Management of constipation in children with disabilities

Elawad, Mamoun; Sullivan, Peter B.

doi:10.1111/j.1469-8749.2001.tb00171.x

Cited by 21 publications

(29 citation statements)

References 20 publications

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“…In accordance with previous observations, we found that fibre intake was inadequate in nearly 53% of our study population; 8,9 however, we found no relation between fibre intake and constipation. This is in concordance with previous studies in children with 4,23 and without neurological impairment.…”

Section: Discussionsupporting

confidence: 92%

“…For each child, the daily average intake of fibre (g) and water (mL) was calculated, as these nutrients are reported to influence stool frequency. 9,10,14,17 Recommended fibre and water requirements were calculated for each child individually and subtracted from the mean daily intake. Fibre requirement was based on age (recommended minimal daily fibre intake=age+5g) 18 and water intake was based on weight (<10kg, weight · 100mL; 10-20kg, 1000 + 50 · [weight-10]mL; >20kg, 1500 + 20 · [weight-20]mL).…”

Section: Discussionmentioning

confidence: 99%

“…Because most children with severe disabilities need to use nappies, faecal incontinence as part of a definition of constipation cannot be extrapolated to children with neurological impairment. 9 Furthermore, a difficulty that we faced in determining the presence of constipation was that the national ethics committee did not allow us to perform rectal digital examination in our participants on the grounds that this procedure is too invasive for this particular population. Despite the controversy on this subject, a recently published guideline recommends that digital rectal examination should be performed at least once when assessing constipation in children.…”

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confidence: 99%

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Prevalence and clinical presentation of constipation in children with severe generalized cerebral palsy

Veugelers

Benninga

Calis

et al. 2010

Develop Med Child Neuro

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AIM Our aim was to study the prevalence and characteristics of constipation in children with profound multiple disabilities, as data in this area are scarce.METHOD A cross-sectional observational study was performed in specialized day-care centres and schools in the Netherlands. The study included 152 children (81 males, 71 females; mean age 9y 6mo, SD 4y 6mo). Intellectual disability ranged from moderate (7%) to profound (52%) in all participants who also had severe motor disabilities (83% classified at Gross Motor Function Classification System level V). We collected data on defaecation characteristics, food and fluid intake, and laxative consumption using standardized bowel diaries and interviews. Constipation was defined as (1) scybalous, pebble-like, hard stools in over a quarter of defaecations in combination with a defaecation frequency of less than three times per week during a 2-week study period; (2) large stools palpable on abdominal examination; or (3) laxative use or manual disimpaction of faeces. RESULTSOf the studied population, 57% were constipated and 55% used laxatives, 27% of whom showed symptoms of constipation. Daily intakes of water and fibre were below the required standards in 87% and 53% of participants respectively, without a proven relation to constipation.

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Section: Discussionsupporting

confidence: 92%

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

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Prevalence and clinical presentation of constipation in children with severe generalized cerebral palsy

Veugelers

Benninga

Calis

et al. 2010

Develop Med Child Neuro

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“…São realizadas orientações dietéticas com aumento da ingestão de fibras e de ingestão hídrica adequada, mas como a fisiopatologia envolve alterações neurológicas, pode ocorrer pouca ou nenhuma resposta com essas medidas. Também podem ser prescritos uso de laxantes via retal ou medicamentos via oral, como os laxantes osmóticos 69,70 .…”

Section: Constipação Intestinalunclassified

Digestive tract neural control and gastrointestinal disorders in cerebral palsy

Araújo¹,

Silva²,

Mendes³

2012

J Pediatr (Rio J)

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Objectives: To examine the neural control of digestive tract and describe the main gastrointestinal disorders in cerebral palsy (CP), with attention to the importance of early diagnosis to an efficient interdisciplinary treatment.Sources: Systematic review of literature from 1997 to 2012 from Medline, Lilacs, Scielo, and Cochrane Library databases. The study included 70 papers, such as relevant reviews, observational studies, controlled trials, and prevalence studies. Qualitative studies were excluded. The keywords used were: cerebral palsy, dysphagia, gastroesophageal reflux disease, constipation, recurrent respiratory infections, and gastrostomy. Summary of the findings:The appropriate control of the digestive system depends on the healthy functioning and integrity of the neural system. Since CP patients have structural abnormalities of the central and peripheral nervous system, they are more likely to develop eating disorders. These range from neurological immaturity to interference in the mood and capacity of caregivers. The disease has, therefore, a multifactorial etiology. The most prevalent digestive tract disorders are dysphagia, gastroesophageal reflux disease, and constipation, with consequent recurrent respiratory infections and deleterious impact on nutritional status. Conclusions:Patients with CP can have neurological abnormalities of digestive system control; therefore, digestive problems are common. The issues raised in the present study are essential for professionals within the interdisciplinary teams that treat patients with CP, concerning the importance of comprehensive anamnesis and clinical examination, such as detailed investigation of gastrointestinal disorders. Early detection of these digestive problems may lead to more efficient rehabilitation measures in order to improve patients' quality of life.J Pediatr (Rio J). 2012;88(6):455-64: Cerebral palsy, dysphagia, gastroesophageal reflux disease, constipation. ResumoObjetivos: Abordar as peculiaridades do controle neuronal digestório e descrever as principais manifestações digestórias na paralisia cerebral, atentando-se à importância do diagnóstico precoce para intervenção interdisciplinar eficaz. Fontes dos dados:Revisão sistemática de 1997 a 2012 das bases de dados MEDLINE, LILACS, SciELO e Cochrane Library. Incluem-se 70 artigos, como revisões relevantes, estudos observacionais, ensaios clínicos e estudos de prevalência. Excluíram-se pesquisas qualitativas. Os termos pesquisados foram: paralisia cerebral, disfagia, doença do refluxo gastroesofágico, constipação intestinal, infecção respiratória e gastrostomia. Síntese dos dados:O controle adequado do trato digestório depende do funcionamento e integridade do sistema nervoso. Como indivíduos portadores de paralisia cerebral possuem anormalidades estruturais evidentes no sistema nervoso central e periférico, estão mais propensos a desenvolver distúrbios do trato digestório, com repercussões nutricionais. As alterações vão desde imaturidade neurológica até interferência do estado d...

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“…2,4,16 As a result, combined with other problems, constipation may lead to a decrease in quality of life of both children and their families. 4,16,17 Along with laxative drug regimens and diets including fibrous food, there are also some alternative approaches in trial for the treatment of constipation. Probiotics, hypnotherapy, chiropractic methods, and abdominal massage may be considered as alternative treatments.…”

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confidence: 98%