If you can increase the amount of fibre in her diet, that would give her body more to work with. Fibre is found mostly in fruit (especially pears and corn) and vegetables and salads and complex carbohydrates (like the Weet-Bix you are already giving her). If she isn't eating much fruit and veg, this might be the place to start. Some children prefer vegetables raw, other prefer cooked, some like salad and some prefer fruit. Some prefer bite-sized cherry tomatoes, or carrot sticks with hommus to dip into. If you can find a way that she likes to eat fruit/veg this would be the best way forward. Modelling can help here - if she sees you eating fruit/veg and enjoying it, that might help her to feel positive about it too. Equally important is to avoid foods which are “binding” such as banana.
Other options would include “artificial” fibre supplements such as Benefibre or Metamucil, which can be taken as a drink, or various kinds of brans like oat bran or rice bran which can be added to foods. Bran can be added to rice or casseroles and disappears without changing the taste of the food. It is probably not quite as good as natural fibre, but better than nothing! Also look at switching her bread/rice and other grains to the highest fibre forms you can find.
Then there's medication if neither of the above work, or while you are waiting for her habits to change. Lactulose is a good one, as it is not absorbed into the body and does not cause abdominal pain from increased bowel contractions. It is safe for long-term use and tastes reasonable. It might help if you gave it to her every day, or gave a reduced dose for maintenance (such as 5 mls daily when she is well, 10mls daily when she is constipated).
Ultimately, the idea is to try to keep her bowel actions soft enough that she can go without pain. Her bowel actions will need to be soft all the time for her to get past the fear of pain and “holding on” behaviour which often results from painful experiences. Ideally it would be better to accomplish this before trying to toilet train, when a painful experience can derail the whole process.
It is quite likely that if her low tone in her legs extends to her bowel, that this might be a lifelong problem. Some people are always more vulnerable to getting constipated and there are many people walking around with “slow bowels” which predispose to this problem. Once they are aware of the issue, early and vigorous management is the key. It is also difficult if the person is not able to exercise, as physical movement is another trigger for the bowel to become more active.
Times to be especially vigilant will be if she is sick and eating/drinking less, as this will slow the bowels further, and especially if she is running a fever. Higher temperatures will burn off more fluids from her body, potentially leading to more constipation.
Talk to your GP or paediatrician about “tweaking” her diet and medications. Constipation can make the child (and her parents) miserable, and it can become a chronic problem as the child becomes older and more aware of her body. Children sometimes say they are “never going to poo again” which, as you can probably imagine, doesn't help the issue at all! Keeping her pain-free is the key to avoiding this fear-based holding on, which is one of the main psychological factors in constipation.
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