Nutrition Interventions for Children with Special Health Care Needs

Chapter 6
Nutrition Interventions for
Constipation
Susan Brand, RD, CD, CDE
Updated by Melissa Mortensen, MS, RD, CSP, CD
Section 2 - Problem-Based Nutrition Interventions
Constipation is defined as incomplete or infrequent passage of stool persisting for 2
or more weeks. The presence of hard, dry fecal material with difficulty in defecation,
even if passed frequently, may also be considered constipation (1). Most authorities
agree that a stool frequency of less than three times per week would be diagnostic of
constipation in any age group (2).
Management of constipation is important because it can cause physical and
emotional complications. Chronic constipation can lead to impaction and stretching
of the rectal wall resulting in fecal soiling. Painful bowel movements might result in
withholding behavior or encopresis (3,4). Urinary tract infections and other urinary
pathology are reported in 30% of children with constipation, relating to fecal flora
entering the urethra or the dilated rectum pushing on the bladder causing spasms
(4). Decreased quality of life has been reported in children with chronic constipation
and in their families. About one third of children never outgrow it (4,5). Signs of
constipation include abdominal pain, abdominal distention, decreased oral intake and
irritability (1).
There are many causes of constipation with specific relevance for children with
special health care needs, and these are listed below. In some cases, reasons for
the constipation cannot be determined. When no organic cause for constipation is
identified, this is termed functional constipation (1).
Causes of Constipation Seen Commonly in Children
With Special Health Care Needs
• Abnormal anatomy or neurologic function of the intestinal tract (e.g. anal
stenosis, Hirschsprung’s disease, and neurogenic bowel associated with
myelomeningocele)
• Abnormal muscle tone (hypertonia or hypotonia) leading to impaired function of
the intestinal tract
Nutrition Interventions for Children With Special Health Care Needs 71