Please help me w/...

[aris99]

the best way to administer an enema to a severely constipated 6 yo

We saw a ped GI today. My son, 6.5, has severe constipation and we were directed to give him 2 fleet enemas 12hrs apart. After the 2nd enema he is supposed to drink 8oz of liquid w/17g miralax once every hr for 5 hrs!! That's 40 oz in 5 hrs...he'll never do it! The alternative is to put him in hospital and have a ng tube placed to relieve the constipation (not sure why this would work).

My son has severe oral aversions and though the Dr told me the miralax was tasteless and I can put it in his smoothie, I'm kind of doubting that it is completely tasteless so I have a feeling we're going to end up in hospital.

Weird ques....but can anyone tell me what miralax tastes like? How can I make an enema not as bad as it sounds? Please help us avoid hospital!!!!

[KatWrangler]

It's tasteless.

Are you sure the directions is right? Thats a whole cap full. I can't believe they want a whole cap full once an hour for five hours.

Dose the smoothie have dairy in it? We added to pudding once for Gabrielle and it made the pudding watery. It's better in juice.

I would do the best you can. Gabrielle is use to the enemas (we do a high volume cone enema every night). She is 4.

[anj_rn]

It is tasteless, although I agree with PP that the dosage seems kind of high. It is great in juice (esp pineapple juice).

The hosp will put in an NG tube to give the meds through, possible even changing to something like go-lytely to completely flush him out. The tube itself id not the remedy, just what you put down it.

I would suggest setting the enema up in the bathroom (or on a hard floor surface). Have him lay on something washable and try to relax. It won't be easy, and will probably be very scary, just talk him through it.

[StephandOwen]

Originally Posted by aris99

My son has severe oral aversions and though the Dr told me the miralax was tasteless and I can put it in his smoothie, I'm kind of doubting that it is completely tasteless so I have a feeling we're going to end up in hospital.

Weird ques....but can anyone tell me what miralax tastes like? How can I make an enema not as bad as it sounds? Please help us avoid hospital!!!!

My son (asd, spd) has a lot of sensory/food related issues too. In fact, until recently he only drank water. I can tell you that when he was on miralax it was completely tasteless and colorless. We mixed it with ds's water and he couldn't tell (trust me- if it changed the taste at all he wouldn't have drunk it!).

I'm sorry, I can't tell you much about the enema.

[aris99]

Thank-you all for your replies. I'm absolutely sure of the dose as the Dr. wrote it down. It says: 17g in 8 oz every hour for 5 hrs, a total of 5 doses. My son is only 40lbs. He's been in this condition for about a yr now. I stupidly thought he had diarrhea

I can see him *maybe* tolerating the enema but drinking 40 oz of anything in 5 hrs seems EXCESSIVE for him. So, let's say I get through the enemas, and a couple of the doses....how do I know if this is enough or whether we need to go to the hospital? The Dr was worried about dehydration. She wanted him to try a fruity neocate type juice and became stern w/him when he refused...she probably thought I was a wimpy enabling mother. I know my son wouldn't at this point touch ANYTHING fruity and I wasn't going to pretend to insist that he do so. Maybe down the road w/therapy he'll do it but certainly not now and maybe never....man, I am feeling depressed!

[anj_rn]

Well, I will start by saying call the doc and ask what the minimum intake needs to be.

IME, usually when you are constipated you do not want to eat or drink (due to the already overful feeling). I would give him the miralax in an oz or 2 (to make sure he gets the dose, then just push fluids.

Try to make it fun, like maybe trying different juices/drinks in medicine cup size containers. So if the medicine is in one oz, he would need to drink 7 medicine cups in an hour to make the goal. That does seem like a lot, I don't know that I could drink that much.

[aris99]

Thank-you so much for your help!

I did ask the Dr yesterday about the possibility (and indeed probability) that my son would be unable to consume that much in 5 hrs. She said vehemently that it was that or the ng tube. She did not seem to be very flexible on that at all! My "fear" is that the enema will go ok but that the follow up miralax laced beverage will not go beyond 2, 8oz servings. The other thing I'm unsure about and I'm sorry if this is TMI but I can't quite understand how my son can have hard backed up stools (as the Dr put it) and still be passing normalish, large sized poops which he's been doing for the past 3 days since I added florastor to his smoothies. I mean, he has in the past, recent past, had encropsis (i thought this was diarrhea) but he doesn't currently seem to have it so is all this enema/miralax stuff really necessary?

[TzippityDoulah]

Originally Posted by aris99

Thank-you so much for your help!

I did ask the Dr yesterday about the possibility (and indeed probability) that my son would be unable to consume that much in 5 hrs. She said vehemently that it was that or the ng tube. She did not seem to be very flexible on that at all! My "fear" is that the enema will go ok but that the follow up miralax laced beverage will not go beyond 2, 8oz servings. The other thing I'm unsure about and I'm sorry if this is TMI but I can't quite understand how my son can have hard backed up stools (as the Dr put it) and still be passing normalish, large sized poops which he's been doing for the past 3 days since I added florastor to his smoothies. I mean, he has in the past, recent past, had encropsis (i thought this was diarrhea) but he doesn't currently seem to have it so is all this enema/miralax stuff really necessary?

]

thatis interesting.... if he was having the runs I could totally see how he could still be backed up - bu if he's having non-painful regular sized/smelling/and textured poops I think the enemas and miralax are WAY too much. I would take it a step at a time.

ok first off (having dealt with GIs for both my son and myself through the years) they are often heavy on the meds and low on the common sense. (ok not saying that's true all around... but really they give out higher doses of medications than like anyone!) the common GI theory is to attack hardcore until the poop cowers and runs right outta ya! lol but really sometimes that level of 'get it done" kinda attitude can CAUSE constipation to be worse in the future. see if you power flush everything you also usually flush out the good stuff. it's like emptying out your entire house and cleaning it top to bottom and then bringing back in the dirty furniture. I mean what good did it really do? it's just going to end up dirty again. and that's how it is with constipation. not to mention stress can cause constipation and stressing a body out by forcing down copious amounts of water against it's will can cause a system to just clamp down even hard!

if you decide on a serious system flush like that (which can be useful) you must consider other things like probiotics and flora to put back into your clean system to keep it clean. does your GI have a plan for that? if she doesn't expect to be back in her office again in a few weeks.

as far as dosage - it is up to your kid to drink what they drink. you can't force it. and you are the mom - the DR.s orders are suggestions - but you have to decide what works best for you. any good doctor knows that. having two kids with serious SPD, there is just no talking a kid into doing something they are dead set against. I would say give him as much miralax as you can get him to drink. what works for him? goals? rewards? explanations? whatever you need to do. but who wants to drink 40gallons of anything if they are backed up!? any GI should have the common sense to realize that's asking a lot of ANYONE - especially a 6 yr old!

I would just do what you can. and if you're doctor don't like it, so be it. she works for you. fire her and get new one!

( don't mean to be so negative towards GIs... I'm sure some are great! but this whole "take 100 doses of every laxative on the market and call me in the morning" crap gets on my nerves! that's not doctoring! it's bandaiding!)