guide for managing constipation in children · 2018-08-17 · guide for managing constipation in...
TRANSCRIPT
Guide for Managing Constipation in Children:
A Tool Kit for Parents
These materials are the product of on‐going activities of the Autism Speaks Autism Treatment Network, a funded program of Autism Speaks. It is supported in part by cooperative agreement UA3 MC 11054, Autism Intervention Research Network on Physical Health (AIR‐P Network) from the Maternal and Child Health Bureau (Combating Autism Act of 2006, as amended by the Combating Autism Reauthorization Act of 2011), Health Resources and Services Administration, Department of Health and Human Service to the Massachusetts General Hospital.
Overview of Constipationa. What is it?b. Whatcausesconstipation?c. Isconstipationharmful?
Impaction and Encopresis
Daily Treatment of Constipation
Increasing Fiber in Your Child’s Diet
Increasing Fluid Intake
Bowel Habit Training
Daily Medicines for Constipation
Medicines for Impaction
How to Give an Enema
Stool Diary
Treatment Plan/Action Plan
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Manychildrenhaveconstipation.Childrenwithautismmighthavemoreproblemswithconstipationthanotherchildren.Difficultywiththingslikesittingonthetoiletandeatingdifferentfoodscanmaketreatingconstipationchallenging.
Thistoolkitistohelpparentsmanageconstipationintheirchildrenwithautism*.*Inthistoolkittheterm“autism“willbeusedtodescribechildrenwithalltypesofAutismSpectrumDisorders,includingAutisticDisorder,Asperger’sDisorder,andPervasiveDevelopmentalDisorder,NotOtherwiseSpecified(PDD-NOS)
Table of Contents
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Managing Constipation in Children
1. WithholdingSomechildrenholdtheirstoolinandtrytostoptheurgetohaveabowelmovement.Thismayhappenformanyreasons,suchas:• fearofthetoilet• notwantingtouseadifferenttoilet• notwantingtotakeabreakfromplay• worrythathavingabowelmovementwillhurt
2. Toilet TrainingChildrenresistandtrytoholdinstoolswhentheyarebeingtoilettrained.Sometimesthisbecomesahabit.Habitscanbehardtochange.
3. Diet ProblemsFiber:Noteatingenoughfiber,foundinfruits,vegetables,andwholegrainsDairy:Anallergytocow’smilkorintakeoftoomuchdairyfoods(milk,cheese)Water/Fluids:Notdrinkingenoughwaterorotherfluids,especiallywhensickIllness:Changesinachild’sappetiteordietbecauseofillness
4. Changes in RoutineTravel,hotweatherorstresscanaffectthewaybowelswork.
5. MedicationSomemedicines,suchasantacids,antidepressantsandsomeADHDdrugscancausehardstools.
6. Medical ConditionsChildrenwhohavedifficultyusingtheirmuscles,havelowmuscletoneorhaveCerebralPalsycanhaveproblemswithconstipation.Othermedicalconditionssuchasproblemswithglutenorcaseincouldfirstbeidentifiedbecauseofconstipation.
What causes constipation?
Constipationiswhenachildhas:• Hardstools• Painortroublepassingstool• Lessthanthreestoolsperweek
What is constipation?TAlk TO YOuR CHIlD’S DOCTOR
OR nuRSE. HE/SHE CAn HElP YOu
knOW IF YOuR CHIlD HAS COnSTIPATIOn.
Impaction
Some (not all) children with constipationhave this problem. Impaction is when achild has a large, hard stool in the colon.Thismakesithardforthechildtopassstool.Your child’s doctor or nurse can feel it bypressingonthelowerstomachorbylookingatanx-ray.
Manychildrenwithimpactionhavealossofappetiteandare less interested inphysicalactivity. After passing the stool, the childfeelsbetterandsymptomsimprove.
EncopresisSome(notall)childrenwithconstipationhavethisproblem.Encopresisistheleakingofliquidstoolinachildwhoisconstipated.Thisisacommonproblem.
Encopresisdevelopswhenachildholdsstoolanditbecomesdifficulttopass.Thestoolbecomeslargerandmoredriedout.Whenlargestoolsareheldintherectum,therectalmuscles become tired and relaxed. When thesemuscles relax, liquid stool can oozearoundthelargestoolmassandleakintotheunderwear.
Thechilddoesnotfeelthepassageofthisliquidstoolandhasnocontroloverthis. Itcanhappenmanytimesduringthedayandresultindirtyunderwear.Sometimespeopleconfusethiswithdiarrhea.Thisisnotdiarrheabecausemostofthestoolinthebowelishard.
Many childrenwhohaveencopresishavea lossof appetiteandare less interested inphysicalactivity.Afterpassingthestool,thechildfeelsbetterandsymptomsimprove.
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Impaction and Encopresis
Treatment of constipation focuses on three main areas. Talktoyourchild’sdoctorornursetoknowifthesetreatmentsarerightforyourchild:
• Increasing fiber inthedietwilladdbulktothestoolandmakeiteasiertopass.• Giving more fluids,especiallywaterandjuice,willhelpsoftenthestoolandhelpwith
constipation.
Gotopage4formoreinformation
• Regular Exercise Physicalactivityhelpsthemusclesinthebellytomovestoolthroughthelargebowel.Regularactivitysuchaswalking,jumpingrope,playingtag,ridingabike,andswimmingwillhelpwithconstipation.
• Bowel Habit Training Itisimportantforachildtousethetoiletassoonashefeelstheurgetogo.Thebestwaytoteachthisistohaveregular“toiletsittingtimes.”
Gotopage 7 formoreinformation
• Medicineisoftenneededtohelpchildrenhaveregular,softbowelmovements.• Dailymedicinesareusedeveryday.• “Cleanout”medicationsareusedonlywhenachildhasalargestoolthatishardtopass.
Gotopage 11 formoreinformation
1. Diet Changes
2. Behavior Changes
3. Medicine
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Daily Treatment of Constipation
Adietthatishighinfiberpromotesregularbowelmovementsandcanhelpwithconstipation.
Fiberisasubstanceinfoodthebodycannotbreakdown.Therearetwotypesoffiber,solubleandinsolublefiber.Solublefiberpullswaterintothegut.Insolublefiberaddsbulktothestoolandkeepsitmovingthroughtheintestine.Bothkindsoffiberareneededforsoftstool.
Fiberisanimportantpartofahealthydiet.Foodssuchasfruit,vegetables,wholegrains,beans,lentils,peas,nutsandseedsarehighinfiber.Theyalsohaveprotein,vitaminsandminerals.Eatingavarietyofthesefoodsisthebestwaytogetplentyoffiber.
Recommended Amounts of Fiber
Finding Fiber
Average Intake (AI) for FiberAge Males
(g/day)Females (g/day)
1 to 3 years 19 194 to 8 years 25 259 to 13 years 31 26
Whenchoosingpackagedfoods,checktheNutritionFactslabeltoseehowmuchfiberaproductcontains.Itwilllisttheamountoffiberperserving.Goodchoicesforfiberwillhaveatleast2gramsoffiberperserving. Look at the ingredients section for whole grains,
whole wheat flourand oats. Some ofyourchild’s favoritefoods are availablewith whole grainand may thencontain more fiber.Lookforwholegraincheese crackers,whole grain whitebread, and higherfiber cereals at thegrocerystore.
High-Fiber Foods Serving Amount of Fiber (g)
Navy beans 1/2 cup 9.5Bran cereal 1/2 cup 8.8Kidney beans 1/2 cup 8.2Black beans 1/2 cup 7.5Baked sweet potato (with peel)
1 4.8
Pear (with skin) 1 small 4.3Raspberries 1/2 cup 4.0Baked potato (with skin)
1 3.8
Almonds 1 oz 3.3Apple (with skin) 1 3.3Banana 1 med. 3.1Orange 1 med. 3.1Plain oatmeal 3/4 cup 3.0Crunchy peanut butter 2 Tbsp 3.0Cheerios 1 cup 3.0Broccoli 1/2 cup 2.8Peas 1/2 cup 2.5Avocado 1/4 fruit 2.3Corn 1/2 cup 1.6Strawberries 1/2 cup 1.5Wild rice 1/2 cup 1.5Raisins 1/4 cup 1.4Air popped popcorn 1 cup) 1.2
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InCREASInG FIBER In YOuR CHIlD’S DIET
Increasing Fiber and Fluid IntakeItisagoodideatogivechildrenfiber-richfoodsatayoungagesoitwillbecomealifelonghabit.
Itisimportanttoincreasefiberslowlyovertwotothreeweeksifyourchildiscurrentlyconstipated.Youcanaddonenewhighfiberfoodevery2-3days.Increasingfibertooquicklycanmaketheconstipationworseorcausegas,crampinganddiarrhea.
Increasingfiberhelpswithconstipationonlyifthechildalsodrinksmorefluid.Makesureyourchilddrinksmorewaterandjuicewheneatingmorefiber.
Fun Ways to Increase Dietary FiberChildrenwithautismoftenresistdietchanges.Familiesoftenneedtobepatientandtrymanydifferentthings
• Switchtowholegraincrackersandpasta.• Trywholewheatbreadandpizzacrust.Manybrandsmakewholewheatbreadthatlookswhite.• Usewholegraincerealorairpoppedpopcornasacrunchysnack.• Giveyourchildsnacksofdriedfruit(suchasprunes,raisins,driedcranberries)andnuts.• Makesmoothieswithfrozenfruit,juiceormilk,and
yogurt.• Dipcarrots,sweetpeppersorceleryincrunchypeanut
butter,hummus,orsaladdressing.• Addgratedorpureedvegetablestofavoritefoods,such
aspasta,pizzaandtacos.• Makefunnyfruitfacesorfruitkabobs.• Offerhealthydipssuchaspeanutbutterorflavored
yogurtwithslicesoffruit.• Bakewithwholewheatflourwhenmakingbreads,
cookies,muffinsandcakes.
kid Friendly FoodsGrams (g) of Fiber
per ServingWholeGrainGoldfish 2FruitLoops 3FrostedMiniWheats 6BrownRiceKrispies <1WholeGrainPop-Tart 3Cheerios 3KashiCereal 9WholeWheatRitzCrackers 1TriscuitCrackers 3
If you are not able to increase fiber in your child’s diet, talk to your doctor or nurse. He or she might suggest a fiber supplement.
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Waterisneededtokeepthebodyhealthy.Watercanbefoundinthefoodsthatweeatandotherfluidsthatwedrink.Whenincreasingthefiberinyourchild’sdiet,itisimportanttoincreasefluidaswell.
• Givewaterbetweenmeals,sochildrenwillnotfeelfullbeforeeating.
• Givewaterorjuicyfruitssuchasgrapes,orangesorwatermelon, asasnackbeforeactivities.
• Keepabottleorcupofwaterhandyforyourchildtotakesipsanytime.Addawedgeofcitrusfruittowatertogiveitmoreflavor.Ortryasplashofunsweeteneddrinkmix.
• Showagoodexample.Childrenaremorelikelytodrinkwaterwhentheyseetheirparentsandsiblingsdrinkingwatertoo.
usual Water intakeAge Boys (oz/day) Girls (oz/day)1 to 3 years 45-50 45-50
4 to 8 years 60-65 60-65
9 to 13 years 85-90 75-80
Types of Fluid:
“Followyourthirst”–Theamountofwaterachildneeds to drink every day can change based onactivitiesandthe foodthat thechildeats.That iswhyitisimportanttopayattentiontoyourchild’sthirstcues.
Clear,paleyellowcoloredurineisagoodsignthatyour child is drinking enough water. Darker, teacoloredurineusuallymeansheor she should bedrinkingmorewater.
How much fluid is enough?
Itisimportanttoincreasefluidswhenincreasingfiber.Fluidswillhelpsoftenthestoolandmakeiteasiertopass.
• Somejuices(pear,appleorprune)areanaturallaxative.Giveplentyoffluidsbetweenmealstokeepthestoolssoftandregular.
• Fluidsthatcontainalotofsugarorcaffeineand“vitamin-enriched”drinkscanmakeconstipationworse.
Fluids & Constipation
Tips to Increase Fluid Intake:
1. Water: bestsourceoffluid2. 100% juice: healthychoices,butshouldbelimited:
• 4-6ozperdayforchildrenlessthan6yearsold• 8-12ozperdayforchildrenolderthan6• Sugarsincertainjuices(pear,apple,prune)area
naturallaxativeandcanhelpwithconstipation.3. Milk:
• animportantpartofchild’sdiet• toomuchmilkcanalsocauseconstipation• Aimfor16-24ozperday(2-3cups).
4. Electrolyte drinks, sports drinks: • oftenhaveaddedsugars• notusuallyagoodchoiceforchildren• checkwithyourdoctorornursebeforegiving
themtoyourchild.5. Fruit drinks, soda:
• oftenhaveaddedsugars• notusuallyagoodchoiceforchildren• saveforspecialoccasionsoroccasionaluse.
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InCREASInG FluID InTAkE
Animportantwaytohelpconstipationistoteachyourchildtousethetoiletassoonasheorshefeelstheurge.Childrenlearnthisbestwitharegulardailytimetositonthetoilet.Onceyourchildgetsusedtosittingonthetoilet,hemaybeabletorelaxthemusclesthatholdinstool.Byhavingadailytimetodothis,yourchildwillholdinstoollessoften.Whenachildnolongerholdsinstool,thecolonreturnstoanormalsizeandfeelinginthecolonreturns.
1.Bepatientwithyourselfandyourchild.Teachingnewskills,especiallythisone, is not easy.
2.Startbyteachingyourchildtositonthetoilet,evenifhedoesnothaveabowelmovement.• Startwith1-2minutes.Slowlyincreaseupto10-12minutes.• Tryusingatimertohelpyourchildknowhowlongtosit.• Providequietactivitiesthatyourchildcandowhilesittingonthetoilet.Ideasincludebooks,
drawing,handheldcomputergames,music,andbooksontape.• Trysavingspecialactivitiesforuseonlywhilesittingonthetoilet.• Praisesmallimprovements.• Neverforceachildtositonthetoiletorholdachildonthetoiletunlessyouareworkingwith
abehaviorspecialistwhocanhelpyoudothissafely.
3.Pickadailytimeforyourchildtousethebathroom.• Aregularschedulewillhelpthebodydevelopanormalbowelpattern.• Childrenwithautismoftenlikeroutines.Havingtoiletsittingaspartoftheusualschedulecan
reduceresistance.• Trycreatingapictureschedulethatincludesbathroomtime.• Ifyourchildhasaregularpatternofbowelmovements,planthetoiletsittingatthosetimes.• Morningisagoodtimeformostpeople,butcanberushedforchildrengettingreadyfor
school.• Afterschoolisagoodtimeforsomechildren.
4.Helpyourchildbecomfortable• Chooseatoiletorsmallpottythatis
comfortableforyourchild.• Useachildseatifthetoiletseatis
toolargeforthechild.• Useastoolifthechild’sfeetdonot
touchtheground.
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BOWEl HABIT TRAInInG
How to set up a daily toilet sitting time:
1. Makesureyourchildissittingonthetoilet1-2timeseachday.2. Teach“poopgoesinthetoilet”byemptyingdirtydiapersor
underwearintothetoilet.3. Trytomatchtoiletsittingtimewithwhenyouthinkyourchild
mighthaveastool.4. Beforetoiletsittingtime,trytostimulatethegastrocolicreflex.
Thisnaturalreflexhappensaftereatingordrinking.Itallowsthecolonmusclestoclearthebowelsaftereating.To stimulate this reflex, try having your child: •Eatasnackormeal •Drinkawarmdrink
5. Watchyourchild’scues.Whenyouseesignsheorshemightneedtohaveabowelmovementtakehimorhertothebathroom. Cues might include: •Changeinfacialexpression •Goingofftoaquietpartofthehouse •Straining
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How to Teach Stooling on The Toilet
• Beginbygivingyourchildarewardfortheactofsittingonthetoilet.• Asyourchildbeginshavingabowelmovementonthetoilet,begingivingarewardforthis.• Rewardsworkbestwhentheyaresmallandgivenrightafterthebehavioryouwant.• Overtime,spreadouthowoftenyougivethereward.
Rewards:Trynottousefoodasareward.Instead,consider:• Singingorplayingaspecialsong• Hugs,high-fives,verbalpraise• Stickerorstarcharts• Playingaspecialgame• Timedoingapreferredactivity• Tickets(availableatofficesupplystores),poker
chips,orothertokensthatthechildcansavetoearnlargerrewards(triptomovieorpark)
Childrenwithautismoftenhavespecialinterests.Usethesewhenplanningrewards.Ifyourchildisinterestedin
cars,haveautomagazinesforrewards.Ifyourchildlikestrains,havetrainstickers.
Positiverewardsaremuchmorelikelytoresultindesiredbehaviorchangesthananypunishmentorcriticism.When your child soils:• Saysomethinglike“Inoticeyou’vehadanaccident”or“pleasecleanyourselfup”.• Givehelpwiththesetasksasneeded.• Avoidscoldingchildorgivingattentionforsoiling.
Thebestrewardsareextra adulttimeandattention.
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Positive Reinforcement
• Haveyourchildmovealittleclosertothebathroomeachtimeheisstartingtohaveabowelmovement.Worktowardhavingyourchildhavethebowelmovementinthepull-upwhilestandinginthebathroom.
• Whenyourchildhasabowelmovementinthepull-up,dumpthebowelmovementintothetoilet.Theparentcansaysomethinglike,“Poopgoesinthepotty.”
• Practicesittingonthetoiletwiththelidclosedandthepull-upon.Givingyourchildatoytoholdatthistimemaybehelpful.
• Overtime,worktowardhavingyourchildsitonthetoiletwiththelidupandpull-upon.
• Onceyourchildiscomfortablesittingonthetoiletwiththelidup,cutasmallholeinthepull-up.Overtime,increasethesizeoftheholeinthepull-up.Tryhavingyourchildkeepthispullupon,whilesittingonthetoilettohaveabowelmovement.
When Your Child Is unwilling To Sit On The Toilet
Itisoftendifficulttomakechangesathome.Toiletingcanbeaverychallengingbehavior.Sometimesfamiliesneedhelp.Signsachildorfamilymightneedmorehelp:
• Childbecomesveryupsetwhentakentothetoilet• Childisholdingstoolmore• Constipationisgettingworse• Childishavingtantrumsoraggressionwithtoileting
Don’tbeafraidtolookforexpertswhocanhelpyouandyourchild.
Experts who might help:childpsychologist,socialworker,behavioranalyst.Yourchild’sdoctor,nurse,orschoolteammaybeabletohelpyoufindanexperttohelp.
Help From A Specialist
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• Canbeginrightawayifthechildhasnoimpaction• Usuallytakenbymouth• Workbestifitisgiveneveryday
Goal of medicine• Softbowelmovement(likemashedpotato)everyday• Allofstoolinrectumispassed
Medicine Dose• Yourchild’sdoctorornursewillprescribeastartingdose.Sometimesthedosewillneedtobe
changed.Talkwithyourchild’sdoctorornurseaboutthis.Heorshewillhelpyouadjustthedose.
• Signsyourmedicinemightneedtobeincreased:• Stoolsaresmallandhard• Childdoesnothaveastooleveryday• Childhasahardtimepassingstool,orhaspain
• Signsthemedicinemightneedtobedecreased:• Stoolislooseorwatery• Childhasbellypainorcramps
length of Treatment • Usuallyatleast6months• After6monthsofdailystools,yourchild’sdoctorornursemaydecidetoslowlydecrease
medicine• Ifmedicineisstoppedbeforethecolonandrectumhavereturnedtonormal,constipationwill
occuragain.• Itisimportanttomakesurethechildcontinuestohaveasoftstooleachday.
Therearethreetypesoflaxatives.Theyworkindifferentways.
1. Osmotic laxatives Bringwaterintothestooltokeepitsoft.Safeandcommonlyusedinchildren.Usuallygiveneveryday.Canbeusedlong-term.
2. Stimulant laxatives Helpthecolonmusclescontractandmovethestoolthroughthebowel.Usuallyusedonoccasion.
3. lubricant laxatives Makestoolgreasysoitpassesthroughtherectumeasier.
Examples:Polyethyleneglycolwithoutelectrolytes,magnesiumhydroxide,magnesiumcitrate,lactulose,sorbitol,phosphatesodiumenema.
Examples:senna,bisocodyl
Examples:mineraloil,glycerinsuppository.
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REGulAR DAIlY MEDICInES
How Do Medicines Help Constipation?
Medicine name notesPolyethylene glycol
(Brandname:PEG3350,DucolaxBalance,MiraLax)
• Overthecounter• Notastepowder• Mixedwithatleastonefullcupofjuiceor
water• Isdescribedas“tasteandtexturefree”,
butmayberejectedbysomechildrenwithautism
• MixesbestwithliquidatroomtemperatureMagnesium hydroxide
(Brandname:FleetPedia-Lax,Ex-LaxMilkofMagnesia,PhilipsMilkofMagnesia,Pedia-LaxChewable)
• Overthecounter–liquidorchewable• Comesastabletandliquid• Extracareneededforthosewithkidney
orheartproblems,oriftakingothermedications
lactulose
(Brandname:Constulose,Enulose,Generlac,Kristalose)
• Prescriptiononly• Liquid• Extracareneededforthosewithdiabetes
Sorbitol • Overthecounter• Presentinapple,pruneandpearjuice• Canbeprescribedasaliquidsolution
Senna
(Brandname:Senokot,Ex-lax,Fletcher’sCastoria,Nature’sRemedy)
• Overthecounter• Generallyusedforshortperiodoftime
(upto2weeks)
Bisacodyl
(Brandname:Dulcolax,Correctol)
• Overthecounter• Tablet,shouldnotbecrushedorchewed• Generallyusedforshortperiodoftime
Common Daily Oral Medicines For Constipation
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Fecalimpactionoccurswhenchildrenwithconstipationgetalarge,hardstoolinthecolon.Thismakesithardtopassthestool.Ifyourdoctorornursethinksyourchildhasastoolimpaction,heorshewillprescribemedicinefor“cleanout”asafirststeptotreatingconstipation.
Yourdoctorornursewillworkwithyoutodecideonthebesttypeofmedicine.Sometimesmedicinetakenbymouthisbest.Sometimesmedicinethatisputintotherectumisbest.“Cleanout”usuallytakes2-3days.Itisagoodideaforcleanouttobedoneoveraweekendorschoolbreak.Yourchildwillneed2-3dayswithatoiletnearbyandtimetousethetoiletfrequently.
Yourchild’sdoctorornursepractitionerwillprescribetherightmedicineforyourchild.Heorshewilltellyouhowoftentogiveitandforhowlong.
Oral Medicine Rectal Medicine (enema or suppository)
PROS COnS PROS COnS
• Lessinvasive• Mayhelp
thechildfeelmoreincontrol
• Childmightnotliketaste
• Hardforsomechildrentodrinklargeamountsofliquids
• Worksmorequicklythanoralmedicine
• Insertingmedicineintherectumcouldupsetthechild
• Maycausestomachdiscomfort
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MedicATionS To TReAT iMPAcTion
Medicine name How given (oral or rectal) Type of medicine notes
Polyethylene glycol-electrolyte solution(brandnames:Colyte,GoLYTELY,NuLYTELY,TriLyte)
Oral Osmotic • Prescriptionneeded• Extracareisneededifachildhasheartorkidney
problemsoristakingothermedications
Polyethylene glycol(Brandname:PEG3350,DucolaxBalance,MiraLax)
Oral Osmotic • Overthecounter• Notaste• Mixedwithafullcupofjuiceorwater• Describedas“tasteandtexturefree”,butmaybe
rejectedbysomechildrenwithautism• Mixesbestwithliquidatroomtemperature
Mineral oil Oralorrectal Lubricant • Overthecounter• Rarelyusedbecauseofdangerifitgetsintothelungs
andbadtaste.Cannotbegivenbymouthifchildhasproblemswithbreathingorswallowing.Shouldnotbegivenforcefullyduetoriskofgettinginlungs
Magnesium hydroxide (brandnames:FleetPedia-Lax,Phillips’MilkofMagnesia)
Oral Osmotic • Overthecounter• Extracareisneededifachildhasheartorkidney
problemsoristakingothermedications
Magnesium citrate(brandnames:Citro-Mag)
Oral Osmotic • Overthecounter• Extracareisneededifachildhasheartorkidney
problemsoristakingothermedications
Phosphate sodium enema(brandnames:FleetEnema,Pedia-LaxEnema,LaCrosseComplete)
Rectal Osmotic • Overthecounter• Extracareisneededifachildhasheartorkidney
problemsoristakingothermedicationslactulose (brandnames:Constulose,Enulose,Generlac,Kristalose)
Oral Osmotic • Prescriptiononly• Usewithcautioninchildrenwithdiabetes
Sorbitol Oralorrectal Osmotic • Prescriptiononly• Usewithcautioninchildrenwithdiabetes
Senna (brandnames:Sennosides,Senokot)
Oral Stimulant • Prescriptionoroverthecounter• Maynotseeeffectfor2-3days
Bisacodyl(brandnames:DulcoLax,ExLax,Fleet,Correctol)
Oralorrectal Stimulant • Overthecounter• Iftakenbymouth,itshouldbetakenonanempty
stomachwithwaterGlycerin suppositories Rectal Lubricant • Overthecounter
(Give only as recommended by your child’s doctor or nurse)
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Mostofthetimechildrentakemedicinesbymouthforconstipation.Sometimeschildrenneedmedicineintheirrectum.Youshouldtalktoyourdoctorornursetodecideifthisistherighttreatmentforyourchild.Donotgiveanenemawithouttalkingtoyourdoctorornursefirst.Thissheetwillhelpyoulearnhowtogiveanenemaifthisisneeded.
Preparing Your Child:• Explainenemainwordsyourchildwillknow.• Letyourchildlookatandtouchtheenemabottle,andtip.• Rubthecoveredtipagainsthisarmtoshowwhatitwillfeellike.• Helpyourchildpracticelyingonhisside.
Getting Ready:• Readtheinstructionsheetthatcomeswiththeenema.Thepicturesanddirectionsmaybe
helpful.• Makesureenemaisatroomtemperature.• Gathersupplies:
• Enemabottle• Towelforchildtolieon• Pillows• Music,favoritetoy,orothercomfortitem• Washcloths,clean-upsupplies
• Decidewheretogiveenema.Itmaybegoodtohaveyourchildlieonablanketortowelonthebathroomfloorornearatoilet.
• Setuptowelsorpillowstomakechildcomfortablewhenlyingdown.
• Askasecondpersontohelpbyfacingyourchildandreading,singing,playingmusicandhelpingyourchildholdstill.
How to Give an Enema
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**If,atanytime,yourchildbecomesveryupset(crying,screaming,kicking),itisoktostop. Youcantalktoyourdoctorornurseaboutotherwaystotreatconstipation.**
1. Washyourhands.2. Takethecoveroffthetipoftheenema.Thetipwillhavelubricantonittomakeit
easiertoinsert.3. Helpyourchildlieonhisleftsidewithhiskneesbenttowardhischest.
Haveyourhelpertalkorsingtoyourchild.
4. Holdthebottleinonehand.Withyourotherhand,separatethebuttockcheeksuntilyoucanseetheanalopening.
5. Gentlyinsertthetipofthebottleintotheanalopening.Youshouldnothavetoforceit.
6. Pointthetipoftheenemadevicetowardthechild’sbackafteritisinserted.Contentsshouldbedirectedtowardthebowelwallandawayfromthemassofstool.
7. Squeezethebottleuntilthecorrectamountisnearlygone.8. Ifpossible,trytokeepthechildlyingdownfor15-20minutes.Youcanholdthe
buttockstogethertokeepyourchildfrompushingtheenemaouttoosoon.9. Ifyourchildwearsadiaper,puthisdiaperon.10.Ifyourchildusesthetoilet,after15-20minutes,havechildsitontoilet.Enema
fluidwillcomeoutintothetoilet.Stoolshouldalsocomeout.
Giving The Enema
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Usethespacebelowtokeeptrackofyourchild’sstoolasyoumakechanges
Date Medicine & Dose # Stools Today
Stool: Hard, Soft or loose?
Pain with Stooling (yes/no)
Overall Symptoms (better, worse,
the same)
notes (behavior, appetite, sleep, other)
Stool Diary
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Forquestionsorproblems,call:
Name:_____________________________
Phone:____________________________
To be completed by your child’s doctor or nurse so that you know how best to manage your child’s constipation
DoingWell:Stools every 1-2 days NostrainingorpainStoolissoft
Constipationworsening:
no stool in 2-3 days
somepain,orhardstools
Alert!no stool in 5 or more daysStomachpain,vomiting,.
Payattention:More than 3 stools each
day
DailyMedicineName:Dose:HowOften:
**Continuestoolsofteners,highfiberdiet,increasedfluidintake,exerciseandscheduledtoiletbreakseveryday.
In addition to your Green Zone medicine, you can:• Increase your:
• If your symptoms do not return to the GREEn zone after 3 days of treatment then add:
• First,Take:
• Second,callyourdoctornowforhelp
DoeschildseemtohaveGIillness(fever,vomiting,waterystools,diarrhea)?Stopconstipationmedicinesfor3daysoruntildiarrhearesolves•Calldoctorfor:Refusingliquids,darkurine,loosestoolsfor___days
Notes:
Notes:
Notes:
Notes:
Nofever,vomitingorsignsofillness?Changedailymedicine:DoseHowoften:
Adapted from Stafford B, Wills H, Punati J, Deavenport A, Yin l. Constipation Action Plan. (C) 2012 Children’s Hospital los Angeles. All Rights Reserved
Constipation Action Plan
Guide for Managing Constipation in Children - An Autism Speaks ATn/AIR-P Tool kit
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This publicationwaswritten by Linda Howell, RN, Johanna Stump,MS, PNP, BrianneSchmidt,MS,RD,andLynnCole,MS,PNP(LeadAutismSpecialist,UniversityofRochesterAutismTreatmentNetworkSite). TheconstipationactionplanwasadaptedfromworkofBethanyStafford,M.D.,HopeWills,MA,RD,CSP,JayaPunati,MD,AlexisDeavenport,DrPH, and Larry Yin, MD,MSPH at Children’s Hospital Los Angeles Autism TreatmentNetworkSite. Wearegrateful for reviewandsuggestionsbymany, including theATNFamily Advisory Committee, GI Committee, Behavioral Sciences Committee, and theUniversity of RochesterMedical Center’s Pediatric Practice. For revision information,[email protected].
These materials are the product of on-going activities of the Autism Speaks AutismTreatment Network, a funded program of Autism Speaks. It is supported in part bycooperativeagreementUA3MC11054,AutismInterventionResearchNetworkonPhysicalHealth(AIR-PNetwork)fromtheMaternalandChildHealthBureau(CombatingAutismActof2006,asamendedbytheCombatingAutismReauthorizationActof2011),HealthResourcesandServicesAdministration,DepartmentofHealthandHumanServicestotheMassachusettsGeneralHospital.ItscontentsaresolelytheresponsibilityoftheauthorsanddonotnecessarilyrepresenttheofficialviewsoftheMCHB,HRSA,HHS.ImagesforthistoolkitwerepurchasedfromiStockphoto©,and123RF©.WrittenApril2013.
TheAutismSpeaksFamilyServicesDepartmentoffersresources,toolkits,andsupporttohelpmanagetheday-to-daychallengesoflivingwithautismwww.autismspeaks.org/family-services. IfyouareinterestedinspeakingwithamemberoftheAutismSpeaksFamilyServicesTeamcontacttheAutismResponseTeam(ART)at888-AUTISM2(288-4762),[email protected].
ARTEnEspañolal888-772-9050
Resources
Acknowledgements
Guide for Managing Constipation in Children - An Autism Speaks ATN/AIR-P Tool Kit
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