DESPERATE. Please help. My poor DD's constipation is making her so miserable

[TheNewShmoo]

Poor DD has been suffering with constipation for 3 months since she was only 13 weeks old and has been dropping centiles in weight. We have tried lactulose but now administering it has become so distressful for her that she has gone from a very chatty baby to quiet and miserable, always having her lips tightly locked shut for fear of us force feeding her the lactulose. We've started weaning but are avoiding all binding foods. DD is exclusively breast fed. We can't get her to drink water as she won't take the bottle or beaker, and is generally scared of us trying to put anything into her mouth. I've cut out wheat, dairy, gluten in my diet, massage and cycling her legs. She's now 6 months old... can anyone please offer any advice? All our GP is offering is lactulose and movicol.

If you have been giving the lactulose and movicol exactly as prescribed, and it is not working, you need to ask for a referral to a paediatrician.

I would think that constipation this severe in an exclusively breast fed baby is very unusual. Are you confident that your supply is good, and that she is feeding enough?

Are you drinking orange juice? I understand this can help. Otherwise would you consider a glycerine suppository? I'm by no means an expert so happy to be corrected if not appropriate for her age but it may be worth discussing with the GP. Poor thing, hope it eases soon.

Mix the lactulose with her food. I have had to do this with my baby too. Try mixing it with something like pureed sweet garden peas as it will go through her system fairly easily. We have been referred to a dietitian as DS has struggled with his digestion. Echoing 3littlefrogs, how is your supply?

Correction- we couldn't get her to take the movicol as she won't take a bottle/beaker- so have kept to the lactulose.

Namechange and 3littlefrogs- I think my supply is good as am able to pump a fair bit and it does separate out into a nice fatty top layer and liquid - not sure if this is a good measure though. She does eat less on the days she does not poo. Are your supply concerns about the amount of fluid in my milk?

Flamegirl- have tried juices too. The suppository would be a last resort if she hasn't gone for ages- 8 days has been the most so far. What I'm desperate for is a solution to make her more regular without the trauma of force feeding her the lactulose.

I've seen a paediatrician at our local hospital, who after examining her abdomen etc just recommended continuing the lactulose. I wasn't convinced so have managed to get a referral to one at UCH- hoping they will be more helpful.

Namechange- how much lactulose do you mix into the peas? We have to give her two doses of 10ml a day so not sure how this would work out in practice...

I mixed the normal 10ml dose into the peas and then gave him yoghurt later in the day and added the other dose to that. It worked for us, but I agree with you about not force feeding medicines, it is traumatic.

I'd focus on the movicol rather than lactulose. They work differently ways. I don't understand it completely but from what I've been told by hcp's the movicol allows the body to heal and fix itself as it just softens the poo. Teh lactulose acts in a different way that isn't so benign on the body and the body can get reliant on it.

You can mix the movicol into food - yogurt or even just sprinkled on food. Make sure you have the paediatric plain variety as it isn't flavoured. You can use pretty massive amounts of it without causing any damage.

But this could be a very long term thing. DD1 has been on movicol for over 2 years and is showing no signs of coming off it. She started on 2 sachets a day and is now down to 1 a day. Going lower than that causes problems again.

The other thing I found when breast-feeding was that if I ate licorice and sorbitol it didn't affect me at all but did help the baby.

YOu really need to focus on the Movicol rather than the Lactulose as camdancer says they wrok in different ways with Movicol being the main help in constipation.

DD has been on medication for over two years now, she was on both lactulose and senokot (she refused movicol after being prescribed adult one rather that child one) and is now just on senokot as this is the one that will help her more. Lactulose softens but doesn't help with the evacuation of poo from the body, senokot or movicol does this.

Which is why they are used in conjunction wth each other.

Lactulose is only a sugar solution that cannot be absorbed in the gut, so it retains water in the intestine by osmosis. It is harmless, and doesn't cause dependency.

But it is important to use all the prescribed medication in the quantities advised, and then, if this doesn't work you need to seek further investigation.

You dd sounds as if she is already suffering a great deal, and you need a specialist opinion asap.

Thanks for all your suggestions- wasn't aware that you could mix Movicol into food or use the lactulose in conjunction with it. Will the dosages remain the same if using both?

Also the Movicol is not recommended for under 1 years of age? Any opinions on this and why?

I'm aware that this is a long term treatment- am I right in thinking that the goal is to retrain her to into going and not holding onto the poo by getting rid of the discomfort of passing it? Poor thing has had a fissure so the thinking is probably quite entrenched by now :-( Just wondering how long all this will take. But if I can get her to take the medicines without upsetting her, then that will be a great start.

OP - can I ask a stupid question? What is the consistency of your DD's poo?

My DD was EBF and only pooed about once a week but it was normal runny bf poo.

Just realised that my question makes it sound like I don't believe you. Sorry for that, please ignore me.
Hope your DD gets better soon.

Treatment of with-holding and constipation after an anal fissure is a long, long process. It will take at least as long as the problem has existed, and probably much longer than that.

In such a young child I would expect this to be under the supervision of a consultant paediatrician. I think your dd is too young to be managed in primary care.

There are psychological as well as physical issues with this, and you must get expert help.

It is also important to rule out any physiological or anatomical abnormalities that may have led to this, and a specialist can organise the necessary investigations.

I really hope you can get things sorted out soon.

I don't know why Movicol isn't recommended for under 1's but DD1 was prescribed it by the hospital at 10mo. We've put it in and on pretty much anything! She now has it in her milk in the morning. For ages she didn't know she was having it but recently she has cottoned on and reminds us if we forget her "poo powder"!

The holding is something that takes a very long time to get over. DD1 still withholds if she feels bunged up even 2 years later. We tried reducing her dosage this week and today she is very bad. It is horrible to see and there really isn't much we can do except wait for the higher dosage to kick in again.

I hope UCH are more help for you.

TickledOnion- no you didn't sound suspicious! Nice to hear your concern actually. We've only just started on solids and she wolfs down semi-mashed solids on the days she has pooed. I wanted to BLW but as she doesn't get to actually 'eat' that often and happily takes the spoon once she's pooed (but detests spoon feeding on the days she hasn't- which further adds to the trauma) I've gone with spoon feeding but I do put finger food on her tray to play with. So last week her poos were very dry and pasty even with the lactulose. Today she went after 4 days and it was a lot runnier and less homogenous, and smelt sweet like her old pre-solids breastfed poos- but I guess that's because she's been off solids for the past few days. They are mid brown now since weaning.

As she pooed today (a lot of tears) I'm hoping tomorrow morning she'll have a big appetite for breakfast so I can add in some Movicol, and hopefully go down that route, and some mix the lactulose into her peas at dinner.

We're seeing a baby reflexologist on Friday as feel like the medical route has not much to offer. DD used to be such a chatter box, 'catching flies' all the time with her wide-open mouthed smile- it's so difficult to get her to smile now as she seems so withdrawn, it's breaking our hearts :-(

BTW anyone seen a reflexologist for their DC? Or any other alternative therapies?

camdancer - so has your DD1 been on Movicol since 10 months old? Aaaw, poo powder.

DD has been on medication for over 2 years now, she refuses to poo on the loo since she had a bout of constipation, she will be 6 in a few weeks. She is still in nappies because of it, but thankfully not during the day at school.

No to alternative therpaies at the moment.

fivegomad - gosh, for 2 years? And she'll still get a bout even on the medication? Oh dear.

She seems to have big issues with actually pooing on the loo which is our main problem at the moment.

If you are still breast feeding have you tried drinking fennel tea? My HV suggested trying it for ds2 and it seemed to work for him. But that was before he was weaned and i dont think his constipation was as bad as your dds.
Hope you find a solution soon

When my ds was constipated, i tried everything - prune juice, apple juice, medication, the list goes on. None of this worked. What I discovered worked for us was grapes.

i think that different things work for different bodies, but if you could cut some up for your dc and try it, you never know.

I feel for you. My ds' only lasted a month or so, so it obviously wasn't as bad, but the poor thing would hold it in and when it did come out, it was a big, hard ball. I'll never forget it.

I really hope you find something that works.

Yup, movicol from 10mo. She'll be 3 in March, so almost 2 years. She is like your DD - won't eat when blocked up. It is horrible watching when she is bad. Yesterday was awful. My sunny, funny girl was just crying in pain and withdrawn and quiet at other times. There just doesn't seem to be any rhyme or reason to it, which is really frustrating. So we just keep going with the movicol and hope things improve as she gets older.

We are having a nightmare with potty training because of it all. She is scared of pooing anywhere apart from her nappy. (And she's a very stong-willed girl who just can't be bothered! )

Gottasmile will try the grape juice in her food.

Camdancer - sorry to hear about your DD. It's all psychological now it seems? I'm wondering for my DD is there any point in trying to figure out what the initial cause for the blockage was as it now seems to be just fear of pooing. But I wonder if there is something else irritating her bowels. I'm getting so much pressure to switch to formula, it's making me mad because I've worked so hard to keep her just breast-fed. But how will I know if it is my milk that's causing it without taking her off it and compromising my supply?

I tried the movicol in her papaya this morning (she loves papaya) but it went quite salty, she didn't eat it, so will try later in her veg where a bit salty may work. I put a couple of beakers on her playmat too so hoping she'll make friends with them.

UCL won't see us for another 3 weeks which seems an age away at the moment.