Childhood Diseases

Posted by: Shoane | 2010-03-02


constipation - physical/psychological?

Hi Doc

Looking at my 7yr old''s diet I am sure I could make it more fibre-rich and get her to drink more water, which I will be trying from now on. That said, it concerns me her encopresis is daily, for many months now. Every panty is soiled, it can be light but on occasion warrants the panty being thrown away. Can constipation run for that long?

I now wonder if maybe a dynamic in our lives is causing her stress. I''m a single parent and of late, for the last year or so, she has been telling me she is so sad she does not have a daddy at home. Her biological father sees her fortnightly but is very remote in his dealings –  he picks her up, drops her at his parents for the weekend and they are the ones who return her to me on Sunday. He gets extremely defensive when I ask if the weekend shd not be about time with him so I have dropped the issue.

She is more for the idea of a daddy than the idea of siblings - she persistently asks me if I would still love her if I had other children and asks how much I would love them as opposed to how much I love her, what the variance would be. Since a tiny age, she is always panic-stricken when she sees me holding other kids. The jealousy issue has not really let up over the years. She had problems when my brother had a daughter a year ago  up till then she had been the only granddaughter and only one of two grandchildren, the other being a 14yr old boy.

It''s an issue when I hold a child of any age, except much older ones. It is also an issue if I buy something for another child  she asks if I still love her. Every single day I tell her I do but this seems not to relieve her anxiety. There was a worrying time last year when for some months she asked who would look after her if I died, and whether I would still love her from heaven. I couldn’ t figure out what got her thinking along that path.

To outsiders, I am an extremely cloying mother, the suffocating type. That’ s because apart from living all alone, not even with a maid, my daughter and I do everything together, from gym to shopping to movies. There is only one little cousin she likes to visit, and she is also very happy going to see my mum, who lives in Zimbabwe though. Outside of that if she cannot see that cousin, she wants to be with me. Since birth she also sleeps next to me although I am now doing up a little room for her, with some money from my sister.

I am going to try Duphalac to ease her tummy woes - not only is she having very infrequent bowel movements but she complains of a really sore tummy. I watched her last time she made a poo  it was huge, dark in colour and caused her much discomfort. That was last week, nothing since. Clearly there is a back-up in the colon but I also worry if above and beyond sorting out the physical element, I shd not be getting her assessed. I have no idea where I would start looking though. Do you think she needs a psychological assessment and how would I find a reliable practitioner, particularly one who''d have some familiarity with the encopresis issue? We’ re in the Sandton area.

Many thanks, sorry for long post I just needed to put the problem in context

Expert's Reply



This is such a brilliant letter and question.You have in fact made the entire diagnosis by yourself. Your daughter has encopresis which usually has a strong psychological cause. Your daughter may also be constipated but her primary problem is psychological. She needs to be seen by a child psychologist. I am afraid that I do not have the name of a child psychologist in your area but ask your GP or paediatrician for the name of an expert near you.

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