Product recall; constipation

Please note that on July 16 the FDA sent out an alert that Pharma Tech LLC has recalled liquid docusate (brand name Diocto  Liquid) after it was found to have bacterial contamination in 5 states.  This product is also sold under the name “Colace”(among others) and is frequently used to treat constipation in children.  The recall does not specifically apply to that brand but I do think caution should be exercised when using this stool softener at this time.

Please allow me to segue from this to some remarks about the unpleasant topic of constipation.  Firstly, normal stool texture varies from child to child and according to diet and hydration status.  As my erudite and beloved residency mentor, Dr. Walter Bundy (Gd rest his soul) taught me–“anything from mustard to putty” is ok.  Secondly, not everyone stools daily.  Additionally, grunting and turning red is not necessarily abnormal–as I often suggest(“LOL”): take a video selfie some time while one answers nature’s call; most of us grunt and turn red a bit.

If a child does appear to experience pain while stooling (infants or toddlers screaming and turning red, older kids with complaints of abdominal pain) there are a number of more natural things that we can do:

 

  1. Increase fluid in the diet (water is fine)
  2. Increase fiber with vegetables (strained or cooked and soft for toddlers) and fresh or dried fruit (strained for littler kids).  Careful about calories in dried fruits with chubbier kids.
  3. Gentle rectal temperatures stimulates defecation (better for littler kids)
  4. There are a number of fiber supplements available.  I like maltsupex (liquid or powder) with its less gritty texture, but metamucil, citrucil, naturacil, and others are good too.  Generally,  1 TBL/day for toddlers.  “Gummy fibers” are gummy bear candies with added fiber–  1-2/day for younger kids, but for both above,  please call for specific dosing.
  5. There are a number of relatively milder medications that may help “from above”(by mouth): Simethicone (“mylicon”) drops or liquid, magnesium hydrates (“mylanta,” others) are usually well tolerated.  Again, call me to discuss dosing.
  6. Mostly, I try and avoid more aggressive interventions–laxatives or enemas and suppositories– where possible.  While they can be stronger and more effective, they carry greater risk of side effects like pain, vomiting, bleeding, or even electrolyte abnormalities.  Moreover, no child is a fan of having objects stuck in their rectums.  Take a child uncomfortable with/about stooling, shove stuff up there and you may cause more problems than you solve.

Be sure to call me if your child is vomiting, has bloody or black stools, poor weight gain or weight loss, more disruptive behaviors associated, or combined urine and stool issues. Remember, parents: your mission in life need not be to get a poop out of that kid every day.  Call me to discuss or with questions or comments, and thanks for following.

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