Constipation in 4 year old - beyond normal?

[mom650]

We have a four and a half year old who refuses to have a bowel movement on the toilet. She never has accidents and always goes to gets a diaper when she is ready (except at daycare where she just holds it). After each movement, we remove the diaper and sit her on the toilet for five minutes and then she receives a treat. Hope this eases her in the right direction. The refusing the diaper would not work as we are also struggling with issues of serious constipation and if we don't offer the diaper she just holds it (beware to parents trying this technique – you could cause a cycle of constipation – thank goodness we didn’t go this route, it would have just made things worse!)


Our bigger concern is that she goes a week at a time without passing a movement. She will strain for 2 hours and still not pass anything. Sometimes it takes two days before she is able to pass any significant stool. We have taken her to the doctor. She in on Colace regularly. She is well hydrated and eats lots more fibre than most children. The doctor recommended a naturopath who put her on a no wheat no dairy diet for 2 weeks with no real improvement. She also just started wetting the bed almost every night this week (something she has rarely done before). We now feel like we are at an impasse. The doctor has no further suggestions (except testing for celiac but this seems unlikely). Is this normal? Should we be asking for further tests? It has gone beyond psychological issues. My daughter now clearly wants to pass a movement but just can't.

[jmom3]

All good advice above! My daughter 11 recently was severly constipated, they said all the way full. One suppository later she was going. My son 4 has his days where I worry and I bought some supositories for him too incase he goes over 3 or 4 days without going. Diet and exersice helps. My doc gave miralax and sitting after dinner each night to make it routeen. Good luck!!!

[mom650]

Thanks. She only lost energy when she was off dairy. She bounced right back as soon as she started back on cheese, yogurt milk. Good to know about the gluten. We did try to avoid gluten but didn't know to be that strict.

[Nic306]

Hi, my son has Celiac and constipation was his only symptom.  That being said, children can become constipated from withholding.  Our gastrointerologist  made the following recommendations.  He called them potty training.  We gave him 1 capful (17 grams) of Miralax everyday at night.   This is an over the counter now (used to be an RX) stool softener that is safe to use daily for as long as you need to.  Also, he said to have him sit for 10 minutes on the toilet after each meal whether he says he has to go or not.  Don't wait for her to say she has to go as you need to try to establish a bowel movement schedule for her.  Once my son started to go, I still had him sit every morning after breakfast for 10 minutes and believe it or not it worked.  As for Celiac, 2 weeks off of gluten will not be enough.  It takes my son a good two weeks to show signs of constipation again if he accidentally eats gluten.  And gluten isn't just wheat.  It is in barly, rye, and oats can be contaminated by it.  So hopefully you were told that and went gluten free, not just wheat free.

[FutureDoc4503]

Hi  you say shes less energetic than she normaly is.   Did they do any blood, urine, or stool samples or did the DOC just say accute constipation?  You should see into have it tested if you havnt already. Something is causing this.  After yesterday talking about Botulism it seems like the only road I would ask you to look at, at this point.  Sometimes cases dont surface until 6 months down the road.  Like I said earlier, its very uncommon but 12 year old have been known to stilll get it.  She hasnt been eating honey or anything to that nature? (more for infants but just a shot). I would have OL' DOC look for the spore nuerotoxin that Botulism would produce.  Also after we talked yesterday, the bed wetting thing.  Botulism can cause the nervous system to go haywire it might be that.  Im still gonna say its just presure though.  Thanks- P

[mom650]

Thanks for the advice. We have used Senokot on and off but the doctor says it is time to stop so that she does not become dependent (this problem has been going on for 6 months). We tried a no dairy diet but she as much less energetic than normal (even with soy, rice milk, etc.) and it didn’t seem to make a difference to her bowels. Doctors here seem to be strongly recommending against mineral oil.

For treats, we are doing a fish bowl of (wrapped) toys, pencils, etc, rather than food. Mind you, tonight she was easily convinced to sit on the toilet for 5-10 minutes (albeit insistent that nothing would come out - but at least it's progress!) It took heating the toilet seat with the hair dryer and reading a book, followed by a gummy bear (at least she still has appetite!) but it worked.

[FutureDoc4503]

Also For the stool softner bit  FYI

senokot is a stimulant laxative not a softner,good for the initial push.  After that regulate how much you use it (dont use it everyday). Maybe once a week. Plus to the best of my know-how senokot is a natural laxative as well smells very vegie like (smiles). Also keep the water flowing.  I have found that senokot works best with plenty water.  (DO NOT OVER HYDRATE THATS VERY SERIOUS)  You can find senokot in tablet or liquid form.

Also Forgot to talk about Accute Constipation, which this is.  talk to the DOC about  mineral oil and, enema. A glycerine suppository should be simple to give getting her to hold it is the hard part. Mineral oil shouldnt be given if shes on Colace (AKA Docusate) or asprin.  To me I dont think Docusate would be the right RX  I think its time for a laxative not a softner.  Once you can clean it out you can start fresh.  Now if the Botulism is in play Docusate might not  work well or even at all.  sorry about the way this post is put together I write as I think and remember things just be open to what other MDs have to say there is more than one way to skin a cat..   THANKS P

[FutureDoc4503]

1.  Shes more than likley holding it because of the pain constipation causes.
2.  Water, minimum 4 oz of water or diluted fruit juice (apple or prune see what works best).
3.  Senokot works well for over the counter.  RX wise ask you DOC about Miralax.
4.  Food treat , I dont know about you if I was that constipated even at 4 yrs old Im not to worried about a treat at the time.  Try using a really cool toy they havnt seen that my spark her intrest to relax (relax being the key word)  Shes four shes more worried about pain.
5.  I wouldnt be to concerned with celiac right yet.  Without looking at her and seeing body comp and energy levels I wont rule out Botulism.   Your child attends a daycare as you said earlier.  if a playground is on or in the daycare they might have sand or some sort of dirt or maybe other sediment.  Some kids for some reason like to eat dirt.  I would have a chat with the DOC about it.  Also this can be found on fruits and other vegies so be washing those mom.  Its uncommon but might put you in the right direction if you havnt tested for it yet.

6. the bed wetting might be from just presure (for lack of a better word)  think about when you go to the bathroom cant have number 2 with out number 1.

MY ROLL UP
Try the stool softners shes little so alot is alittle.
NO MILK. if she has to have it try SOY
High fiber fruits and vegies read the backs of the can of soups some are very good in fiber.  Like before atleast 4oz of fruit juice apple or prune
Ask your DOC about Botulism and have it looked into
Goal one to two soft stools a day.

Iam in no way a MD (yet)  You know your child best and without seeing her I cant give you a good take except for the above

Hope it Helps   P