My son has Constipation

[Y2KRN]

Hello Peds nurses,

I have got a question for you! My son has been vomiting since Sunday morning. He had a fever of about 101.1, could not keep fluids down. I thought it was the flu, so I gave him lots of tlc and fluids every hour ( even though he was wretching) Gave hime tylenol and motrin around the clock. Monday came and he remained afebrile, still vomited could not keep anything down. More tlc and pushing of fluids. Got up this am vomited first thing out of bed. Called Peditrician, got an appointment for 14:45, he remained afebrile for the day. Took him to the Doc. got an x-ray of the abdomen flat and upright. Results called to me at home. Told he is constipated.

I am an ER nurse have treated many children for constipation. None ever had a fever.

Could he have become constipated because of the fever and dehydration?? I must confess I was thinking he may have a small bowel obstruction, but x-ray supposedly shows it is in his rectum. I would think if the obstruction is that low the child would not vomit 5+ times a day, or about 15 -20 minutes after drinking water.

I kept an ongoing assessment of him, he never became tachycardic, had tears, and was voiding a little less than usual. Blood sugars remained okay.

Urine at the Doc office showed some ketones not surprising he has been vomiting for three days. I guess I am just not convinced it is constipation. This is a child who has a great constitution. He however has not had a bowel movement in three days. But, did have a normal one the day before he got sick.

Am I just being too synical. Does a fever go along with constipatieon??? Any insights would be appreciated. I respect my colleagues opinions and experiece.

Thanks

Y2KRN

[Jolie, BSN]

How old is your son? What did his abdominal exam reveal? Any tenderness or guarding? What are his bowel sounds like? What recommendations did the doc make about keeping him hydrated? Did he do any labs such as a CBC and/or chemistries? Did he make any recommendations about his care at home or under what circumstances he should be returned to the office or ER?

It sounds like you need a better explanation from the doctor as to what he thinks the underlying problem is and what you should watch for at home.

Best wishes. I hope he feels better soon.

[kids]

How old is your son? (my opinion depends on his age)

[Y2KRN]

Hello,

My son is six and a half years old. He had a bowel movement on Saturday nov.15th. His x-ray showed that he was " full of stool" as the DR. nurse said. They did not do any lab work just the x-ray of his abdomen. They also checked his blood sugar because he had some ketones in his urine.

I asked for a promethazine supp. The Doc said that she finds that really does not work after a child has Ketones. The Doc told me to try fluids first.

I got home and my phone was ringing and I was told he was " full of stool" and constipated. The nurse said that he had a large amount of stool in his rectum and that is was going to be very hard for him to pass. She said now the Doc wants me to administer the suppository with a lot of vaseline on it and if need be do a disimpaction. I gave him the suppository and he had bowel movement without any difficulty about an hour later.

He has not vomited since I gave him the phenergan, he is still complaining about his belly hurting and the thought of food makes him "weasy" he said. Now I know he pooped most of the phenergan out and but, some of the medicine probably was absorbed.

I truely hope that it is just constipation. However he had only gone three days without having a bowel movement priior to the one he had last night. I was expecting the bowel movement to be hard for hime last night and it was not. Plus all the vomiting.

His belly is benign, he says it hurts, but it is soft and supple and bowel sounds are hypoactive. His pain is not localized.

Anyway, thanks for the replys!! He has a re-check at 10:00 this am.

Y2KRN

[kids]

I am glad he is feeling better!

A thought I have about your little guy from your update...

The N&V is probably bowel related but for his bowel to be so full when he had nothing in makes me suspect an ongoing problem (that wasn't previously obvious). At his age some kids go to the bathroom in a hurry so they can get back to what they are doing. It is possible he gotten in the habit of only pooping while the "urge" is there and being done with it rather than taking a couple of minutes to relax and let peristalisis move more stool down (one of the Peds I used to work for called it "stock piling").

Once he is back to eating and drinking normally again I would really push the fiber and fluids in his diet and encourage him to take his time in the bathroom.

The fever is probably a coincidence.

[hock1]

I noted the age of this post but had to reply anyway. My son is currently recovering from something similar. He is ten years old. Docs thunk it appendicitis at first...turned out to be a mild ileus virally induced. He was never full of stool though. I had never heard of this before. Poor kids has been subject to I & O, etc by his nurse mom. Some of the nurse in me rubbed off on him. He cracked me up when he stated that 'the solid food must have stimulated my bowels to move, mom'.