toddler 3yo 3 weeks after 14 sachets still not reached

[Reina4874]

hi all, we thought we had reached disimpaction after 3 weeks with 4 days on 14 sachets..as we saw un digested food..however, when we titrated down to 6 sachets or below she has been having the same struggles. Now we are going back up and on to 10 sachets…looking at pics I don’t think she’s actually reached it ever as hers is liquid but still like thick gravy…so just came across this forum and it’s defo how I’m feeling looking at everyone’s posts…. what happens if you can’t reach disimpaction? Is it safe to keep going on and on …?

[Yaleamanda]

Who prescribed the high doses? The Eric website provides a good guide on how to disimpact.

[Reina4874 in reply to Yaleamanda]

hi, thanks for your reply. Shes under a paediatrician at the hospital and I had been in constant contact with them. Waiting for them to call me back again today as we’ve ended up starting again.. back up from 6 she’s now on 10. She did 2 poos yesterday that were like thick gravy and then in the middle of the night a real black sticky one that was obviously old poo from what I have read..which tells me we definitely didn’t reach it originally . I’m just wondering how long this is supposed to go on for before it’s called a day and it’s not working for the child ? Shes also on 5mg piccosulfate

[Yaleamanda in reply to Reina4874]

Ideally you work upto the maximum dose for their age until you reach watery stools with no lumps consistently for a few days before you start reducing the doses down extremely slowly ie one sachet every few days until you reach a suitable maintenance dose to remain on. Disimpaction can take time. Rapid drops in doses doesn't help, slowly reducing is much more effective. Are you seeing a paediatric gastroenterologist or just a paediatrician?

[Reina4874 in reply to Yaleamanda]

from what I have just googled he is a consultant paediatrician who is also an oncologist.. we had been stepping up 2 sachets every few days, she had been on 2 sachets for about a year from GP as we awaited the specialist appointment.. so the original disimlaction last month went on for 3 weeks, starting from 2 sachets up to 14…she was prescribed the piccosulfate on day 2 of the 14 sachets as we started to ladder down..was told to go down as it appeared she was passing undigested food, but my friend is a specialist paediatric bowel nurse and after sending her photos she says it’s clear we haven’t reached disimpaction..so I am now laddering back up as I await

The call back from the doctor today..I’m just wondering whether it’s worth pushing for further in estivations at this stage ?

[Yaleamanda in reply to Reina4874]

To be honest it sounds like you just need to disimpact correctly, most of the time this resolves the case. However I would ask to see a paediatric gastroenterologist rather than a standard paediatrician.

[Reina4874]

thank you, that does make sense . I just feel like it’s hard to pass over the description of the nappy by telephone and you’re left thinking you’ve disimpacted when you clearly have not

[ERIC-Charity Partner]

Dear Reina4874 , here is our guide to disimpaction, based on NICE Guidelines,. eric.org.uk/childrens-bowel...

Here is an excerpt from the guide:

The only way to be sure disimpaction is achieved is to continue until your child is passing watery poo - i.e. brown water with bits in. You may feel worried about giving such large doses, but as long as you follow the regime you will not hurt your child. Macrogol laxatives are not absorbed into the bloodstream but simply ‘bind with’ the water and deliver it to the large bowel, where it will soften and lubricate the poo and stimulate a bowel action.

NICE Guidelines recommend adding a stimulant if disimpaction is not achieved after two weeks on macrogols; some doctors prefer to add the stimulant earlier. Stimulant laxatives increase the muscular squeezing of the bowel, speeding up evacuation. Because of the way they work, stimulant laxatives can cause abdominal cramps. The medicine prescribed might be called Senna, or Sodium Picosulphate, or Bisacodyl – or there are others. Your doctor or nurse will tell you how much to use.

You may wish to listen to the podcast with our ERIC Nurse on Disimpaction:

eric.org.uk/podcast/episode...

[PeterPan1234]

eric.org.uk/wp-content/uplo...

I would contact the eric helpline today as well as your doctor. They are so helpful. My understanding is a child of that age should not be having more than 8 sachets. I’ve sent the link above. I would seek medical advice re black poo.

We have had a very difficult experience getting lots of different advice in the nhs. In the end I just spoke with eric advisors. Hang in there. Good luck

[Reina4874 in reply to PeterPan1234]

Ok great thank you I will definitely call them today..I am getting so stressed out and conflicted with it I feel a bit lost as to where to go next …I must mention she’s also been prescribed an iron supplement for 3 months from the same doctor due to low iron on bloods…so this could be contributing to the colour..

[PeterPan1234 in reply to Reina4874]

Yes that might explain the dark poo but also iron supplement also can cause constipation!

[Reina4874 in reply to PeterPan1234]

I know, this has been a worry for me too…surely it’s counter productive right now ..