Questions for paediatrician and preparing for school

[Em2006]

Hi, we have our first meeting with a paediatrician next week. He specialises in gastroenterology, so we're hoping this will be helpful. I just wondered what we can expect from this meeting (it will probably be a video call), and what questions I should be asking. My six year old will be returning to school in Sep after a year off role and the school are keen to support his needs. What sort of things have other parents found helpful to know or ask when dealing with the paediatrician and school?

[Hudson_can]

Sorry I can’t help but following as we also have our first/only paediatric gastro appointment this Weds - a telephone call.

Our 5 year old always poos in his pants. No obvious pain, has previously said he doesn’t know how to try and that he can’t feel it coming, but he definitely knows when it’s happening and afterwards, just often denies it. And now all he’ll say is that he doesn’t want to go to the toilet. So I think now they’re going to say it’s probably just behavioural, now anyway, but wonder if there’s anything we should be asking for just to rule out constipation or inadequate muscular sensation or something. He’s been taking 1 sachet of Movicol daily for the last 2 weeks to no effect, which I intend to ramp up depending what the consultant says but tbh I don’t think he’s constipated, just not bothered as he barely has skid marks/pellets like he has in the past, just does a big dump in his pants every day or so. Would be good if an X-ray or something could definitely rule out constipation though. I don’t know what else there is to be done other than trying disimpaction, and getting him to sit on the toilet for 10 mins after a meal is just not going to happen, he’s so resistant to using the toilet. (Though he will wee - just not poo - incentives have very little/no effect).

[Robinia in reply to Hudson_can]

Yes if I were you I would try disimpaction and see what comes out. It does them no harm and then you would know for sure if there is constipation. The x rays aren’t always reliable anyway.

[Robinia]

You haven’t said why he’s been off school for a year so this is a bit hard to answer. Would you like to give some more info?

[Em2006 in reply to Robinia]

Hi Robinia,

We've been travelling for a year so the kids haven't been in school. We tried the disimpaction a couple of months ago. He was at 12 sachets for 15 days before we reduced super slowly, as advised on here. We've not had a solid poo through all of this. Recently reduced to 3 sachets but, after a few days of birthdays and excess carbs, we suspect he may be blocked again. Increased back to 4 sachets and going to discuss with the paed getting some senna or something. What comes out of him doesn't equate to what goes in, and is nothing compared to what his little brother leaves in the toilet! Not loads of accidents but I can just see it going backwards as soon as school starts and there isn't someone forcing him to drink and follow toilet time. It's so worrying and frustrating that we can't seem to fix it.

[Robinia in reply to Em2006]

I think you are on the right track. If the disimpaction didn’t result in rusty brown water then it wasn’t a complete disimpaction. Senna or another stimulant will help make the next disimpaction work better. I would try it again when you have a stimulant to use alongside the movicol.

In terms of school - things that have helped my son- changing bag always with him, spare clothes, nappy sacks, pads, wipes etc, 1 litre dark drinks bottle (he has squash in it) and has it with him all the time, all staff knowing what the issue is, toilet pass/permission to use the toilet as soon as is needed/encouragement to use the toilet/ being allowed to use the disabled toilet/ meetings in school to monitor progress

[Em2006 in reply to Robinia]

That s really helpful! Thank you. Hopefully we can squeeze another disimpaction in before September. Poor little dude