Everybody Poops. Except for you, apparently.

August 11, 2009 6:05 PM

Poop (or lack thereof) Filter: Curing someone else's constipation. That someone else is four years old.

One of the boys I've just started working with has some serious constipation issues. I mean, I've dealt with kids for years, and I've never seen anything like this. The poor thing was literally *howling* in pain today.

He does have some "bathroom issues" in general, but as I am his nanny, I'm letting his parents take the lead on this one and will go with whatever general plan they adopt. He is seeing a psychiatrist. (Just getting that out there up front.)

What I need is some advice on how to comfort the guy. Is there anything I can give him that will help things... erm... run smoother? He eats plenty of fruit, though obviously a few more dried apricots wouldn't hurt him any. Mainly - in the throes of agony, what can I do to make him more comfortable?

posted by grapefruitmoon to health & fitness (29 comments total)

I am basing this on my own (adult) experiences, so it might not be suitable for kids. But, is it wrong to provide a child with a stool softener to help the process along? Obviously, this is not a good long term solution, but it might get things 'running'.
posted by AlliKat75 at 6:12 PM on August 11

I have a son, who is now 25 but was chronically constipated, although he would have loose stools, the majority of it was compacted up further into his colon. To make matters worse, his diet was cheerios and french fries. The doctor had him on a teaspoon daily of mineral oil, and that did the trick. I had him to psychologists, hospitals, etc.... that is just his thing. He wore a diaper until he was four.
posted by ~Sushma~ at 6:14 PM on August 11

Somehow, I came across this Q and A recently:

http://www.askdrwarren.com/qa090126.htm#q7

Related: http://www.mindspring.com/~drwarren/encopres.htm
posted by zeek321 at 6:21 PM on August 11

One word. Miralax. It totally works. You mix it in with whatever he drinks (it's tasteless) and it will work in usually less than 24 hours. You can get it at any drugstore, Target, etc.

Seriously, it's worth every cent.
posted by dancinglamb at 6:24 PM on August 11

Oh, and it's non-addictive.
posted by dancinglamb at 6:25 PM on August 11

My wife always gave our son prunes when he had this problem. It seemed to work pretty well, but your case seems more serious than what we experienced.
posted by dealing away at 6:30 PM on August 11

Juice. Let him drink all he wants during the day ... in my kids, usually opens the floodgates by nightfall.
posted by jbickers at 6:30 PM on August 11 [2 favorites]

Twizzlers makes a fine stool softener and many kids like it (makes for green poop but does the job.) You'll want the black ones. A nice slug of hot coffee often stimulates the bowel, as well. A nice brisk walk outdoors can do wonders for the reticent bowel. I speak from experience here, but by am no means any sort of doctor.
posted by metagnathous at 6:30 PM on August 11

(it's hard to imagine an addictive laxative)
posted by mr. remy at 6:31 PM on August 11

Prune juice mixed with OJ, more fluids, dissolvable psyllium husks in his drinks. Lay off the dried fruit - it doesn't help, it makes things worse. If symptoms persist, see a doctor.
posted by obiwanwasabi at 6:31 PM on August 11 [2 favorites]

(it's hard to imagine an addictive laxative)

Heh. No, what I meant was that his intestines won't become reliant upon the Miralax in order to work properly. That can often be a side effect of taking too many stool softeners, and then it becomes a vicious cycle.

Grapefruitmoon, you might also want to try getting him into a warm bath and letting him play there for a while. The warm water will help his intestines relax a little bit. Just make it deep enough that his belly is entirely submerged.
posted by dancinglamb at 6:35 PM on August 11

sorry, not stool softeners - I meant laxatives.

Too distracted by barking dogs and screaming kids...
posted by dancinglamb at 6:36 PM on August 11

Yeah absolutely what obiwanwasabi said. At least 1 glass off prune juice a day/mixed with grape juice or something else if he doesn't like the taste. No foods that need more hydration on his part to digest.
posted by twins named Lugubrious and Salubrious at 6:39 PM on August 11

Pineapple juice, lots of it. A little of the fruit as well if he likes it. Cures bunny bowel blockage every time ;) It's an effective laxative, not harsh, and virtually impossible to overdo. Hope your little guy feels better soon.
posted by variella at 6:41 PM on August 11 [1 favorite]

Hi, I am a daycare provider and had a girl last year come to be with bathroom issues. The parents and previous provider had really made a big deal of it, not in a negative way, but it became a cycle. When the little girl (also 4) joined us, I basically left her to it. Instead of having me in there with her cheering her on and fussing she got a friendly "it will come when it's ready" as I walked by (often) and "we'll just wait".

She went from screeching in agony and being given every remedy under the sun to being fairly er regular in no time.

Obviously, not everyone is the same but avoiding making a big deal of it is probably wise.

As an aside, we give our 3.5 year old daughter lansoyl when she's having a hard time. Works great.
posted by Abbril at 6:52 PM on August 11

Seconding juice and prunes. My daughter actually begs for "dried plums" now. They helped us through potty training. Some kids just take a lot longer than others to get comfortable with their bodies' signals.

And don't feel bad about taking some initiative without the parents. You're just giving the kid a healthy snack, which is part of your job. It's not like you're _trying_ to make him poop.
posted by monkeymadness at 6:58 PM on August 11

So the kid wants to poo, I suppose, if he's howling about it.

Barring psychological issues, which are being taken care of, the one and only time I was ever constipated was while under the influence of heavy doses of Dilaudid and Percocet at the same time after a particularly invasive surgery on my leg. (Google fasciectomy and fasciotomy. It's a fun procedure. My leg was open for five days. And it STILL hurt when they changed the dressing and closed up the wound.)

This is probably going to be TMI: what did the trick was a suppository laxative.
posted by kldickson at 7:00 PM on August 11

My son has a tendency to constipation, and I will say that for the kids who have it bad, some of the solutions that help for kids with mild or occasional constipation just won't touch the problem. We have given him Miralax, and it helps. Recently on a trip he had unfettered access to super-tasty juice boxes and I was astonished by the effect. So, as the nanny, and unless the parents restrict food, juice is a really non-invasive thing you can do.

Oh, re-read: you're asking, "What can I do in the moment?" I have some ideas about that, that have helped with my son, but they're pretty invasive and I'm not sure they're nanny-appropriate.

One thing I have done is lubricate the anal opening with a little oil.

Once I looked at my son's anus when he was really having trouble, and he had three or four little poop "marbles" at the opening of his anus. It's hard to describe, but there was a little traffic jam there--any one of those marbles would have come out, but none of them was aligned with the opening, and nome of them was going to budge. His pushing was just continuing to push several of them against an opening they couldn't all fit through . I grabbed some toilet paper and started removing them myself and voila!

I know, ewww. But it really solved the problem, and, hey, I'm a mom, so I do these things. That's the worst he ever had it.

Warm baths do seem to help, too. Glycerin suppositories help if he'll allow them; my son found having them inserted so distasteful we couldn't keep using them.
posted by not that girl at 7:02 PM on August 11

Er. The kid's psychological issues. Not my psychological issues. Which had nothing to do with my ass and were taken care of long ago. :D
posted by kldickson at 7:02 PM on August 11

A kid I used to babysit for used to eat those little metamucil "cookies." I think giving those out would be less of a liability than handing out pills.
posted by melissam at 7:43 PM on August 11

Maybe a warm heating pad on his tummy when he's in pain? I work with a lot of kids who have major constipation issues, and I agree, it's awful when they're in so much pain and you have to have to wait it out for remedies to work.

You've probably already tried this, but it might also help to give him a picture book while he's sitting on the toilet. At least that way he's got something to distract him from feeling crummy.

Other things (administered by parents) that I've seen work for constipation: magnesium supplements, limiting banana intake, suppositories, stool softeners, unrestricted access to juice, and small amounts of Starbuck's frappucinos.
posted by corey flood at 9:51 PM on August 11

One of my DD's had this problem (still has and she's 27, sigh). What we did that worked: lots and lots of water, juice, prunes (kids like them as they're sweet), roughage plus LOTS of water as not enough can make things worse. And, as a last resort, tried my mum's trick which worked, prob because it relaxed her: get a clean ordinary bucket, put two or three inches of water in it hot enough to feel warm when you hold your hand about rim height but not hot enough to hurt a child, let child squat over the bucket while you hang on to them around the waist, wait until the warmth relaxes the bowel and just let them go in the bucket. Crude, but it usually works. I used to do a lot of 'there, there dear-ing' while DD was squatting as I think her prob was/is mainly tension.
posted by x46 at 10:03 PM on August 11

Glycerine suppository's worked for our child. He definately didn't like them, but they worked and be ready for what comes next it didn't take more than 30 minutes.

My brother when he was younger was prescribed an enema.

Both of these are more than what you want to do as a nannie though, make sure you are in synch with the parents are doing though. If he is howling in pain it probably should be taken care of sooner rather than later.
posted by psycho-alchemy at 1:59 AM on August 12

Thanks for all the responses! Normally, I try to limit juice with kids as it tends to be an issue with parents due to sugar content, but I'm just going to go right ahead and open up a juice bar in the kitchen.

I've got no problem with remedies that involve touching his butt. I change his younger brother's diapers. If *he* doesn't have a problem with it, I'm sticking my hands on butts anyway, so I'm really ok with helping him out that way if he needs it.

Any kind of medication isn't going to fly, which I thought was implied by my being his nanny, not his mom - but yeah, unless his parents tell me to, there aren't going to be any powders or suppositories in his future. His parents are, of course, aware of the problem and working with him on it - I'm just looking to get a let extra input on what *I* can do for the little guy when life (and poop) gets hard.
posted by grapefruitmoon at 3:26 AM on August 12

grapefruitmoon, please check out the (medically reviewed) kidshealth.org article on constipation:

* Give your child more fluids. Drinking enough water and other liquids helps stools move more easily through the intestines. The amount of fluids kids need will vary according to weight and age. But most school-age children need 3 to 4 glasses of water each day. If your infant is constipated during the transition from breast milk or into solid foods, try serving just a few ounces of prune juice each day. If the constipation persists or is causing your child distress, it may be due to a health problem, so call your doctor.

* Serve more fiber. Foods that are high in fiber, such as fruits, vegetables, and whole-grain bread, can help prevent constipation. Fiber can't be digested, so it helps clean out the intestines by moving the bowels along, while a diet full of fatty, sugary, or starchy foods can slow the bowels down. Fiber doesn't have to be a turn-off for kids: Try apples, oatmeal, oranges, bananas, baked potatoes, and popcorn.

* Make sure kids get enough exercise. Physical activity nudges the bowels into action, so encourage your kids to get plenty of exercise. It can be as simple as playing catch, riding bikes, or shooting a few hoops.

* Develop a regular meal schedule. Since eating is a natural stimulant for the bowels, regular meals may help kids develop routine bowel habits. If necessary, schedule breakfast a little earlier to give your child a chance for a relaxed visit to the bathroom before school.

* Get kids into the habit of going. Try having a child who fights the urge to go to the bathroom sit on the toilet for at least 10 minutes at about the same time each day, preferably after a meal.
posted by MonkeyToes at 5:25 AM on August 12

I read this in a potty training book just the other day - if kids don't have their feet on the floor or a stool (no pun intended) it can be more difficult for their muscles to relax and facilitate a bowel movement. You may be able to help ease a little of his discomfort during the waiting-to-go period simply by providing him with a platform to rest his feet on. Good luck!
posted by rosebengal at 10:51 AM on August 12

There is no better constipation fighter on the planet than PUMPKIN. I found this out when my dog was constipated - called the vet and she said tehre was no need to bring her in, just give her canned punmpkin from the grocery store. It worked wonders. I then tried it when I was constipated adn i am a believer for life.

You can give the kid canned pumpkin straight if he'll eat it or you can;

1. make soup - put the canned pumpkin in a blender, add a little chicken stock and blend. Pour into a pot and add a touch of cream (or milk) and some pumpkin spices (nutmeg, cinnamon work) and heat till warm

2. mash up the canned pumpkin and mix it with shredded cheddar cheese. serve on toast or with biscuits.

I may sound crazy, but it works for me and my dog...
posted by WeekendJen at 1:40 PM on August 12

The guy does already have a stool (ha) for bathroom use, and a kiddo sized toilet seat that goes on *over* the regular one, so he's really all set as far as bathroom comfort goes.

The parents and I talked it over and decided that the best route (in terms of *my* involvement) is to cut cheese out of his diet for a few days and open a juice bar in the kitchen. We found out this morning that he actually*likes* prune juice. There's hope.
posted by grapefruitmoon at 2:57 PM on August 12

cut cheese out of his diet for a few days

Oh, good God, yes. Cheese is one of the biggest culprits when it comes to constipation. Unfortunately, that tends to be a prime food group for most four year olds.

We had to switch from full fat to 2% milk and that helped with the issues with our youngest, too.



I found this out when my dog was constipated - called the vet and she said tehre was no need to bring her in, just give her canned punmpkin from the grocery store.

Huh. We give our dogs pumpkin for the exact *opposite* reason. It apparently will work both ways. Who knew?!
posted by dancinglamb at 3:33 PM on August 12