Dear J.,
If I had this child, I would first start including some sugar free metamucil stuff in everything I fed the child--enough to get at least a tablespoon a day into him/her. Ten times that much would be safe but should not be necessary. As soon as 3, soft movements a day is present, the child is getting enough. next, I would learn how to get enough fiber into the diet without the metamucil. THEN, after 6 months or so of an adequate diet, I would start gradually reducing the metamucil. Offer lots of fluids but avoid fruit juices since they are empty calories and have had the fiber removed.
Also, remember that a child that age shouldn't have a transit time of more than 18 hours. That means that you can change the dose of metamucil once a day till you see results.
If you have more questions, write again. let us know what happens.
Walt
Hello Dr. Stoll,
Thank-you for responding to my note regarding P.E.G. solution used for treating this problem. Golytely is polyethylene glycol, sodium sulfate, sodium bicarbonate, sodium chloride, and potassium chloride. It is usually reconstituted with water and makes a 4 litre jug used for patients undergoing bowel examinations. In children, the dose is 2 tbsp. daily or less for 6 weeks and then taper off. The goal is to help the bowel return to a normal diameter.
Your comments on "who's in charge of this child's food" is valid however, believe me, this is not an easy problem to conquer. My son had an extensive gag reflex from the time he started eating baby cereal at 6 months. He was breast fed until almost 8 mths. then formula until 12 months then homo milk until 2 years. Unfortunately, he would gag and spit up any food with texture. This resulted in him eating only baby foods until 1 1/2 years. Any solid that didn't melt in his mouth would result in gagging. There is no apparent physical problem causing this.
So, he has never developed the desire to eat. Food was not a source of pleasure unless it was pureed. This has changed somewhat, however his appetite has been poor since the age of 2 years. He dropped from the 75% on the growth chart to below 50% for weight although height continues to be at the 75th percentile. I asked for a consult to a nutritionist at the Children's hospital during this time and we saw her twice. My son was put on a liquid dietary supplement, Boost, which only served to dull his appetite more.
So, you are right about the food intake but what do I do? He does see other people eat nutritious foods and he is now at school, eating lunch with the other children before he comes home. I had hoped he would see others eating and would follow suit. He eats some - peanut butter and jam on whole wheat, raisans, bran muffins, oatmeal cookies, cheese sticks, granola bars and either milk or apple juice. You are right, he prefers apple juice. So what should he have - milk and water only. What about orange juice?
You can see, this problem has become complicated and I would be delighted if it could be resolved. He is very strong-willed and controlling.
Thanks again for your response. Any other comments are appreciated.
Megan
Dear Grandfather of 1 yr old. I have a 3 year old who was in the same boat as your grandchild. Don't mix laxitives. Example: Senecot, mineral oil. Don't give up. Be patient. He is probably afriad of pooping, because of the enema. The enema will totally clear out his system making it very difficult to poop without having another enema. He needs something slimy, like prune juice, and prunes, to help him start pooping again. Example: about a cup of prune juice before eating each meal, with regular meal and drink. Between meals a large drink of water or juice, Example 10:00 a.m. and 2:00 P.M. Also the angle of how the child sits when pooping might be a problem, even at such a young age try sitting on a little potty. This is personal. (sorry) examine the way you sit on the toliet vs him sitting on the floor. If he is at the wrong angle the poop will just won't come out, but stay in. We also do one more thing, and that is to practice pooping. We tell our son that it is time to practice pooping, and we praise him for moving his spinckter muscles. He is not expected to poop just to recognise moving the muscle and making it stronger, and he gets a reward, like ju-ju fish. (This helped him not to be so afraid). With my son, laxitives, molassis, enemas, supositories, just weren't working, and I had to increase dossages, and still wouldn't work, sometimes they made him sick. But we have found that just prune juice, practing pooping, and pooping in the little potty, has been most benefical. If you are religious or not, I also suggest praying, I already got my answer to my prayers, and I hope you do to.
Dr. Stoll
All questions regarding constipation on this BB seem to be
concerning childeren. I have had this problem for 15+ years.
Does the MO and metamucial apply as well? If so, how much?
There are other problems to address, but till this is corrected, I feel I'm just "mixing up the mud in the bottom
of the bucket". Please help.
In Reply to: Re: constipation in 3 - 4 year olds posted by megan on April 01, 1998 at 21:34:55:
Dear Megan,
Next week, the problem will be more difficult to resolve. Every day that has gone past since he gagged with anything with texture, you were getting deeper into the hole.
He MAY be doomed to a life of chronic illness because of this. I have seen a few that did not come to me till they were 10. Twenty years later, they were still in deep doo doo exactly because their habit of manipulating others was SO unhealthy that they couldn't get along with anyone.
If you had had competent medical advice in the beginning, it would have been relatively easy to resolve: offer him only water and textured foods. If he did not eat, so what? This is an aspect of "tough love" and is well known among the profession. The problem is that it takes patience on the part of the physician & it takes him/her time to work with the parents anxieties about the "poor child will starve" concepts. Few physicians care enough to bother.
At that time, the problem would have been over in a week. I have managed MANY such cases--it is not rare.
You have SOME idea of what is going on here. This is about CONTROL and nothing else. Unfortunately, he has been so successful with this for so long that you are going to have a time. The solution is still the same as it would have been at 6 months of age only NOW it will take about a month. Also, NOW you will have the added problem with well-meaning "others" interfering with what you are doing.
By the way, something that would help you understand the depth to which he has carried this (with your help & that of your doc): In medicine, we have tests to determine whether old people are really having trouble swallowing or if it is psychological. Bread, peanut butter and mashed potatoes are among the most difficult things for anyone to swallow if they are really having a physical reason for the problem. Your note, even without prompting, lists 2 out of the 3 as foods that he will eat. By the way, his diet sucks! I know you know it. How can you expect him to know it at his age?
What would you do if he passed out every time you tried to take him outside????? If he does not learn--very soon--
to stop using unhealthy ways to control those around him, both of you are in increasingly serious trouble. You MAY even have to take him out of school for a 6 month period till this is really solved for a while. He will steal food from his classmates so as to defeat what you are trying to do. You can't blame him for that you just have to structure his life so he can't do it.
At this age, he should not be allowed to be in control of anything but his bowels. How about when he is a teenager? I am sure that you can conjure up scenarios that would make anyone's hair curl & get straight.
Unless there are some big changes around your house pretty soon, the eating problem will be one of the least of your concerns.
This is a common enough problem that I would be very surprised to hear that there were not many authorative books in the library about how to go about reversing this far advanced problem.
As you go though this, I stand ready to support you on this BB so others who are moving his way can learn how to avoid it.
Remember, the child knows: You have put the control of his life in the hands of an incompetent---HIM. He knows that he doesn't have a clue and here he is running not only his life but yours as well. This causes tremendous insecurity that makes him need to control even more. This is a very frightened & unhappy little boy.
He would be a lot happier & more secure if he knew he could depend upon you to make these decisions for him. When he is 15, he MAY have enough knowledge to feel secure making the decisions that will be appropriate then but ONLY if you get him on the right track NOW.
Walt
In Reply to: Re: constipation in 3 - 4 year olds posted by Walt Stoll on April 03, 1998 at 14:43:00:
Hello Dr. Stoll,
Well, your response was certainly not what I expected however, you are probably correct in your assessment. My son is not yet 4 years old and he does try to control EVERYTHING. This started in an overt behavioral way at 3. Aside from the food and bowels, he has had difficulty in his school, junior kindergarten, because he refuses to listen to the teachers. He acts up, ignores them etc. At other times, he is fine. The teacher said "she has never seen this behavior to this extent before". He does not seem to be bothered by the consequences of his behavior ie: time outs etc. He also does not seem to want to socialize with the other kids. He does like to play with two neighbourhood children although sharing is still a hard task for him.
As I read this, this seems to be behavior appropriate for his age however, much exaggerated.
I am not a marshmallow mother. In fact, my fear was that I was too controlling. I have numerous books on this subject; The Difficult Child, Raising a Spirited Child, Positive Disipline for the Pre-Schooler etc. They all stress routine, consistency, boundaries, positive re-direction, consequences, giving choices etc. I think I am doing this however, I appear to be failing. I hate to think of such a young child with soooo many difficulties. And why you think he is frightened and unhappy, well that is troubling to me.
So, I don't expect to solve this on the internet however, any practical advice is always welcome. I obviously need to seek out professional help, WHERE is the big question?
Megan
My daughter has had this problem since she was about 1. She is now 3. She holds her stools for about 5 days at a time. She has had fissures in the past (we were unaware until the tears has already healed). A doctor suggested we use mineral oil but when we tried it she vomited an hour or so afterward. What would the proper dose be for us to try (she is 38 lbs.)?? Also, how would we get her to take the metamucil (I have a feeling she wouldnt want to drink it).
we have also tried lactulose, it didnt do much. We have tried enemas and suppositories which she is now deathly afraid of. She will not drink prune juice and, like most toddlers, isnt crazy about too many fruits and veggies. She doesnt drink much fluids even when pressured to do so.
Please help. Thanks
In Reply to: Constipation posted by S.A on April 03, 1998 at 06:51:16:
Dear S.A.,
Constipation for that long in an adult is always related to leaky gut syndrome & possibly associated with insufficient fiber intake.
Even with these causes present, you can still resolve the symptom of constipation using the same principles discussed for children. Since none of these substances are "habit forming" for the colon, once you have dealt with the LGS, you will be able to gradually discontinue the MO & metamucil till it is no longer needed.
Remember, the correct dose of the MO is the highest dose that can be taken & not have oil floating around on the top of the toilet water 2 days after whatever dose was taken (depending on your transit time). The correct dose of the metamucil (or generic equivalent) is whatever dose it may take to produce 2-3 movements a day. Since this is also dependent upon your transit time, it may take several days for you to find out what any dosage might produce.
Let us know how you do. This ALWAYS WORKS.
Walt
In Reply to: Re: constipation in 3 - 4 year olds, other issues posted by megan on April 03, 1998 at 22:02:20:
Dear Megan,
If this guidance were readily available, you would already have found it. Unfortunately, the commitment needed for the professional to be effective goes far beyond the "standard of therapy" and so insurance has never covered it. This is another example of insurance companies dictating medical treatment and people like you fall through the cracks.
There ARE professionals out there for which money is incidental & the welfare of the patient is primary. Unfortunately, they are few and far between. If I knew what part of the country you lived in, I might know someone close to you. Don't hold your breath.
In the meantime, one of the adages for the situation you find yourself in is: Start somewhere. By resolving one situation at a time, the problem will start taking care of itself. Were he mine, I would resolve the dietary thing first. Unfortunately, you will probably have to have him out of school (in essence using your home as a jail for awhile) for 6 months. However, by the time he goes back, the teacher will be amazed and thank you for the change.
I am saying he is frightened and unhappy because he thinks you have placed control of his life in the hands of an incompetent---HIM. How would YOU feel if you were dropped, totally unprepared, in the middle of Iran & expected to survive without someone taking you under her wing to help you understand the cultural bias against women. You would be "frightened & unhappy" too. He KNOWS he doesn't know. Yet he is allowed to make decisions that are profoundly screwing up his life. You would not be reading this if his decisions were working for him.
I know that you may not like what I am saying. However, I am more concerned about you &him than I am about whether you like me or not.
Walt
In Reply to: Stool Withholding and Constipation in Children posted by Karen Begeman on April 05, 1998 at 00:04:15:
Hello Karen,
I too have this problem with my son who is almost 4 years old. I have asked this same question on this bulletin board, see constipation in 3 - 4 year olds.
This is apparently a common problem however, very difficult. I have no answers yet but am continuing to seek help for it. Diet is certainly a big issue but hey, you can't make them eat if they won't.
My son will drink prune juice but not daily so he got very constipated. He has minimal fibre in his diet, no fruits or veggies either except apples without skin and only a quarter on one.
Good luck. I know I could use it too.
Megan
In Reply to: Re: Constipation posted by Walt Stoll on April 05, 1998 at 11:24:05:
Dr. Stoll, Thanks for the quick response. I have searched
the BB for instructions on how to take this, but to no avail.
Do you mix the MO and fiber together? Is there anything
special about "metamucial" or will any psyllium work?
Empty stomach? In the morning or evening?
Thanks so much for your time
In Reply to: Re: Constipation posted by SA on April 06, 1998 at 14:30:37:
Dear S.A.,
Go to the homepage at Stool Witholding & Constipation in Children
If that doesn't answer all your questions write again.
There is nothing special about "metamucil". There now is an equivalent product by "EQUATE" that is sold at Walmart. It comes sugar free sweetened by aspartame and flavored. It also has the extra fine grinding that makes it much more palatable than most plain psyllium products one can get at the healthfood store. If you can tolerate the no flavor graininess of the straight psyllium products, you can save yourself some money. I have found that the doses needed to resolve a resistant problem are so large that the finely ground products are MUCH preferable.
MO should not be taken with the metamucil. It should only be taken upon retiring. The metamucil can be taken alone or with meals. Twice a day is a LITTLE better than once but not a lot. It is the total/24 hours that counts.
Walt
In Reply to: Stool Withholding and Constipation in Children posted by Karen Begeman on April 05, 1998 at 00:04:15:
Dear Karen,
There have been lengthy communications about exactly this problem within the past week right here on the BB. Please save me some typing by finding them & then get back to me.
Just a few points from your note:
Remember, children this age will drink kerosene, gasoline, lye, etc. They will eat the most disgusting things. As a matter of fact, this proclivity is one of the most common causes of death in this age group. What she is willing to eat has nothing to do with the taste or texture. It is one of the few ways that the child can exert control over your relationship. To the extent that you give in to her eating only what SHE wants, you are doing both of you a great disservice. WHAT TODDLER KNOWS WHAT IS GOOD FOR HER TO EAT?
You think THIS problem is a big one. Wait till she pulls what she has learned with this when she is a teenager!!!
You are fortunate that she is only 3. You still have total control over her diet if you will just do it. She is trapped inside her little growing body. If you offer her nothing but wholesome foods and water, eventually her body will make her eat. You MUST win this war. Have no doubts, this IS a war between you and she. At this age, it will only take a week or so if you NEVER give in.
Remember the story about the chickens that have been trained to peck a lever & get a grain of corn. Once they have been trained, you can stop giving them the grain of corn and they will still peck about 10 times without getting a grain of corn. By the 11th peck, the chicken becomes totally untrained & the training has to be done all over again. If, however, the chicken is given a grain of corn on the 9th peck, it will peck the lever forever till it dies.
Chickens cannot tell the difference between 10 pecks and infinity. Children are somethinng like that. If you give in right at the end of the 2 weeks, (if she is stubborn enough to last that long) she may try to hold out for a month--or till the lack of food actually could damage her. No child has ever been damaged by taking in nothing but water for 2 weeks. If you are firm, it will not last nearly that long. Avoid fruit juices like the plague. Thay are empty calories and will prevent the need for wholesome calories in the diet.
If you need to know what a wholesome diet IS ( a condition that is more common than you might think among parents) I would not even try this till you knew. Get a copy of Beth Loiselle, RD's classic "The Healing Power of Whole Foods". Thers is still no reference that comes close to this for accomplishing what you need to do. Call (800) 870-5378.
There ARE palatable forms of MO. The only problem is that they are made palatable by emulsifying them with equal parts of water. That means that you need to use twice as much. If it is vomited up, it does NO good AND is dangerous since that is when aspiration into the lungs can occur.
You CAN solve this with the metamucil alone just by using an adequate dose. However, the first movement might be as painful as the ones she is already having. Sprinkle some metamucil onn everything she eats & drinks. A little is practically undetectable & does not have the annoying tendency to gel before ingestion. It is the total dose per 24 hours that does the trick.
Once she is on a healthy diet, NEVER offer her anything else for a year after the problem is solved. If you are smart, you will only offer her anything else RARELY after that. This is a kid that would easily relapse without vigilence.
Let us know how she does. This is a totally unnecesasary condition. However, if you only focus on what comes out of her butt, you will be missing the point since this is a much deeper problem and your relationship is part of it. YOU HAVE TO BE THE BOSS AT THIS AGE.
Walt
In Reply to: Stool Withholding and Constipation in Children posted by Karen Begeman on April 05, 1998 at 00:04:15:
Dear Karen,
I have a daughter who is six that has had the same situation of holding movements of up to 6 days from the time she was one. Consequently, she has had very large and firm bowels which has caused great concern.
I too have gone through the doctor suggested mineral oil, prescribed laxatives, and metamucil without success. How can you get a child to take these when their diet has the same struggle?
Fortunately, recently I have found that she will prefer to eat bran cereal (with suger) every evening rather than face an enema. I have also placed a calendar in the bathroom so she can mark off each bowel movement. When she attains three bowel movements in a week she earns a bowling trip.
I still have to keep on her at times with the enema threat if she waits too long, but at least we have finally achieved some sort of routine.
The bran cereal worked for my daughter and perhaps some mixed in your daughters favorite cereal could help too.
Good Luck,
Cathy
In Reply to: Re: Stool Withholding and Constipation in Children posted by Cathy on April 07, 1998 at 12:42:15:
Dear Cathy,
Was the failure of the mineral oil & metamucil because she wouldn't take it? I have never seen this approach fail if the child would take it AND the parent understood how to increase the dose until the proper result occurred.
Please let me know EXACTLY what happened. If you have been reading the notes from the past 2 weeks, you know that the dietary problem is only a control game the child plays. It is interesting that, back when there were many orphanages in the country, there were NO problems with dietary causes like this in those institutions. Only relatively whole food was offered, the bell was rung at a certain time to start eating & again when it was time to stop.
No junk food was offered between meals. There were no feeding problems. We have created this problem with our desire to let the child decide what s/he wants to eat. The food manufacturers are only too happy to convince us parents that children are the ones who should choose. They are very vulnerable to the pitches on TV as to what is OK for them. All of us adults should be ashamed for letting this happen.
Walt
In Reply to: Re: constipation in 3 - 4 year olds, other issues posted by Walt Stoll on April 05, 1998 at 12:36:37:
Hello Dr. Stoll,
Since my last note telling you about the P.E.G. solution, my son began experiencing episodes of incontinence that produced only water and mucous. The mucous is white sometimes frothy and occurs 4 -5 times per day. After speaking with the nurse at the kids hospital, we stopped the peg solution for one week. The mucous continued as did the watery discharge. What is causing this?
We saw the gastroenterologist and he suggested adding Metamucl and restarting the P.E.G. solution. This is the same concept as the mineral oil and metamucil. I have been trying to add the metamucil to food, the peanut butter and jam sandwiches, milk etc. HE CAN TASTE IT and refuses to drink. I bought the unflavored one, smooth. Do you know which one they don't taste!!! This is a job in itself.
We are making progress on "who is the boss in this house" however, he continues to test. As for the food, no luck but I will keep trying.
Do you really mean no milk, no apple juice JUST WATER???
and heathy food? What about calcium needs? I have not started this yet. I will wait until after
Easter.
Megan
In Reply to: Re: constipation in 3 - 4 year olds, other issues posted by megan on April 09, 1998 at 21:53:21:
Dear Megan,
"Princess and the pea" strikes again. You need to be constantly aware that this has nothing to do with how it tastes but which foods you want him to eat. Kids this age will eat dirt or drink kerosene if they think you DON'T want them to. If you offer him nothing BUT food with the metamucil in it, eventually he will have no choice. Even though you could mix in a little with even water, I would not force that. Water has no calories and you run some risk that he would be stubborn enough to starve himnself for even water.
There is nothing that will disguise the slight taste of the plain stuff and that is all you should use since you are mixing it in food. Were he mine, I would only offer him healthy food that has a little of the plain stuff mixed in. If he doesn't eat it, I would throw it out & offer him the same (healthy food with metamucil in it) the next meal. No snacks and no other choices. Eventually he will get hungry & eat.
REMEMBER THIS IS NOT ABOUT TASTE OR TEXTURE. IT IS ABOUT WINNING OVER YOU!
Yes, I DO mean no fruit juices. Even milk (unless there is plain metamucil mixed in). You have the right stuff (plain/smooth). At least milk has SOME food value but it is a terrible source of calcium. He could get along without any calcium for at least 6 months without harm. If you stick by your guns, this will be over in a few weeks.
His present watery mucus stooling is the next stage of his problem if you do not get it resolved. The doc who told you to restart the P.E.G. and the metamucil is right on. He needs more of it, NOT less.
You are right to not start this till you can be absolutely consistant. Evey calorie that he gets that does not have metamucil in it will defeat your purpose. HE WILL EAT WHEN HE GETS HUNGRY ENOUGH AND YOU WILL NOT DAMAGE HIM BY STICKING TO THIS. The only risk is that you will give in and prolong the agony for you both.
Walt
Dr. Stoll
I seem to be blessed with leaky gut and constipation. [what could be worse] I am a little "scared" to try the MO and fiber. Having trouble digesting fats, and hear a lot are
alergic to psylium. [i have a lot of food sensativities
already, from the leaky gut I presume] Drink 2-3 quarts of water a day. Been down the "senna and cascara" road, they
make my face break out in cysts. [painful] This has been going on for a number of years, and I'm tired of feeling like a pregant cow and spending half the day trying to "go".
Are these concerns about MO and psylium valid? There are other problems to address, but its hard to think or concentrate in this condition. Any help or suggestions would be greatly appreciated.
Thanks
Glenn
In Reply to: Getting Started posted by Glenn on April 16, 1998 at 04:54:46:
Dear Glenn,
Your LGS (anD associated constipation) is causing you a LOT more damage than ANY of your concerns about psyllium or MO. If you practice an effective skilled relaxation technique at least 20 minutes twice a day (not counting any you might do within 2 hours of retiring) your lgs will likely be resolved within 6 months-----even if you do nothing else. Fat soluble vitamins are stored in the body. There is NO way you could deplete your vitamins: A,E,D & K in that period of time anyhow. If you are ALREADY depleted of those vitamins, your NOT using the MO has not hleped you prevent it, has it?
ANYONE can be sensitive to anything. People with LGS are a lot more likely to be sensitive to anything. STILL, your chances of having a sensitivity to psyllium would be remote. There are MANY other kinds of fiber you could use IF you actually did have a sensitivity. They are just a lot more expensive.
IT IS THE CONCEPT OF "ENOUGH" LUBRICATION PLUS FREQUENT ENOUGH MOVEMENTS (fiber dosage) THAT FINALLY RESOLVES THE CONSTIPATION PART OF THIS PROBLEM.
If you have more questions, write again. As you get well, please share your experiences with the BB participants. You can bet that there are a lot of closet sufferers out there who would get a lot of good from your experience.
Walt
Help,
What might cause sisters aged 3 and 5 to withhold bowel movements in the absence of physical discomfort? The 5 year old has a 2.5 year history of this and the 3 year old just began. There is noticable weight loss in the older girl. Could this be a control issue, and the anorexia ( despite the obvious abdominal discomfort from distension ) a worrisome problem?
In Reply to: Re: witholding stools in small children posted by Julie on April 22, 1998 at 00:34:44:
Dear Julie,
This is ALWAYS at least partly a "control problem" but ESPECIALLY SO when there is not the serious pain problem that eventually can contribute significantly to this problem.
The fact that there are two of them in the same family tends to put the onus directly on the family relationships. The children are running the family & KNOW that the responsibility for making their decisions has been given to incompetents: THEM!
This WILL become a more serious problem unless the nonsense that created the problem is stopped at once. It will be a lot easier to resolve before they get into school.
It might interest you to know that these kinds of problems were unknown in orphanage children. Think about it. Only plain food was offered & few people cared whether the child ate or not. No one knew, or cared, whether the child had a bowel movement or not. Orphanage children could not use eating or bowel movements to control their elders. Children do NOT have the knowledge or expertise to know what food is good for them. Most kids get away with eating junk but SOME do not.
I know I am being blunt. However, the fact that you have come to the internet tells me that you may be ready for someone who won't "beat around the bush". I am not here to browbeat anyone. However, I am not willing to waste my time by not talking straight. If you have more questions, please do not hesitate to write again.
Walt