Guide for Managing Constipation in Children · 2018-08-17 · Guide for Managing Constipation in Children: A Tool Kit for Parents These materials are the product of on‐going activities

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

Guide for Managing Constipation in Children - An Autism Speaks ATN/AIR-P Tool Kit

p.1

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


p.13

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


Magnesium citrate(brandnames:Citro-Mag)

Oral Osmotic • Overthecounter• Extracareisneededifachildhasheartorkidney


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)

Common “Clean Out” MedicinesGuide for Managing Constipation in Children - An Autism Speaks ATn/AIR-P Tool kit

p.14

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


p.15

**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

Guide for Managing Constipation in Children - An Autism Speaks ATn/AIR-P Tool kit

p.17

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

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Documents

Guide for Managing Constipation in Children · 2018-08-17 · Guide for Managing Constipation in Children: A Tool Kit for Parents These materials are the product of on‐going activities