How to talk to pediatrician

[mommyatty]

Tomorrow is DD’s annual check up. She’s healthy as can be, but still wets the bed. It’s not genetic. After a couple of people on here asked someone else if their kid who was wettingvthe bed was constipated, and I went to Dr Google’s School of Instant Medical Knowledge, it really rang true to me. DD eats an order of magnitude more than her brother, but she poops a tiny fraction of what he poops. And she hasn’t pooped daily since I can remember. In fact, she occasionally goes a few days, to the point that I worry.

The kid eats a TON of fiber. An amazing amount, in fact, so this isn’t something diet is going to help.

How do I ask her doc to do an abdominal X-ray to check to see if this is her issue? I was reading that a lot of doctors kind of roll their eyes, even though multiple small studies have all found constipation causing bed wetting is a real thing. Our doc is very non-interventionist, so I have a feeling he’s going to say to just give her something OTC for a few days and let that be that. But if she’s seriously compacted, that’s not going to solve the problem.

I’m seriously stressing over this, and stressing even more over having this conversation in front of my slightly anxious 6 year old.

[waverly]

I don’t know but my guess is that they would also do over the counter.

Have you tried something going like Miralax before? If you have a history and already tried something and it didn’t work you could use that information to build a case.

Your other choices are keep pushing which could you get somewhere or not but better than nothing.

Or try another doctor perhaps more in the specialist realm.

I am a big fan of getting a second opinion if necessary.

[erinshelley21]

If the pedi isnt into intervention, can you ask for a referral for a pediatric gastroenterologist?

DS saw one when he was 6 months old and then annually for a few years. His diagnosis was constipation. He helped us figure out a miralax dosage and when to use more or less. Last time we went when he was having trouble again, we were sent for an xray to see if we needed to do a "clean out" dosage schedule or not.

ETA: a pediatric GI doctor may have more insight to that correlation too since thats in their world. A regular pedi has to research so many other areas that they may not ever reach those kind of studies.

[Gwen]

First, the conversation is going to go well. Have some confidence in yourself. This seems a bit new, so don’t beat yourself up about one specific conversation.

Second, what’s wrong with an OTC and seeing how it goes for a few days? That it won’t work and the doctor won’t follow-up? Then say that. “If you don’t think an x-ray is warranted now, when would it be? Should I talk to you or a nurse on your staff? Would you be making a referral or seeing us again?”

I’ve been through this with my nephew. He was on a daily dose of Miralax. Speak up and get the treatment plan that you want. Write down specific symptoms, you already outlined a great picture of what is going on. Remember, the doctor is not expecting this. It’s the first time it is showing up on her chart and the appointment was not made with this in mind. It’s okay to come back after a course of treatment to review again. It’s also okay to say you don’t want to wait, that you really need help getting more information on what’s happening in her body and that means a referral or an x-ray. The doctor has to convince you that his treatment plan is the best plan - not the other way around. If you are not satisfied, say so.

[judyblume14]

I don't have advice on how to talk to a doctor. But, do you have an online portal where you can submit questions, or can you call the office and speak to the doctor privately, as opposed to in front of your daughter if you think it will stress her out?

[2chatter]

Just book an appointment with a pediatric urologist. Make sure you choose a generalist practice so they aren’t just focused on specific conditions. The scan is part of their assessment. They will do a urine test (to map flow and output) then a scan. At most I’d ask your pediatrician for a referral. The magic age seems to be 8 for them to want to discuss this as most kids resolve by that age.

We do fiber supplements (benefiber) when needed (despite DD eating a high fiber diet) and it really does make a huge difference.

[covergirl82]

My pedi has also mentioned super aloe as a laxative and Fiji water (which has naturally-occurring silica).

[waverly]

How did it go mommyatty?

[vasc]

Late to the party, but I’m pretty sure a pedi can rule out or diagnose constipation with an abdominal check....if her abdomen is hard, constipation could be a problem.

My DD was still in diapers when she was having constipation issues. Doctor gave her a rectal exam. Not sure a pedi would do that on a six year old though.

[mommyatty]

Sept 5, 2018 5:02:50 GMT -5 vasc said:

Late to the party, but I’m pretty sure a pedi can rule out or diagnose constipation with an abdominal check....if her abdomen is hard, constipation could be a problem.

My DD was still in diapers when she was having constipation issues. Doctor gave her a rectal exam. Not sure a pedi would do that on a six year old though.

This is what’s so interesting to me. They can’t! The only way to know if they have a mass of poop pushing against the rectum is with an X-ray. Or a very invasive test. So X-ray is definitely my preference.

So he was exactly as I feared. “Feed her prunes and have her sit on the toilet twice a day for 10 minutes with no distractions to try to get her to poop. Then try Miralax.” So I’m calling a pediatric GI. She hasn’t pooped in the last 3 days at least. And this isn’t unusual for her. When I told her she should be pooping every day, she was like “Are you kidding me??? I poop a couple of times a week!”

[2chatter]

A ped urologist will say the exact same thing, IME. It really is a protocol that works!

[mellym]

DD1 has been complaining of random back and hip pain for over a month now so we took her to her Ped yesterday. He thinks she's constipated and had her get an x-ray. We will hopefully get results today and I can share what the protocol is if she in fact constipated. I really haven't been paying attention to how often she goes since she does it all by herself now and is in school.

[freezorburn]

I know very little about this stuff, except for another home remedy that I remember from childhood. I was probably occasionally constipated and my parents would give me a teaspoon of honey mixed in with a glass of water. I guess honey may have some laxative effects, plus hydrating in general is supposed to help. If it counts for anything, pretty sure I had plenty of fruits and veggies in my diet, and my dad was an abdominal surgeon, so perhaps some professional knowledge applied there .... but this was 40-some years ago ...

[mustardseed2007]

New related issue at my house: DS (6.5) still wets his pull up every night but wants to sleep in underwear. DD (4) is dry every night and now also wants to sleep in underwear. This is going to become a problem.

[sdlaura]

mustardseed2007 can you just make a rule about when they get to sleep in underwear and apply it to both? Like if they wake up x number of days dry, they get to sleep in underwear. Your DD will get there first but at least it was objective, so hopefully your DS understands?

[mommyatty]

mustardseed2007- DS age 4 has been sleeping in underwear since he was 2.5. DD had 3 dry days last week, and that was her longest streak of her life.

[k3am]

Some people just don't poop daily. I've never been a daily pooper (I'm sure you wanted to know that), and it isn't an issue.

Does she have other symptoms that are bothering her or are you just concerned with how it relates to the PTing issue? How old is she again?

[mommyatty]

Sept 6, 2018 16:48:08 GMT -5 k3am said:

Some people just don't poop daily. I've never been a daily pooper (I'm sure you wanted to know that), and it isn't an issue.

Does she have other symptoms that are bothering her or are you just concerned with how it relates to the PTing issue? How old is she again?

She’s 6. She has no other symptoms, but apparently that’s not unusual. One of my concerns is that if she really is chronically constipated and it goes untreated, it can weaken both the bladder and the pelvic wall. I had issues with a weak pelvic wall even before kids, so that part really caught my eye. 

[k3am]

mommyatty, give your pedi's advice sometime, see if it makes a difference, and request the xray after that. We've done a lot of "just to check all our bases" tests that have a relatively low risk at our request, and our doctors have never really had any issue with it. Heavy metals testing for DD when trying to diagnose her seizures, MRI and radioactive PET scan even though the first MRI indicated nothing abnormal, and an MRI for DS just because his head was big. 2 of 3 times, they came back with some serious results. 1 of 2 serious results I'm very glad we found - the other is just extra worries for something that most people go through life without even knowing they have.

[erinshelley21]

If you have trouble getting her to eat prunes, they make fiber gummy bears that help. Ds gets 2 every morning with breakfast along with apple juice. Limit things like fruit snacks and bananas. These things help DS go comfortably about every other day. Without these things, a poop can take 45 minutes. I wish I was joking.

[mommyatty]

Well, today was Day 4 with no poop. Gave her a pediatric laxative, which gave her a terrible diarrhea episode. (Just 1). She already eats a very high fiber diet, so I don’t think extra fiber will help. For example, many mornings she eats two bowl of oatmeal. Plain, no sugar or fruit oatmeal. We eat fiber rich whole grain bread, so she gets a peanut butter sandwich with that bread for lunch. She eats an epic ton of fruit (some bananas, but not often.)

Also, DH says she has to be pooping because she constantly has skid marks. After talking to her today, what happens is she thinks she needs to poop, tried for a second, then stops trying. So probably a little is poking out and then is getting on her undies. We talked tonight about giving herself more time to try to get the poops out. If she feels like she needs to poop, odds are very good that she actually needs to poop. I think after how much she hated the laxative episode, she will try harder. Or start lying and saying she’s pooping.. One of those two things.

DH finally bothered to read the freaking article I sent him, so now he agrees we should get the X-ray. I’m going to call the pediatric GI tomorrow. We don’t need a referral, so that’s a plus.

[erinshelley21]

She might be eating too much fiber then. Even with half of a banana we require DS to drink an extra glass of apple juice.

Nothing will make DS shit quicker than some refried beans though if you want to throw some of those her way. Gives you a good excuse for a margarita. I know the beans are high in fiber as well but there's something about them.

[186momx]

mommyatty, DD has had poop issues since she was little. A lot of it is becuase she doesn't drink much. Like maybe 8oz all day. We do high fiber and it helps as the laxative just gave her the runs which got her sent home from daycare, LOL. When she feels the need to go and nothing is helping she sits in the bathroom with her feet propped up on her step stool and reads a book, used to be I read a book to her. This seems to help her relax enough to go. She basically now spends 5-15 minutes per day chilling in the bathroom to go especially this week since she isn't drinking at school. Pears and peaches help clean her out better than prunes do and taste way better. We also used to have her eat an Activia yogurt each day which seemed to help.

[mellym]

mommyatty, we have a confirmed diagnosis of constipation. Protocol is to start with Miralax once per day and we are monitoring the dosage so she goes every day with a normal poop. She is supposed to sit for 10-15 minutes when she goes. High fiber diet and at least 40oz of liquids per day. We do this for 3-4 weeks to clear out her system. She is definitely not drinking enough water but this is really helping me to get her to eat more fruits and veggies.

erinshelley21, are the fiber gummies specific to children? I saw some at Costco but I wasn't sure if they make different ones for kids.

[erinshelley21]

mellym, the fiber gummies that I give DS are. We've used both of these. The CVS brand more then the other.
www.target.com/p/nature-made-kids-first-fiber-gummy-60ct/-/A-16292040
www.cvs.com/shop/cvs-health-children-s-fiber-gummy-bears-fiber-supplement-60ct-prodid-997037?skuId=997037&searchType=4&typeAheadTerm=children%27s%20fiber