad or grated & mixed with aomething he would eat. Linseeds are awesome, but you need to increase liquid intake.

Hi, My DD1 was a terribly fussy eater and constipated from around 2 years. She wouldn't take any medication so Lactulose and Movicol were no good, she didn't drink much which is required for both of those. The thing that fixed it for her was Senna syrup (Senakot we got it on prescription). We could put it in her milk once a day (usually bedtime) and the next day she would poo. As its Senna (which is a natural) we didn't have to worry about any side effects or her not exercising her bowel muscles. We continued with senna until she was around 4 when I stopped it and she has been really regular ever since.

have only read OP so sorry if I repeat anything anyoen has written.
We had this with DD1 till she was 5yrs and tried all sorts. Things that worked for us was

1. Yachult, one bottle in the morning really worked!

2. blowing bubbles while sitting ont he loo, its impossible to hold in while blowing

3. stories while on the loo, this means its less thining and taking time, so less painful.

4. tummy massage

Hope some of this is helpful but def try yachult if you can

Avoid bananas - they are constipating. ( A shame, of course, if they are a fruit that he will eat.) If he will have those baby purees, then go ahead. I still buy them and my youngest is 3, because the eldest - 9yo! - is not a good fruit-n-veg eater but will eat the purees as a pudding.

The trick with suppositories is to push them in quite deep. You don't need to put your finger in the anus, it will close up after the suppository, but keep pushing gently until you are pushing at the anus. Just for a moment, and then hold his buttocks together for a minute or so - distraction tactics may be needed at this point - until the immediate urge to push passes.

It helps to put them in if he is lying on his side with his knees drawn up, and when you're done he sits up on the bed for another couple of minutes before getting up and moving around. The pressure of the mattress on the bottom also helps to reduce the immediate urge to push.

(Can you tell I've used a few supppositories in my time? )

FGS, speaking as a nurse now, do not give suppositories unless you have been shown how, DO NOT start pushing them in deeply you are at risk of perforating the bowel.

Keep on with the movicol, it doesnt always work straight away but it does work by adding fluid to the stools to make them softer and as a stimulant. It is replaces the movicol and is more gentle than movicol.

you need professional advice when he is not constipated on his diet to avoid it recurring. I dont know if its diet induced or just one of those things that toddlers have a tendancy to develop.

its also worth bearing in mind that toddlers do not need a high fibre diet - it bulks them up so that they do not want anything else to eat. It has been known to cause malnutrition.

With toddlers if anything you need a high fat diet because is what they need to develop up until 5yo. (not macd every day )

The size of a portion is the size of your childs fist so to me from what you say it sounds as though he is getting plenty of fruit and veg so I really wouldn't worry on that score.

movicol really worked for my ds1. I used to put it in his morning and evening milk. He had got really bad and was sad and withdrawn and as soon as the movicol started working he became his old happy self again. He was same age as your ds and he was on it for 6 months before we managed to cut it out and has been fine since thankfully.

try these as well - I find a few of these help me and DS a lot