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...ole grains (11,12). These changes may be more successful to implement when the child is feeling better. In our clinic, we have noted a dramatic improvement in intake once the constipation was treated. The final step is behavior modification. Parents are counseled to include routine toilet sitting for 5 minutes 2-3 times a day, and offer praise and rewards for compliant behavior. Maintenance therapy is discontinued only after consistent regular bowel movements are achieved, and may continue for many months. Tolerance and addiction to these agents has not been noted for the majority of patients (10). However, relapse is common, and close follow up is recommended (6,11). In conclusion, although constipation is considered a common pediatric disorder, parents may have difficulty initially identifying a problem. Children may demonstrate constipation and accompanying discomfort in a number of different ways. Once the diagnosis of functional constipation has been diagnosed, key components to treatment includes parent education and persistence with maintenance therapy. Regular follow up and continued support are essential components to therapy. Signs of improvement may include an increase in in...

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...nts a ”deviation of normal” versus a pathologic pattern is not well determined. As a result, little anticipatory guidance is given to parents regarding stooling. Concern for constipation, however, is a very common problem in pediatrics. It is estimated that 3% of all visits to the pediatrician and 30% of visits to the GI are initiated for concerns of constipation. (4). A recent study identified the prevalence rate for constipation in the first year of life at 2.9%, and in the second year of life at 10.1% (9). Studies of older children reported rates up to 37% in children up to 12 years of age (13). Problems with constipation do not only involve frequency of stools and stooling effort; many behavioral, developmental and health consequences can also be associated with constipation, calling for increased awareness from health care providers. The purpose of this article is to review what is already known about constipation and its influence on behavior and health. We would then like to suggest some anticipatory strategies and finally, discuss some interventions. Normal Stooling Motility of the colon and transit time through the gut change with age. Gut transit time increases with age; it h...

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... harder consistency of stool with or without distress to the child (5). Another author defined constipation for infants and preschool children, as the presence of hard, pebble like stools for the majority of stools, or firm stools two times a week or less, with no evidence of structural, endocrine, or metabolic disease (5). Constipation was defined by a group of pediatric gastroenterologists from the North American Society of Gastroenterology and Nutrition (NASPHGAN) as a delay or difficulty in defecation, present for 2 or more weeks and sufficient to cause significant distress to the patient (8). Functional constipation, the most common cause of constipation was defined by an international group of pediatric gastoenterologists in infants and preschool children as at least 2 weeks of scybalous, pebble-like, hard stools for most stools, or firm stools 2 or fewer times per week, in the absence of structural, endocrine, or metabolic disease (9). The most frequent precipitating factor for parents to seek help from a health care professional is the passage of a large, painful stool. Other factors that may contribute to the onset of constipation may include toilet training; a change in sche...

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...ge of 3 months, 4 to 40 stools per week may be considered normal. Infants 6 to 12 months of age may have a frequency of 5 to 28 stools per week. For children ages 1-3 years, the range can be 4-21 stools per week. The expected stool for children over 3 years of age ranges from 3-14 bowel movements per week (6). Expected number of stools also differs depending on what the child is drinking. Breast fed children can stool with each feeding or less than once a day. Bottle fed children may have thicker stools that are harder to pass related to the differences in fats between formula and breast milk (5). Constipation Just as there is great variability in range of normal stool frequency, there are many varied definitions of constipation . Some health care providers consider a decrease in stool frequency- with fewer than 3 stools/week- as a cause for concern. Other definitions include decreased stool frequency accompanied by harder consistency of stool with or without distress to the child (5). Another author defined constipation for infants and preschool children, as the presence of hard, pebble like stools for the majority of stools, or firm stools two times a week or less, with no evidence ...

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...ehavioral, developmental and health consequences can also be associated with constipation, calling for increased awareness from health care providers. The purpose of this article is to review what is already known about constipation and its influence on behavior and health. We would then like to suggest some anticipatory strategies and finally, discuss some interventions. Normal Stooling Motility of the colon and transit time through the gut change with age. Gut transit time increases with age; it has been measured at 8.5 hours for infants 1-3 months and increases to 30-48 hours after puberty (3). In light of this, expected stooling frequency changes with age. However, there is wide variation in what is considered the normal frequency of bowel movements for specific age ranges. One author noted that for infants below the age of 3 months, 4 to 40 stools per week may be considered normal. Infants 6 to 12 months of age may have a frequency of 5 to 28 stools per week. For children ages 1-3 years, the range can be 4-21 stools per week. The expected stool for children over 3 years of age ranges from 3-14 bowel movements per week (6). Expected number of stools also differs depending on what ...

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...ants 1-3 months and increases to 30-48 hours after puberty (3). In light of this, expected stooling frequency changes with age. However, there is wide variation in what is considered the normal frequency of bowel movements for specific age ranges. One author noted that for infants below the age of 3 months, 4 to 40 stools per week may be considered normal. Infants 6 to 12 months of age may have a frequency of 5 to 28 stools per week. For children ages 1-3 years, the range can be 4-21 stools per week. The expected stool for children over 3 years of age ranges from 3-14 bowel movements per week (6). Expected number of stools also differs depending on what the child is drinking. Breast fed children can stool with each feeding or less than once a day. Bottle fed children may have thicker stools that are harder to pass related to the differences in fats between formula and breast milk (5). Constipation Just as there is great variability in range of normal stool frequency, there are many varied definitions of constipation . Some health care providers consider a decrease in stool frequency- with fewer than 3 stools/week- as a cause for concern. Other definitions include decreased stool frequ...

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...verlooked. A regular stooling pattern is desired and yet our understanding of what represents a ”deviation of normal” versus a pathologic pattern is not well determined. As a result, little anticipatory guidance is given to parents regarding stooling. Concern for constipation, however, is a very common problem in pediatrics. It is estimated that 3% of all visits to the pediatrician and 30% of visits to the GI are initiated for concerns of constipation. (4). A recent study identified the prevalence rate for constipation in the first year of life at 2.9%, and in the second year of life at 10.1% (9). Studies of older children reported rates up to 37% in children up to 12 years of age (13). Problems with constipation do not only involve frequency of stools and stooling effort; many behavioral, developmental and health consequences can also be associated with constipation, calling for increased awareness from health care providers. The purpose of this article is to review what is already known about constipation and its influence on behavior and health. We would then like to suggest some anticipatory strategies and finally, discuss some interventions. Normal Stooling Motility of the colon ...

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...ts of the history include present medications taken; age of onset including initial passage of meconium; frequency and consistency and size of stool; crying, bleeding, or other behaviors such as straining, red face, or squatting during passage of stool. Age of toilet training or any accompanying difficulties if applicable may be helpful. Episodes of daytime or nighttime fecal soiling should be ascertained. A dietary history should include changes in formula, appetite, and presence of feeding difficulties. Information as to amount of activity or exercise for older children may also be helpful. (5,11) In our clinic we have also found it helpful for parents when possible to come with a seven-day intake and stooling record. Parents are asked to record solid and liquid intake, with frequency, consistency, and accompanying behaviors during stooling. Diagnosis of functional constipation most often is based on history and physical exam. A fecal mass may be palpated in the suprapubic area; other physical findings include a distended abdomen and hyperactive bowel sounds (5,8). In the absence of any red flag, which can point to an organic cause, no further testing is required. A radiograph may demo...

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...axatives such as Metamucil work by adding bulk and water to the stool, allowing the stool to pass more easily (3). Doses for oral agents may need to be adjusted depending upon effectiveness and tolerance. It is challenging to offer these agents to young children due to taste, and parents THE POWER OF POOP (continued) Dr Peggy Eicher and Louise Vitello, MSN, APNC Volume 6, number 1 are often more successful when they place these in the child’s milk or juice. Dietary changes may be suggested including the introduction or increase of fiber- rich foods such as fruits, vegetables, and whole grains (11,12). These changes may be more successful to implement when the child is feeling better. In our clinic, we have noted a dramatic improvement in intake once the constipation was treated. The final step is behavior modification. Parents are counseled to include routine toilet sitting for 5 minutes 2-3 times a day, and offer praise and rewards for compliant behavior. Maintenance therapy is discontinued only after consistent regular bowel movements are achieved, and may continue for many months. Tolerance and addiction to these agents has not been noted for the majority of patients (10). However, rel...