Dietary Changes

First of all, a HUGE THANK YOU to everyone who responded to my request for avoiding constipation for Elena.  The followers of this blog provide invaluable information regarding life with cerebral palsy, and I seriously appreciate your readership and your comments.

So, after overnight hospitalization for constipation, with x-rays to prove impaction, we were sent home and told to give enemas every 2 hours until productive.  After #12, we switched to 1x/day for a few days.  We stopped at #14 or #16, I forgot.  Elena was a pretty good patient, even though she seriously disliked what we had to do.  I felt so bad for her...once she was eating and drinking well, I knew we had to find some changes to improve her ability to make bowel movements.

That was two weeks ago.

We're doing the "full court press" against constipation.  Elena will do just about anything to avoid this happening again.  I've made the following changes:

1.  Reduce the amount of milk Elena drinks.  She is still allowed milk (we switched from whole to 2%), but only for one meal (on average).  Instead she will substitute water.

2.  She takes two probiotics at breakfast every day.  We decided on Culturelle Children's chewables and Digestive Advantage probiotic gummies (Wow they are expensive!  But still cheaper than the hospital).  She also has yogurt for breakfast several days a week, half of the time sprinkled with crushed seeds/ground oats/flax seeds.

3.  We've changed her Miralax dosage from 2 tsp to a full capful (~3T) in a super large cup filled with 1/2 apple juice, 1/2 water.  She's supposed to drink it throughout the day until it is gone.

4.  I loved the suggestion of increasing her fiber intake.  For her age, the general rule is age+5 grams of fiber/day, in her case this is 13g.  I think she is close to 10 on a regular day, so my goal is to try to double it.  I haven't made a huge change in her diet to achieve this yet--but we are examining food she normally eats and asking ourselves "does this have fiber in it?".  Some meals there are lots of fiber-rich foods, and others there is ZERO.  I'm switching foods like pasta for the whole wheat version (which none of us really like) and trying different grains instead (which no one but me likes).

5.  Encourage water drinking throughout the day.

One thing I really noticed, though, is that I can't see a way to dramatically increase her fiber intake and keep her calorie intake high.  We've tried extremely hard since she was a baby for her to gain weight.  I'll have to find a happy medium if our dietary changes can't keep up with her energy demands--or if she can't keep close to 38 lbs.  My gut feeling is she'll be fine without pushing high-calorie real foods--or, at absolute minimum, we keep the cheese and dairy and pasta intake while making sure to add something to the meal that has a better fiber content.

Overall I think we are on the right track.  Thank you so very much for your comments!