Nutrition Interventions for Children with Special Health Care Needs

Chapter 6 - Nutrition Interventions for Constipation
• Decreased activity (e.g. due to prolonged illness, body cast, impaired motor skills,
immobility or paralysis)
• Lack of routine toileting habits or the inability to attain an upright position for
toileting
• Coercive toilet training (excessive parental involvement and/or fear of punishment
with fecal soiling).
• Medications, e.g. codeine; methylphenidate HCl (Ritalin), phenytoin (Dilantin),
imipramine, anticholinergics that may be used to treat neurogenic bladder (1,3)
and excessive or long-term use of laxatives, suppositories, or enemas, which can
affect bowel motility or muscle tone and lead to more constipation and reliance on
medications
• Unable to communicate need
• Behavioral withholding (encopresis)
• Excessive fluid losses (e.g. due to constant drooling, chronic vomiting, or fever)
• Inadequate fluid intake
• Inadequate fiber intake
• Underfeeding or malnutrition
• Cow milk protein allergy. This has not been well documented and requires further
confirmation with double-blind studies (6). A time limited trial of a cow milk
protein free diet is only recommended when other medical interventions and
behavioral strategies have been exhausted (1,3).
The treatment of chronic constipation can involve increased intake of dietary fiber
and fluids, a routine toileting schedule and proper positioning, increased exercise
or massage, and use of stool softeners or laxatives (1,3). Evacuation of the bowel,
usually accomplished with enemas or suppositories, is necessary in cases of
impaction (3). A list of laxatives and description of mechanisms is provided in Table
6-1.
When using any form of laxative, it is recommended to gradually decrease the
amount of laxative required over a period of two to three months to a level that
maintains one stool/day and prevents pain or straining (1). In a period of three to
six months, discontinuation of the laxative is possible in about 50% of patients, with
normal elimination then maintained via dietary and toileting practices (1,3).
Several controversies exist regarding the use of a high fiber diet in children, the use
of mineral oil, and the use of highly osmotic liquids such as corn syrup. The following
briefly summarizes the issues and conclusions.
72 Nutrition Interventions for Children With Special Health Care Needs