Chronic constipation

[MichelleRenee]

At least 1 or 2 times a week DD is constipated. This usually consists of her crying and gasping when trying to poop (it is a very specific cry and when she does it I know she is constipated), small hard poops, and larger hard poops that she cannot pass without assistance from me. In between these "flare-ups" of constipation her poops are very normal.

I have talked to her ped several times and while they give a ton of good advice for avoiding and treating the constipation I am starting to wonder what the underlying issue is here. She is going to be 1 year old in two weeks. She is still BF, although she does have one bottle of formula (2-3 oz) per day. The constipation began when she started solids at 6 months. She has never eaten baby food and won't eat any pureed/mashed food for that matter (applesauce, mashed potatoes). So her diet is mostly BM and table food.

To prevent constipation I give her "p" fruits 2x a day: pears, peaches, prunes. (all diced solids, no purees) I also try to avoid foods that could cause constipation, which (to my knowledge) include bananas, too many starches, cooked carrots and dairy (cheese).

When the constipation occurs I give her warm baths, milk of magnesia (as recommended by ped), prune juice and use vaseline to make things a little easier for her. Sometimes it is a one-day thing. In the past it has lasted up to 7 days without relief.

So what's the deal here? From her ped all I get is these recommendations to prevent and treat it but why does it happen? It all began well before she had her first bottle of formula (at 10 months) and the formula she does get is maybe 2-3 ounces per day total. Could that be enough to be causing this? She has also had issues gaining weight in the past. Could the weight and constipation issues be related? It is hard seeing her in pain all the time.

[boilermaker]

I don't have any experience with this, but have you started keeping a food journal and checking to see if you can find a correlation to a specific food? Or doing an elimination diet and re-adding foods back in to see if that would help? Does she get enough water?

Considering that you have been dealing with this for 5m, I'd also consider getting a second opinion with a gasto dr if you can.

It must be very hard for both of you.

[jennylou]

Yeah, that could be enough to cause it. I know of a few people who started supplementing and then the babies had horribly hard poops.

That said, I'd probably go to just BM for a few days (like maybe start on a weekend when you'll be home?) and just nurse. Then, add the formula back in when you have to. See what happens. If the formula doesn't cause issues after 5 days or so, I'd then start adding table foods back in - one at a time, leaving 3-5 days in between each new intro.

[TOMama]

I feel your stress... Interesting about the issues gaining weight... my DS was/is the same-- he's a slight little guy and just got on the chart for weight when he turned 3. I attribute his chronic constipation to low muscle tone. He's now 3.5 and is much more active and finally his BMs are not a huge problem. We also give him benefiber every day (on advice of Ped) and it seems to help too.

Anyhow, his chronic constipation also started when we introduced solids-- Our Ped advised us to start with Miralax at around 12 mo. and we started benefiber when he turned 2.

FWIW, we saw a ped. gastro doctor when he was 18 months and he determined that DS1was "holding" it in, probably to avoid the pain that he associated with pooping. We did 2 months of Miralax (adult dose) to give his muscles time to heal and also hoping that he'd forget the pain. It didn't "cure" his constipation, so I don't think it was so much him holding it in as much as low muscle tone in his intestines. He does have slightly low muscle tone throughout his body, so it makes sense.

[magrat]

I have a friend with a child who pretty much took miralax every day for over a year. She's almost two and a half now and I'm not sure if she is still taking it or not, but she was not that long ago. When she would miss even one dose she'd get constipated. She wasn't a big eater but her parents followed all the diet recommendations and it just wasn't enough. I think some children just have weaker or immature digestive systems and there's not a lot you can do if the regular advice isn't working.

[MichelleRenee]

Thank you all. I am hoping that when we see her ped for her 1 year WBV in a couple of weeks he will refer us to someone. I think she is even starting to get hemorrhoids from all the straining.

She does drink a sippy cup of water with her lunch every day and I think she is getting enough BM to avoid dehydration. Plus when she cries she always has a ton of tears (very dramatic!) which I have read is a good sign that she is not dehydrated. But maybe adding some more water would help her out. I'll have to try that. MIL says to boil water with a bay leaf in it and then cool it off and give it to her. I haven't tried that yet.

I am home with her every day so I am going to stop giving her that bottle of formula each day to see if it helps. We were actually getting ready to wean from BFing around her first birthday but I am worried that weaning from BM entirely will make her constipation worse.

[dal]

Both my girls (ages 5 and 6) suffer from chronic constipation as do I. They still get miralax once a day. They've been on it for years. I have tried to wean them off of it but they go back to being constipated every time.

As for the weight gain/constipation thing - one of my daughters is low on the weight charts and one is right in the middle so I don't really think that has anything to do with it, at least not for my girls.

For us, it is hereditary.

I think some kids are just prone to constipation. It stinks and I know how hard it is to see them in pain. The only thing that has worked on a consistent basis for us is Miralax. Maybe you could try that?

Good luck!

[BTB]

Thank you all. I am hoping that when we see her ped for her 1 year WBV in a couple of weeks he will refer us to someone.

Sincerely wondering - what is it you are hoping for?

The vast majority of constipation in children is functional constipation. Treating it and then preventing it, which you've said you've gotten lots of advice on from the pediatrician already, is appropriate. Functional constipation is not a disease, it just is part of the spectrum. There are times when there is a "disease" cause of constipation, and primary care pediatricians are trained in figuring out which constipated kids need further workup and which don't. Studies suggest that in the absence of medical indication for specialist consultation, seeking an escalation of care is bad for the individual - more tests, more procedures, involving more pain and more risk - without providing better outcomes for the patient, as well as bad for society, in needlessly increasing costs.

If you're unhappy with some aspect of your child's care, or have questions - such as, why is this going on, how long will it last, etc. - why not just ask?

[MichelleRenee]

Sincerely wondering - what is it you are hoping for?

The vast majority of constipation in children is functional constipation. Treating it and then preventing it, which you've said you've gotten lots of advice on from the pediatrician already, is appropriate. Functional constipation is not a disease, it just is part of the spectrum. There are times when there is a "disease" cause of constipation, and primary care pediatricians are trained in figuring out which constipated kids need further workup and which don't. Studies suggest that in the absence of medical indication for specialist consultation, seeking an escalation of care is bad for the individual - more tests, more procedures, involving more pain and more risk - without providing better outcomes for the patient, as well as bad for society, in needlessly increasing costs.

If you're unhappy with some aspect of your child's care, or have questions - such as, why is this going on, how long will it last, etc. - why not just ask?

I'm just hoping for more than "here is how you prevent/treat it." That is all they have offered me and if they aren't even going to offer me their medical opinion on what the cause of this is then I am hoping they will refer me to someone who will.

[BTB]

I think that's perfectly reasonable - and I think simply asking "what's the diagnosis here, and why do you think it's happening?" will get you what you seek faster, easier, and cheaper, with less risk and discomfort.

[merjmo]

Is your daughter only getting that one sippy of water during the day besides the BM? That can have a huge impact on constipation. If she's not getting purees, but just table food, and you've not increased her water she could be not getting enough fluid to help with the BM - she may not be dehydrated but still not getting enough liquid. Have you used any pear or apple juice (diluted)? Those can also be very helpful.

[loving624]

Have you used any pear or apple juice (diluted)? Those can also be very helpful.

Just what I was going to say. The "p" fruits can be slightly helpful for my DS (who is 2), but really what gets him through it each day is diluted apple juice. The days he does not have it, his poops are very hard and pellets, but when he does get it he has very normal stools. His sippy of water is mainly water, with 1-2 oz of juice.

I've always hoped it is something he will outgrow, but I'm okay with it if it isn't, because I know how to "fix" it.

Oatmeal also does wonders for him as well. We use the lower sugar Quaker Instant Oatmeal, and we also have the high fiber variety for the days he really really needs it.

[gardenmommy]

My DD has suffered from this and it appears to be hereditary from my mom's side of our family. I asked my ped about what causes it and she explained it as that different digestive systems pull out nutrients in different ways, and absorb things differently. Everyone is different.

My DD takes a sippy of diluted juice once a say as well. We started it when she was probably 9 months and it keeps her very regular. Her ped recommended white grape as apple juice can also cause issue with digestive systems.

I hope that your ped can give you a better understanding of why this is happening to your DD and how to treat her.

[Marisa]

Something like flaxseed oil could also help with constipation - I make smoothies for myself and the boys with frozen banana and almond milk (or rice milk), and add about a tablespoon or so of flaxseed oil. It even helped me get through pregnancy (and extra iron supplementation) with no trouble!

[MichelleRenee]

I do give her some diluted apple juice once in awhile. It always gave DS diarrhea so I hoped it would have a little bit of that effect on DD. Maybe I should do a sippy of diluted juice in addition to a sippy of water each day? I usually give the diluted juice on the days she is actually constipated but maybe giving her a little each day would help prevent the constipation.

Marisa: you don't think she'd be too young for flax seed oil at 12mo? (I actually do the same thing you do for myself with the frozen bananas and flax seed oil. How funny!) Do you think I could just give her straight flax seed oil with a syringe or something? Or maybe brush it on a piece of bread? I'll have to ask her ped about it. I wouldn't even know how much to give. I thought I read somewhere that infants can't digest flax. Maybe that is just the actual seeds?

[merjmo]

I do give her some diluted apple juice once in awhile. It always gave DS diarrhea so I hoped it would have a little bit of that effect on DD. Maybe I should do a sippy of diluted juice in addition to a sippy of water each day? I usually give the diluted juice on the days she is actually constipated but maybe giving her a little each day would help prevent the constipation.

Marisa: you don't think she'd be too young for flax seed oil at 12mo? (I actually do the same thing you do for myself with the frozen bananas and flax seed oil. How funny!) Do you think I could just give her straight flax seed oil with a syringe or something? Or maybe brush it on a piece of bread? I'll have to ask her ped about it. I wouldn't even know how much to give. I thought I read somewhere that infants can't digest flax. Maybe that is just the actual seeds?

You should be offering her a sippy of water throughout the day, frankly. It allows her to learn that we drink water all day whenever we think we're thirsty, instead of waiting just for meals and instead of relying on calories. Including some juice (1-2 oz/day) could solve your constipation issues in a safe and natural way.

No one can digest full flaxseeds - they must be ground, and your daughter can certainly eat them or the oil at this age. There's no contraindication.

[Marisa]

Yes, I have heard of using flaxseed with infants as young as 6m, though I think Teddy was more like 8-9 mos before he was having some of our smoothie. I'd say no more than a teaspoon per day -- when I make ours, I make a 'double batch' with 1-2 tablespoons, and I probably have half, Joey has about 1/3, and Teddy has the rest.