What can happen to a child that is left untreated for constipation?

[Indy mom]

I am a childcare provider for a 2.5 yo. girl.  She has had constipation for 6 months or more.  There are some periods when it gets better after a really tough week.  I can't remember a solid two weeks that she didn't have this problem going back to November 2002.  

Her parents are annoyed by this.  They are not taking any of my suggestions (soy milk, no dairy, watered-down milk, high fiber).  Their comments are totally to the contrary.

Her symptoms are: bloated stomach, larger than golf-ball sized feces (hard as clay), red-faced straining, crying, goo-like paste leaking all day, rancid-smelling (like mothballs), days of not going at all.

Parents only show concern when I tell them she's been crying, all other times, they roll their eyes, etc.  They make comments like, "I had to give her cheese, because her brother got some", and "She already had Vit.D milk today so, you don't have to give her some."  Once I said, "I'm cutting out dairy completely so you know how much to give her if any at all" and mom said, "Oh, you don't need to do that."

Her parents say that the dr. is aware, but if she doesn't believe it's bad, then the dr. can't possibly know.

Is this girl in danger?

As a provider, what can I do about it?

I'm so frustrated.  I really HATE to call the authorities, because it might just make it worse...but I will call if this child is going to die.

Thank you...I'm so worried.

B

[sammy1979]

A related discussion, What can happen to a child that is left untreated for constipation? was started.

[Indy mom]

Just incase you were wondering...

I gave the parents a letter.  I told them that this has been going on too long, that they don't believe it's serious and I do.  That I've talked to dr's and they agree it could be very serious, and if they continued as they are, then I could no longer be a part of it.  (I said it much nicer and diplomatic than that).

They wrote me back and told me they are putting her on meds asap, they have set a dr's appt, and are going to take it more seriously.

But, they terminated me.  They appreciated my concern, but don't feel like they sould stay here.  They are here until the end of the month, so I'll be able to tell if they are fixing it or not by then.

(I got to my breaking point when the other day mom said she purposly gave her cheese to stop her up because she was tired of changing her all day long.)

After all this transpired, mom dropped off the girl and she had been crying.  I'm sure this was a rude awakening and they seem sincere.  I hope they are.

Thanks!

[BuddleiaGirl]

My daughter, at 4 months old, became badly constipated. You can't tell me that an infant that is totally breastfed is not getting enough fluids!! There were times where the doctor had to pick the fecal matter out of her. They believe that, like her father, she has a long colon. Stuff just dries out because it takes longer to process. We were told to give her mineral oil every day. (always a small amount, 1-3ccs) This continued until she was 5 years old. And it helped. We knew when we were giving her too much because she would "leak" a little during the day. Mineral oil (we were told) has no ill effects, and all it does is slick down the bowels, allowing matter to slide through a little better. Now that she is a teen, she can control it with diet.

At the time when she was first having the problem, a neighbor child was also having a similar problem. He would only go once a week, and was constipated and passed what appeared to be a weeks worth all at once. He later had an operation to correct a loop in his bowels.

Constipation can be caused by such a variety of things. The best you can do it to gice the child lots of fliuds, and things that would give you or I the opposite problem. Lots of grapes,  fresh spinach, broccoli...you get the idea. Good luck with this child.

[jarchokc]

Water - that's what cures constipation.
Think about it - what is missing from the hard packed stools?
Water.  

Laxitives are a one time solution, only.
Bulk types make things worse if you don't drink
water with them.

Have the child drink at least 4 good sized glasses a day.
The problem is worsened by soda drinks.  Make him
drink an extra glass of water before getting a soda.

[Indy mom]

I've done some hard thinking...I have decided to write this little girls' doctor a letter.  In the letter, I'm just going to focus on the facts and tell the dr. that this problem is serious and it's not getting solved.  Since we all take care of the girl, we should all be on the same page with her treatment.  I will focus on how this needs to be a team effort and I will imply that it doesn't have to be me, but I'll be willing to continue on as long as I see progress in her condition.  

I'll send it certified mail, give her a chance to read it and respond, and then give a copy to the mother.  She's going to be pissed.  I think this letter will cover my liability to prove that I am trying to do something.  I'll give it some time before I call the authorities. (If they are still with me, if not, then I'll tell the dr. that she's on her own to deal with this problem).

Thank you for all your advice.  I really want to avoid child services because I really don't think it will be effective.  Maybe I'm fooling myself because I'm scared.

Thanks again!

[colep_2003]

I think if the problem is still continuing, i would bring the authority's in...

[Kevin Kennedy, Ph.D.]

Failure to provide sensible medical care is de facto neglectful, even if parents are well intentioned. If no other attempt to persuade the parents to seek medical evaluation is successful, definitely lodge a complaint of neglect with the proper agency. However, before doing that, try again to convey your concern to the parents. It's likely that the child has impacted bowels; the symptoms you describe would certainly lead in that direction. Medical evaluation is required: (a) to determine precisely what is occurring and (b) to design a regimen to address the problem. It might be helpful to hand the parents something in writing. An example from the American Academy of Pediatrics can be found on the following web site:

http://www.aap.org/policy/constipation.htm

[Indy mom]

The parents say that they are on "medicine", but the problem continues.  I have never seen the medicine.  They first told me about it two months ago when she wanted to start potty training.  (That was a clue...she only wanted to fix this when if interfered with potty training.)  

These parents lied to me in the past and I know for a fact (mom has said so) that the dad doesn't think it's that bad.

These parents are mostly about convenience and their children rule the roost.

First sign of blood or hemmorroid, I'm calling their dr.  I just don't want to be terminated...what is that going to solve?

[justme]

I have no idea about the medical, but I can relate because of my neighbour's son.  He also had some of the same things happening - went on for 6-8 months at least.  Straining and trembling, crying, constipated, as u described (he was 2 when it started).  I was concerned that the doctor prescribed a pediatric stool softener and said 'it'll resolve'.  But, she was right.  Part of the problem was that he was 'withholding' to avoid the pain he went through when he had a movement.  Anyway, are the parents willing to at least try a stool softener for a short time to ease this little girls discomfort?  I'm assuming the doctor has ruled out impacted stool and other medical problems though.