Picky Eater, Constipation, Encopresis and SPD

[pattimomma]

I suspect my 6yr old DS has SPD. We are in the process of evaluating him. He has always been a very picky eater and he hardly drinks anything. He suffers from chronic constipation, probably because of his diet - we are also testing for allergies (celiac, ect.), and now he has encopresis. He hasn't had a bowel movement in over 2 weeks! The pediatrician gave me orders for a "bowel clean out" of course this involves getting him to take things orally. Oh he also only weighs 35lbs. His food issues showed up as soon as we tried to start baby food (he was breastfed for 18 months). He refused to eat any food until around 1 yr old. When he was weaned from the breast his weight went from being in the 70% to now he is only 3% on the growth charts. Height is 40% now but was 95% when he was a baby. Pediatrician isn't worried but I am. He also has speech issues and is in speech therapy. Preliminary results from a psych show an IQ of 116 but processing of 79! Ok so a lot of rambling there. What I really need to know is how to get him to eat and drink. Suggestions???

[pek64]

Two possibilites for the constipation. Coconut water or barley. There used to be a cereal that had barley in it that I used for a couple children. Purely O's. I haven't needed to get it in a couple years, but it used to be available at Whole Foods. It worked within 24 hours, without fail. I hope you manage to clear things up at your house.

[livinglife]

His sensory processing problems can also cause his constipation.  He may have poor muscle tone for pushing out bowel movements and also not like the way it feels to let go and may clench his muscles too much. 

The more loose you can help his stools to become the easier it will be for him to pass them without much effort bypassing any potential issues with muscle tone or clenching.  It seems rather easy but supplementing his diet with a good dose of magnesium every day should do the trick.  It is a muscle relaxant and a stool softener and is often a deficient nutrient in children with special needs.

I would also look closely at the preferred foods in his diet.  When you say he is a picky eater, what does he actually eat?  Many children with food intolerances are drawn to the foods they don't digest well, to the exclusion of most others, thereby being called picky.  But, it explains the children who only eat pasta or bread or milk.  These are the foods that create the most intolerances.  It may seem cruel but to take these foods out of the diet of a child who eats so little.  But, you won't starve your child but may actually "break the addiction" so that they begin eating other more varied foods. 

In our experience with our son when we cleaned his diet up his sensory issues cleared up.  Intolerance won't show up in an allergy test.  There is enormous value in doing a basic allergy elimination diet.  Give it a try if you haven't tried it already.  Clean the diet of typical allergy offenders for a month and then reintroduce one food every week, one at at time, and note their effect.

How did I get him to eat when chewing and swallowing was difficult?  I became his food cheerleader.  Eating was hard work for him like a sport skill that he had to practice.  I'd say, "this is to make your body strong, you can do it, home run!".  And, honestly, it was hard work and he did have to practice.  Maybe for a 6 year old you can liken it to handwriting.  If chewing and swallowing is the issue tell him he has to practice it to make it easier.  If he just doesn't want to eat other things except for a few chosen foods,  liken healthy varied eating to building a strong body and help him understand why that's a good thing in that he can fight off colds, have the nutrients his body needs to grow and think clearly...he can play sports, hang on the play ground equipment etc.  I used to have to explain a LOT. 

Let us know how it goes.  I know it's scarey to have such a tiny guy and I used to worry too.  And, my doctor worried with me and did extra weigh in's when he was younger to support my efforts.  Honestly maybe your doctor is great in all other respects, but it would worry me if my doctor was unconcerned.

[melissa17s]

Our dr.s office gave us a list of foods that help move foods through and those that constipate for dd when she had this.  What I can remember right now is that bananas, cooked carrots, and dairy constipate.  They encouraged more water, grapes (watery fruits), papaya (be careful to eat in small quantities), digestive biscuits (mcvitie's), etc.  I also now that adding bran to breakfast can help- like think raisin bran or maybe oatmeal with bran and Creamy wheat, too, because they are softer fiber that is easier to pass.  We did try the miralax (need a prescription), which dd liked drinking, but there was not a small enough dose for her.  It caused total clean out and temporary lose of control.  

[velveeta]

My 6 yo DS has experience with all of these. Big hugs to you, Mama. It is so challenging! I have a few different things you might like to try...

The first, and our best treatment is culturelle for kids probiotic powder packets. In the beginning, when encopresis was severe, my son would take 6-8 packets per day. Now it is 1 or 2. The flora in children's guts of course changes as they get older, and culturelle reflects the appropriate flora even for very young babies. It really is the best. It is also gluten and casein free. This is an easy intervention bc it does taste very good to kids. It is sweetened with oliggosacchirides, a prebiotic.

Next, you could try higher doses of vitamin c than you might be used to. Check out www.doctoryourself.com. He has a great article on making ascorbic acid powder quite palatable in larger (gram) doses. My children all take between 2-3 grams (2000-3000 mg) each per day. It makes the stools softer and encourages peristaltic action. Once you learn about the wonderful antibiotic, antiviral, and antioxidant powers of vitamin c, you will use it liberally! :-)

Now, some of the more difficult interventions... Definitely go for a trial of the easy ones, first! We found that we did have to stop using gluten completely, and we did extended (many months) of dairy free, as well. These take time to learn and you need to be gentle on yourselves as you learn if you decide to give this a try.

I also give my boys a prescription of compounded low dose naltrexone (LDN) to try to free them from inflammation, sensory issues and food allergies permanently. I invite you to google LDN to learn more. It is actually prescribed by many naturopaths, and non-toxic. This is strictly FYI. Culturelle may be all you need!

Good luck to you and your little boy. Constipation is so uncomfortable, and we found it really made the children have toxic moods, as well.

[pattimomma]

Update: We started on a regimen of Miralax and Pedialax on Friday per Dr. instructions. By Saturday PM he had  two bowel movements. When he started showing behavior that indicated a BM was on it's way he had to be convinced to sit on the potty because he was attempting to hold it which I think is part of why we got into this situation to begin with. Thanks to the Miralax it was very soft and he didn't seem to have any problem going but he talked about BMs being painful. Starting Saturday I cut gluten from his diet. I have no experience doing this so any suggestions are welcome. He loves bread and pasta. Sometimes it's all he wants to eat. So this is going to be a challenge. He will eat some raw fruits (bananas, grapes, oranges, blueberries, strawberries, and blackberries), raw carrots and celery, and cooked broccoli. He eats hummus and peanut butter. He will eat fish and steak but not chicken, turkey, or any ground meats. He loves all baked bread junk products and candy. He likes pizza and spaghetti,  and eggs. We often make stir fry veggies and chicken with rice for dinner and he won't touch it. Forget trying anything new. I keep trying, he keeps refusing. I'm going to look into the different suggestions in this thread and see if I can do a complete diet make over. Thanks!
 

[mamarhu]

Will he drink smoothies? I called them milkshakes (not above a bit of lying and manipulation!) and used them to hide many foods.
 

[pattimomma]

Originally Posted by mamarhu 

Will he drink smoothies? I called them milkshakes (not above a bit of lying and manipulation!) and used them to hide many foods.
 

No I make smoothies all the time and my other kids will down them in a second but not him. He takes maybe one or two sips and that's it.

[melissa17s]

It is great that the miralax and pedilax helped start the process.  I hope he finds relief and feels better.

Ok, so a few things have come to mind that you might address.  First, there is psychological aspect to encopresis.  My dd would withhold when we would go out of town, which was many weekends during the summer for my work.  She had a lot of anxiety and this led to withholding.  Is there an issue that is upsetting your child, Pattimomma?  Change in the family dynamic, new addition, etc?  

Long periods of withholding can stretch the colon and do cause pain.  It may take a long time to recover from this.  It is a cause for regression to withholding, so it is essential that you change his diet to repair if damage was done.  He needs more fluids and fiber.  Unless you are seeing issues of gluten intolerance or celiac disease, I would not eliminate his major sources of fiber you stated he eats- bread and pasta.  If you want to make it more healthier switch to whole wheat because it is a better source of needed fiber.   Here is a list of foods that are good sources of fiber.  Check in the traditional foods forum for grain preparation ideas to make whole grains both more palatable and healthy. 

[pattimomma]

Originally Posted by melissa17s 

It is great that the miralax and pedilax helped start the process.  I hope he finds relief and feels better.

Ok, so a few things have come to mind that you might address.  First, there is psychological aspect to encopresis.  My dd would withhold when we would go out of town, which was many weekends during the summer for my work.  She had a lot of anxiety and this led to withholding.  Is there an issue that is upsetting your child, Pattimomma?  Change in the family dynamic, new addition, etc?  

Long periods of withholding can stretch the colon and do cause pain.  It may take a long time to recover from this.  It is a cause for regression to withholding, so it is essential that you change his diet to repair if damage was done.  He needs more fluids and fiber.  Unless you are seeing issues of gluten intolerance or celiac disease, I would not eliminate his major sources of fiber you stated he eats- bread and pasta.  If you want to make it more healthier switch to whole wheat because it is a better source of needed fiber.   Here is a list of foods that are good sources of fiber.  Check in the traditional foods forum for grain preparation ideas to make whole grains both more palatable and healthy. 

He has had anxiety and withholding of BM for years, that's why I think it might be a sensory issue. He is currently being evaluated.
He is underweight so the doc thought celiac because it can cause growth issues in children when they are not properly absorbing vitamins and minerals. We only eat whole grains and whole wheat bread. I think fruit fiber may be the way to go with him. I also have to get him to drink more fluids. Increasing fiber without increasing fluids will just result in more constipation.

Thanks!

[pattimomma]

Just got back the test results. No allergies, thyroid fine, everything is fine except his vitamin D which is too low.