My daughter has also suffered from constipation since birth and we also tried to manage it at first with diet. Lots of fruit/veggies, no dairy or bananas, flax seed every day. Still, we went to see the GI doc at Childrens when she was about 18 months also. We see Maria Rubio and she is great with my daughter. They are very good with kids and our daughter is never scared when she is there, has never even cried there. For the initial consult, they will get his history. How often he goes, what the stool is like, what symptoms he has, what you have tried to correct the problem, etc...They will spend alot of time talking to you about the issues. They did a super quick exam which consisted of pressing gently on her belly to see if it was distended. They do a super quick rectal exam to get a bit of poop, I think with just a gloved finger. That was the scariest for my daughter, but still not bad and over in a second. You will always stay with your child no matter the exam. They will most likely suggest a suppository or enema to clean him out of any hard stool he is holding. Then they will have you start on Miralax and possibly pedialax strips also to maintain until he is regularly having at least one bowel movement a day. They feel this is the way to go. My daughter has been taking Miralax for over a year now, and we have just tried taking her off of it. We feel now she is older and can understand she has to eat things high in fiber, drink alot of fluids, can't have dairy. We put flax seed in her food every day and also have started her on a probiotic for digestion. I am not sure yet, if we will have to go back to the miralax, having just one hard bowel movement makes her hold it in and then she gets constipated fast. I am sure you know how heart wrenching it is to watch your little one in pain or holding it because they are scared. At 18 months, we really needed to use the meds as she was just too little to talk through some of this with. She is almost three now and is starting to understand better. I hate that she was still on the laxative after so long, so we are trying to make an attempt to forgo them again, but we'll see what happens. I think the GI docs are great at Childrens, but they also feel the Miralax is the answer....honestly I don't feel they work too much at getting them off the meds at that age. It is a hard decision, but I say use the meds until he is a bit older and you can reason with him. Good luck and feel free to send me a PM if you have any other questions.