Toddler constipation getting worse despite laxatives and good diet

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My LO is nearly 2 and has been on laxatives since December. Intially they would work almost immediately but in the last few months they haven’t been as effective and I’m frequently having to double the dose which gives mixed results.

He has a good diet with plenty of fruit and veg etc and most of the time drinks enough water. Every day I’m giving him pears / kiwis and also quite often add prunes to his breakfast too but it just doesn’t seem to make much difference.

We’ve had 3 different GP’s in that time and they’ve all been quite dismissive about it, saying it’s normal for their gut to be a bit slow at this age. It’s only ever been a telephone appt so he’s never been examined.

Anyway, he’s started really straining and doing multiple tiny dirty nappies a day - I’m honestly going through nappies like it’s newborns days!!

I’m starting to get a little concerned about it as the issue seems to be getting worse not better. Not sure if it’s relevant but my MIL is coeliac so in the back of my mind I’m starting to wonder if it’s an intolerance causing this.

Has anyone been in this situation and has any advice please ?

What laxatives are you giving and what dose?

It would be pretty easy to cut out gluten and see if that helps.

consider trying some more natural products - psyllium, ground flaxseed.... and raspberries have a huge amount of fibre....

agree re testing obvious intolerances too

He has been prescribed one sachet of CosmoCol a day but when I said to the doctor it wasn’t as effective she said I could use 2 sachets

Thank you, I’ve not heard of psyllium! Also didn’t know that about raspberries. I will give it a go

https://eric.org.uk/oral-medications-for-childhood-constipation/
Looks like the dosage is up to 4 sachets a day so if 2 a day isn't effective you should speak to your GP again about increasing.

Water intake needs to increase a lot alongside extra fibre or it can be counter productive. Laxatives shouldn’t be used long term and can also be counter productive.

Definitely worth pushing for a coeliac test. Is he drinking plenty of water? This was the problem my DD had as a baby, she was constipated during weaning despite her diet only consisting of breadtmilk and fruit, but once we got her drinking more she was fine.

Definitely worth testing for coeliac, and do this before cutting or restricting gluten. My lifelong chronic constipation (literally some of my earliest memories) resolved after diagnosis

If he’s still constipated, the little bits constantly are probably overflow. He sounds like he needs to be properly disimpacted. Go on ERIC for advice on disimpaction. My child was up to ten sachets of laxido a day until thoroughly disimpacted during one bad time. GPs are sadly not well informed about it. Continence team are way more knowledgable if you can get a referral to them. Good luck.

I did raise using laxatives long term but the doctors said it was fine for him to be on them for years - but it does worry me tbh as don’t want his body to be reliant on it.

In terms of water intake, does anyone have any tips on how to increase it ? We’ve tried a new bottle, drinking with a straw from an open cup, adding ice & drinking from ‘daddy’s special bottle’ - different approaches work on different days !

I use very dilute sugar free squash to keep my toddler drinking enough. I think it's more important to keep hydrated than to avoid the sweeteners. DC had weaning constipation and I don't want to repeat that experience, especially as I can no longer breastfeed to fix it!

sorry to hear your experience but glad you managed to get it sorted in the end. My husband and SIL (his sister) are both quite sensitive to gluten although nothing officially diagnosed but my poor MiL gets very ill if she accidentally has any so I do think it’s worth checking

If stools are at that point then you’re likely to need to do a disimpaction to get the backlog properly cleared out. Then gradually wean the dose down.

There’s probably a dietary cause, fluid targets need to be met in addition to the cosmocol.

Adult straw drinks bottles are good because you get a lot more liquid from a suck that you do from a kids spill proof one.

ERIC website is your friend here.

Laxatives can be used long term and in many cases need to be. My child was on them for 8 years as prescribed by the continence paediatrician.

Try peeling and coring an eating apple, grate all the flesh (it does turn brownish and fizz) and spoon it into him. You can add a little honey or sugar but not much. Put a strong nappy on him and you could see results within the hour! It should clear him right out.

What about ice pops to increase fluid intake?

It;s the heat at the moment making things worse!!
Try watery foods e.g. cucumber, melon. Chia seeds are excellent for constipation too.