Nutrition Interventions for Children with Special Health Care Needs

Table 6-2 - Nutrition Interventions For Constipation
Assessment Intervention Evaluation/Outcome
Clinical
Regular toileting is established and
followed.
Obtain stool history. Differentiate between acute and
chronic conditions. Determine:
Re-evaluate frequently until regular
bowel movements are occurring every
1-2 days, with a normal consistency.
Work with family to establish regular toileting
schedule and appropriate positioning. Include
a physical or occupational therapist to assist
with appropriate positioning techniques, and
assess the need for any special equipment.
• Stool frequency and consistency
• Toileting techniques
• Primary diagnosis (e.g. Down syndrome, cerebral
palsy, Hirschsprung’s disease)
Work with child’s primary care physician or a medical
consultant to rule out anatomic or neurologic disorder.
Medical contributors to constipation
are controlled.
Provide medical management for physiologic
disorders (e.g. a child with myelomeningocele
who has a neurogenic bowel, which may
require surgery) 1
Obtain the following as needed:
Section 2 - Problem-Based Nutrition Interventions
When a potentially correctable
underlying cause of constipation
exists, re-evaluate need for
medications on a regular basis. If
possible, discontinue and manage with
other methods. (Children who have
neurogenic bowel or who are immobile
often need medications indefinitely.)
Use the following treatments with care:
laxatives (including prunes and prune juice),
stool softeners, suppositories, and enemas.
Certain treatments may be hazardous with
long-term or excessive use, or if there is
impaction or megacolon. 1,3 Some of these may
result in dependency. See Chapter 5 for more
information or see reference 9.
• Rectal exam
• Abdominal x-ray
• Barium enema
• Intestinal biopsy/rectal manometrics
• Colonoscopy
(From early infancy, children with spinal cord anomalies,
e.g. myelomeningocele, need close medical assessment
and monitoring for bowel problems.)
Nutrition Interventions for Children With Special Health Care Needs 77
Recommended activity schedule is
followed. Appropriate massage occurs.
Increase physical activity as tolerated. Obtain
OT/PT consult for instruction on infant/child
massage. 10
Assess level of physical activity.
Dietary
Intake of fluid and fiber is increased.
Counsel caregivers regarding appropriate
dietary changes. 11 Advise the following as
needed:
Assess fluid and fiber intake.
Re-evaluate diet frequently until
stools are of normal consistency and
frequency.
Use food record and/or interview.
Increase fluids, especially water and juice.
For the child who cannot easily swallow thin
liquids, try the following:
Determine food textures that are well-tolerated.