4 month old with chronic constipation

[jprn05]

I feel like a dunce, but my daughter needs help. I am a pedi psych nurse, and I am at a loss. My four month old granddaughter has such a problem with chronic constipation. She really suffers, poor thing. Her abd is so hard as she tries to relieve herself. I have talked to her pediatrician myself only to be told that all babies look like they are having a hard time. Not only is that insulting to me as a mother, but it is also insulting to me as a nurse. I gave my children water between feedings, and my son was put on a low iron dose formula, because he was chronically constipated. My granddaughters pediatrician says no water, just formula, or breast milk. My daughter does not produce enough breast milk to keep the baby satisfied so we need to supplement with formula. She has been advised to start cereal (rice). Well hello, I was told that rice is a nono when constipation was an issue. I will take any advice at this point. This child turns purple and screams with every BM it is so heartbreaking to be a nurse and not be able to help her or her mother:uhoh3: . At one point I thought her bowels were folding in on themselves. Any advice will be appreciated. Thanks!

[kidznurse]

As both a paeds nurse and a mother whose fully breast fed (until 6months) infant son was constipated from 4months until 3years I haven't a definitive answer. Some would say mixed breast and bottle feeding encourages constipation but I wasn't doing that.

Fact: Some children have delayed gut motility some have fast guts . In such cases adding a sugar that increases the osmolar water retention and softens the stool helps. Whether that's brown sugar in water( 1tsp to 100ml) pear juice, prune juice, peach juice, orange juice, kiwifruit juice or lactulose/duphalac depends on preference and trial and error. Honey is definately contraindicated in infants as described by someone else

I considered both Hirschsprungs and a tumour but consulting a paed surgeon ruled that out.

It's very frustrating having a child with constipation because everyone is an expert. I felt that if one more well wisher asked if I'd tried prune juice I'd scream!! A dairy free diet and wheat free diets were trialled both by me when I fully breast fed and later when he started solids and neither helped. Too much roughage as he got older made the stools too bulky and difficult to pass. Pain from anal tearing during hard passage added a psychological holding back behaviour. At one stage around 20months he was up to 3-4 20ml doses of lactulose a day. Glycerine suppositories and creams to the anal area to reduce pain and ease passage were used.To keep high levels of fluid intake I allowed a feeding bottle for water until a much later age than I would have wished.I used abdominal massage following the direction of the bowel , rosemary oil, accupressure to the feet,kept breast feeding until 16months, sitting on the potty with a book at regular times, making star charts and poo songs you name it.

Then at around 3 1/2 he got through it. His abdominal muscles seemed to tighten as a develpmental progression ,and no more lactulose. No more straining . Bingo! his bowel grew up. He still passes rather large stool but has otherwise had no further issues and is now 15. In testing the gut motility I measured the length of time it took for sweetcorn to pass through the stools of everyone in our family ...sick what nurses do for family entertainment huh!! 26hours for eldest son, 18hours for youngest son, my husband was 13 hours and I was 32 hours so guess where the slower gut came from... and yes my mother confirms I was prone to constipation in infancy too.

If I hadn't been vigilant though I fear he may have ended up with encopresis which I have subsequently been involved in community programmes- retraining older children with stretched bowels. Hope this helps .

[DoubleblessedRN, ADN, RN, EMT-B, EMT-P]

I'm not a nurse (yet) but I have a daughter who will be 3 next month who gets severely constipated. Her pediatrician wrote a rx for Miralax, a powder laxative that can be mixed with any liquid. I don't have my drugbook handy, nor have I studied peds yet, so I don't know if it's safe for an infant, just something you might want to run by the pediatrician. It works well for my daughter.

[avalancheohio]

I work in a busy peds office where we see a bunch of cranky, constipated kids/babies every day. Miralax works great and it doesn't work like a tradional laxative so it's not habit forming. Karo in the bottle, Baby Lax OTC and giving an addtional 4 oz of water per day can all be helpful. If a child gets 'backed up' they tend to hold it in cause it hurts to 'poop'. Holding it in = bigger, painful poops= more holding in. Cran grape worked like a charm for my kiddo! Good luck!

[Nursonegreat]

my poor baby had the same kind of problem, one time i had to disimpact him and i almost cried. i dont remember the exact age i was given the ok, but 3-4 mos seems about right...i tried apple juice, no luck. so then i tried some prune juice, mixed with formula. worked good....then as i introduced the cereal, i would mix in a little prune juice to the cereal. then after he got used to that, i would puree some prunes and mix that in...really, never have had any probs since...he is now 2 and eats, of course, regular fruits all the time and loves them and never has that horrid constipation. so...while i will not touch prunes or juice, it seemed to do the trick very well. hope that is all u need, GL

[traumaRUs, MSN, APRN]

I am so sorry for your dear grandson's problem. I think we all agree that a second opinion needs to be done. Take care.