Impaction in toddlers?

chris_at_lucas_RN, RN · Nov 22, 2004

If the mother has the child most of the time and does not attend appropriately to her diet, especially fluid intake, even though she has been told, this is medical neglect. The lady needs some one-on-one time with a worker who can help her learn to take care of her child.

Dad needs to bring this to the attention of someone who can help the child--a physician, a clinic, whatever. For him to be repeatedly administering enemas or attempting to disimpact her (if she is impacted--that's not the same as being constipated) sets up a weird father-daughter relationship.

The kiddo also needs plenty of physical exercise. If she's getting enough bulk, enough fluid and enough exercise, then the problem could already be psychological, and she needs to see a psychotherapist or counselor.

sherichance · Nov 22, 2004

The mother does need some type of help. I even brought it to the fathers attention that she is neglecting the child. The mother tells the father about the childs doctors visits after they happen. The doctors did say that it is impaction. I thought maybe they were confused with constipation but I was corrected. I upset the father a little bit because I did bring up the psychological factor. I believe that he doesnt want to think that there is something mentally wrong with his child.

Its just sad because he wants to gain custody of her and has every reason to go to court and say that the mother is neglectful. It would take alot to do because he is currently stationed on a submarine. He honestly doesnt think they will give him custody of the girl while he is on a boat.

Thank you for the reply. I will be bringing up the matter again this week when I see him. Something needs to be done because this little girl is in alot of pain.

prmenrs, RN · Nov 22, 2004

The are toddlers who suppress having bowel movements for long periods of time--they don't like to have them or something. Anyway, eventually, there's hardly any moisture, so then the BM is painful. So, they don't want to go because it was painful last time--vicious cycle.

I don't think he should mess with her AT ALL until he talks with a pediatrician. I can just envision what will happen when the kid tells her mom or a preschool teacher or a grandparent that her Daddy sticks his "finger in her bottom".

kidluvinRN · Nov 22, 2004

Sounds like this child needs further medical attention; obviously colace,etc. not working. Could be something neurological; tethered cord syndrome can cause impaction in children although typically not that young. Definately dietary counseling and a better bowel routine are needed in the least.

allnurses Guide · Nov 22, 2004

I agree with prmenrs . . . he needs to talk to his own pediatrician. My oldest son got constipated once as a toddler and it hurt to void and thereafter for awhile would hold his BM until it was very dry and difficult. I was new at this parenting stuff and took him to the ER a few times for this. One of the older RN's told me to take a sliver of Ivory Soap and place it PR . . softens the BM. And I increased fluid, fiber, fruit . . . it took awhile until my son would trust that it didn't hurt.

I think with all the attention being paid to this poor child's bottom, it IS a vicious cycle.

My niece has spina bifida and had to be cathed to urinate and sometimes had bowel problems. My brother initially helped with that but there came a time when he had to stop because it embarrassed her to have daddy helping her. She has learned to cath herself and bowel training and diet changes has little or no problems now.

There are just some things dad shouldn't do . . .unfortunately he is alone.

I really think further exploration into why this is happening is imperative. Get a second opinion.

steph

sherichance · Nov 22, 2004

The father really doesnt like having to disimpact her. It hasnt been done recently but he gets so upset because she is screaming and crying. The mother doesnt make matters better because she is kind of controlling and doesnt like to let the father see the girl. They actually have been to a few doctors but nothing seems to help. i completely understand the concern with the daughter possibly saying one day that her daddy does stick his finger in her bottom. I will bring that up to him. He's a wonderful dad just trying to do what he can to help her.

I will tell him to take the child himself to the doctor the next chance he has to come down. Maybe he can get better answers than what the mother has been telling us.

ComicRN · Nov 23, 2004

Has anyone checked to see if the child has a megacolon? This could also be causing her problem.

sherichance · Nov 23, 2004

that has not been brought up....i will keep a list of these suggestions everyone is giving me so he has something to work with.....anything to help this poor little girl....

kathy_79 · Nov 23, 2004

except obvoius medical problem, the girl has aslo psychological needs which are not met. she needs attention from her parents ,who probably are separated or during divorce, she wants to have her father with her (he is at navy), maybe she has impaired relationship with her mom because of what is going on in mom life and girl too. i just thinking about immediate physician consult, but also what is hard for mom i would suggest some type of therapeutic consult too. it is not that she is bad mom but all what is going on in her life has huge impact on her daughter. if she will not open her eye that her baby needs her and screaming for attention and love, there can something bad happen.

i hope the girl will get better, i pray for her. and also for you, you are good friend and if any chance help baby girl who needs that. god bless you. :)

akcarmean, LPN · Nov 23, 2004

I will keep the little girl in my prayers.

Angelia

TiffyRN, BSN, PhD · Nov 23, 2004

I met my step-son when he was 7. Soon after my husband and I got married I realized the boy had occasional stool incontinence. I insisted with my husband this isn't normal !! He and his ex-wife had just never done anything about it. After a couple more years with several different docs and even a therapist we finally wound up with a pediatric gastroenterologist. Nobody else had ever had a clue about what was going on. The boy didn't seem constipated to us, besides the incontinent stools he had normal type stools in the toilet as well.

The pedi gastro knew immediately after a detailed interview and exam that his problem was chronic constipation. He had a horrible diet. He ate virtually no fiber ever (he was an EXTREMELY picky eater that probably only ate about 10 items). She said his colon was so full, and had been that way so long that his lower colon had lost it's sensation and he couldn't feel the urge to stool so it just leaked whenever it got overfull. She prescribed a high fiber diet and Miralax (he was about 9 or 10yrs old at the time). He pretty much refused to do the high fiber diet and after reasoning with him, punishing, rewarding, anything and everything we could thing of to change his food behaviors we told him the long term consequences of constipation (personal foul odor from incontinence, abd pain, and even extremely; colostomy). There was no getting through to him and after the 3 month scrip for Miralax ran out (he was fully continent during that time) we told him we wouldn't refill it, he would have to change his behaviour, which he didn't until that last year or so (he's 14 1/2 now). Fortunately his diet starting getting more varied, I assumed more fiber and he is now continent.

We finally found out he has Asperger's syndrome (kinda related to autism though much milder). One common issue with Asperger's kids is very very extreme food preferences/aversions. They literally would starve rather than change.

My final point? It would be best if the child could increase her fiber intake, it would probably be enough. If not, to save the child from all that severe pain, maybe she should be on laxatives that are safe and appropriate for her age. I don't know when they are old enough for Miralax but it was a great product. It has very little stimulant effect, works mostly by drawing water into the colon I believe.