Any ideas/tips please - constipation

[mysterymachine]

My 3 1/2 yr old ds gets very constipated - small dose of laxative needed twice a week

Some weeks he will only go one day (maybe 3 or 4 times) and will only poo in a pull up. Refuses to sit on toilet and it takes up to 2 1/2 hours to actually finish the first poo.

He drinks fresh orange juice all day, but will only eat fruit if he decides he wants to. We try to get cereal in him but he isn't one for eating when he gets up.

If anyone has any ideas on:

a) how we can get more fibre into his diet (as we know this should help)
b) how we can get him to use the toilet rather than pull up
c) how we can get him to go either daily or every other day without laxative

Please let me know - this has been going on now since he was 5mths, we have spoken to docs, hv and just get told it is normal, ok, don't worry, try to increase fibre - no real useful tips on how to achieve any increase in fibre

Thanks in advance

We have similar problems. It would be better to add water to the OJ than give it neat as it's not too gentle on the stomach when you drink too much of it.

I think you need a referal TBH, it's not normal to be that constipated for so long. Our paediatrician advised us to give her a big dose (she's on Movelat sachets) and clear her out completely, then bring the dose down until we find a level that keeps her going.

Might seem like a daft question, but tell me about his meconium. We've been told that difficulty with the meconium can carry on.

no experience in constipation in children (other than myself) but would recommend prune juice as being very effective. Or whole prunes if you can get him to eat them as they will increase fibre as well; or dried apricots, similar.

Take care with the fibre you use as the harsher varieties can make it worse (weetabix, shredded wheat, all bran etc.). Porridge or oat-based cereals will be more helpful - make your own oaty flapjacks with banana or dried apricot or prunes or figs - they will help.

Make sure he has enough water/fluid as low intake can make constipation worse.

Stop the laxatives - it is extremely unlikely at this stage, but overuse of them can potentially create a "lazy bowel" (my grandad had this with overuse of sennapods).

If he is allowed sweets, and will take it, let him have some liquorice - that tends to shift things along! but not the best option as too high in sugar really.

Tinkerbellesmum - he was normal as a newborn and was fine when b/f - went basically every nappy, problems started when we transferred to mixed b/f and formula feeding. We found C&G foods/formula didn't agree with him and the problems have now continued. The OJ has been drunk since he started with the problem and was advised by hv (watered down at first but now neat). Can you buy movelat over the counter or is it prescription only as it might be that we can try that to get him started and then hopefully get diet working properly.

Thumbwitch - Will try the licquorice (sp) to see if he likes it (never crossed my mind that one). Also like the idea of making flapjack (he can help as well). I don't overuse the laxative at this stage - only a very small dose couple of times a week (less than 2.5ml) as he doesn't really like it. Fluid wise he does drink a lot but only really juice with occasional water. Willtry prune juice for him as well (he will prob like it)

Thanks both for your help

Movecol has been a revolution in our lives!

It's prescribed, by a consultant for us, but GP's use it.

dd went 2 - 3 times a week, took hours, staining clothes, not eating cos bloated etc.

Apparently with long term constipation, the bowl just holds whatever is required. dd1 did poo's her daddy would have been proud of!

Dunno if yours is with holding, or need fibre or what, but seriously this medicine has changed our lives.

Were looking at 18 months on it though - Dr said it takes about as long to re wind the bodies habits as it does to instil them.

Personally I wouldn't care where or how the poo is done. Just getting it out with least stress possible is my way! All that can be sorted later when the 'biology' is sorted if you see what I mean.

BTW - dd1 had enough fibre to build a tree from. Had fruit juices and fruit and warm baths. All good but ultimately medicine was needed.

Found papaya and mango, made into smoothie with bio yogurt had an impact.

Our troubles started exactly like yours - going from breast milk to other stuff. Was like her system just couldn't cope.

treedelivery - does sound like my ds is same as your dd. He sometimes only goes once a week (although can take 3 or 4 attempts to get rid of everything). Think I will give a few weeks of dietary changes and then go back to gp to see what they can do. It does seem to take ages for him to empty once he decides he wants to poo - sometimes 3 hours of straining for nothing to appear

Thanks for your advice

Poor mite.

Imagine if we had to do that! If you do go back to GP then the length of time it's taking to pass anything is probably the thing they will be most inclined to act on.

Seems loads of kids are constipated, but the overwhelming need to poo should overcome this. Even if they poo concrete and pebbles it should come out.
When it doesn't, like our 2, the messages from the bowl aren't getting to the brain because their little bodies are so well trained to 'hold'. According to dd paed anyway.

Good luck!! Hope you get progress like we have - dd a different now child bless her.

Sorry, I meant Movicol I wasn't at home. We told from the start to find the level that kept her even on a daily basis. It's difficult though when she's trying to potty train (like everything with Tink it's her choice!) and going to a childminder to have her on regular laxatives. I think it is prescription only but it is brilliant.

treedelivery, that all sounds so familiar!

We were at a bus stop a couple of weeks ago, she slipped through a gap and started to cry, we thought she'd hurt herself. TBD picked her up and I tried to figure out what hurt so I could kiss it better. I think she sobbed something about pooh bum and hurt. She did an adult sized pooh and was so distressed passing it, it seemed to be bit of a bung though as she did quite a few smaller ones for the next day or two. Then she goes back to normal.

Has anyone suggested dairy intolerance? 2 of my kids had massive issues going from BF to mixed diets with chronic constipation. Both went onto dairy free diets under the supervision of paeds and were fine. They both improved as they got older and were able to reintroduce dairy to the diet although neither really drinks milk. They are 4 and 5 now but probably avoided milk to about 3.

Geogteach - how was the intolerance diagnosed? I have often wondered if thats it, but hadn't the guts to go there!!

I hope not! She loves yoghurt, cheese, chocolate, Cee-Cee (cereal)... My brother isn't supposed to have milk, but the only thing he avoids is cream I always find it funny when he refuses cream because he's lactose intolerant "yeah and that casserole dish of cornflakes this morning with green top on it...?"

Only by removing it from the diet, as it is not an allergy I was told it would not show on something like a skin prick test. for DD it took a long time to get to that after trying lactulose etc etc. With DS1 because we noticed as soon as I stopped feeding and the family history he got an immediate referal and then prescribed neocate which he stayed on till at least 2 (longer I think). He couldn't tolerate soya either but DD did have soya.

Hope my with my ds it is just diet n fibre requirement and not dairy intolerance as he also loves his yogurts, milk (although not as much as he used to have), cheese etc

Gonna buy some ingredients and start making some flap jack this week (not baked for years - dh does all our cooking and MIL used to do baking)

Thanks everyone for your advice, I really appreciate it and knowing I'm not alone with this is a great help

mysterymachine - here is my recipe for home-made oaty cookies - works a treat for me!!

Yorkshire WI recipe for quaker oat biscuits, with some adaptation!
8oz quaker oats
8oz brown sugar (to reduce sugar, use 2 ripe bananas and make up the weight with sugar)
1 tsp baking powder
1/4 tsp salt
4oz marg (I use 2oz butter and 2oz olive oil)
1 egg.

Mix all dry ingredients, add melted fat, followed by beaten egg. Blend thoroughly. Drop walnut size blobs onto a greased (and papered) baking tray, allowing space for "run". Moderate oven for ~15-20 mins until golden brown.

The banana makes the biscuits a bit more cookie-like, they don't stay crispy very long but they are yummy! I have also included walnuts before, and chocolate drops, both to good effect. You might need to alter the recipe a little if you are putting more squishy ingredients (dates etc.)in - perhaps use them as part of the sugar/banana weight allowance.

You could also use dried apricots, figs, or a combination instead of/as well as the banana.

thumbwitch thanks very much for the recipe, I was going to start trawling books for a good recipe and get ingredients to do some this weekend - you've just saved me a big task. I'm looking forward to making them now

Thanks everyone for tips.

I just had Tink suddenly start to cry and say "hurts", she wouldn't go to anyone but her dad so he took her upstairs, removed her nappy and it was full of solid pooh that doesn't even look like an adult could have passed it! He said she still looked open when he first looked but it had gone in the time he got some sudo, she's really sore from it. It almost seems to traumatise her when she has a big one like that

I'm thinking we need to get a referal now as she is really suffering

Tink, DS2 (6) had a bout of constipation recently.

We were given a laxative (lactulose)by the Dr to soften things up, but it didn't help straight away.

MNers recommended that we try glycerol suppositories to soften the poo from 'below' IYSWIM. Worked a treat, he was able to poo out the blockage without pain (which was his WORST FEAR) then a week on the laxative to soften and keep all things moving smoothly.

I cannot recommend the suppossitory highly enough. 98p for 12 IIRC, we used just one !!

TMI alert - the poo ran down his leg before we got to the loo for pooing, so stay at home if you ever chose to try 'em.

We've been given Movicol for it, the problem is she's not at home at the moment and is looked after by different people during the day so we worry about giving her too much when someone else has to look after her and it's not so easy to know what's been going into her.

She's been like this pretty much since she was weaned which is 20 months ago. I keep getting told by HV that it's normal but I don't want to just accept that anymore

Well we had a breakthrough over the weekend - went 2 days together without any problem - stopped again now though but hoping its starting to get better.

We had suppository when ds was about 4mths - given at hospital and must agree with Boys... - it does run out before you can do anything about it.

Tink - have you tried the biscuits as that Thumbwitch has given recipe for - I made some yesterday and ds seems to like them (only ate 1/2 one though)