Natty, like many children with Down's Syndrome has struggled with constipation over the years. Despite eating like a fruit bat and having a Mummy who makes biscuits and soups with things like linseeds hidden in them, she is a slow and reluctant drinker and we still had to resort to seeking additional help.
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A powder called Movocol Paediatric was prescribed by our GP last year. This laxative is added to water and together the liquid makes the stools softer and easier to pass. And boy did it do just that! We panicked and stopped using it. We found an alternative called Lactulose which seemed to work fine with a small daily dose, although Natty would still go many days between movements and it could be very painful at times.
Wanting to make sure we were on the best path, I requested an appointment with a BOWEL AND BLADDER SPECIALIST (ask your paediatrician or GP to refer you if you have concerns) which came up last week. After all, being contipated is not only painful, but leads to sluggishness, tiredness and a bad mood.
I know how hard it is to come by fabulous information sometimes, so I will share all her invaluable advice with you.
- Apparently Lactulose absorbs water from the body not the drink it is contained in, so for a child who struggles to drink enough that could have a dehydrating effect.
- Movocol is not a bulker and will not stretch the bowel or cause longterm harmful effects.
- Drinking plenty of fluid (water, dilute juice, milk) is key. I was astonished to find that a child of 7 should be drinking 1.2 litres per day. For a chart for all age ranges have a look at the BBC Good Food Guide to Drinking Water here. We weren't managing anywhere near this, but are getting close now.
- Buy attractive cups and beakers and focus on them as your child drinks rather than simply asking them to drink. I bought a couple of sparkly Doidy cups, 2 patterned screw lid cups with a straw, Camelbak make a great version, (don't use sports bottles that encourage your child to jutt their jaw forward, for an explanation read Terrific Tools for Talking here), a pack of funky straws and a no-spill Munchkin sippy cup. You could try a funky tooth brush holder with floating glitter and fish as a beaker too.
- Take the cup everywhere and offer your child a drink whenever you can.
- Encourage your child to sit on the toilet twice a day after meals. They must be comfortable (we still use a padded child toilet seat) and a foot step to raise their feet so that ideally their knees are above their hips.
- I cannot recommend the Rock and Pop method highly enough. Place your hand on the child's lower left stomach (or encourage them to do it themselves), let them lean forward and relax for a few seconds, then ask them to sit back, push and... pop. It works 9 times out of 10.
- Make the experience relaxed and fun. Keep books or stickers in the room.
- Encourage your child to blow bubbles or play a small wind instrument such as a plastic flute or similar whilst on the toilet to strengthen abdominal effort.
The specialist is also able to advise on other aspects of toiletting, positioning and so on. For help with steps and handrails, ask to see an Occupational Therapist.
For more information and a baked bean recipe with a laxative effect, read
Contact the Childhood continence experts ERIC for more advice, leaflets,
wall charts and continence products.