Definition of Chronic Constipation
Infrequent, hard bowel movements that are usually painful
causing staining and sometime tearing of the rectal mucosa. In toddlers
this is as a result of play habits that interfere with toileting habits and a
vicious cycle set up by the idea that bowel movements have to be painful.
MY "Usual" Treatment Regimen For Infant Constipation
Constipation will almost certainly happen to
any baby, usually around 3-6 weeks. At that time you may need to start
fruit juice (white grape and apple are preferred since they don’t stain clothes
when spitting occurs) – usually ½ ounce of dilute juice twice / day.
Glycerin suppositories (1/4 or a “chip”)
are safe to use frequently during the first few months (despite the dire
warnings on the packaging!) Honey and Kayro (corn)
syrup work well - but in rare cases cause botulism. Soy formulas tend to cause less constipation
than cow’s milks formulas in general.
Repeated passage of feces into inappropriate places (e.g.,
clothing or floor) whether involuntary or intentional. At
least one such event a month for at least 3 months. Chronological age is
at least 4 years (or equivalent developmental level). The behavior is not due
exclusively to the direct physiological effects of a substance (e.g.,
laxatives) or a general medical condition except through a mechanism involving
constipation.
MY
"Usual" Treatment Regimen For Encopresis
1) A mild bowel stimulant such as Senna,
10 to 20 mg/kg/day (the syrup
comes 218mg/5cc). It can be dosed at night or twice a day (prescription)
or a dosage of Fletcher’s Castoria may be suggested
(nonprescription.)
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Sennacot dosing (1-2x/day) |
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5 pounds |
0.5 cc (ml) |
|
10 pounds |
¼ tsp |
|
20 pounds |
½ tsp |
|
40 pounds |
1 tsp |
|
60 pounds |
1.5 tsp |
2) Dulcolax (prescription) or glycerine suppositories (nonprescription) five times per week after the evening meal.
3) Sitting on the toilet 15 minutes twice a day after breakfast and the evening meal (using an egg timer).
4) Increase the fiber content of the child’s diet. (We have a recipe in our office, tried and true by one of our parents for bran muffins. These taste delicious with a cream cheese icing on them.)
5) Pediatric
Fleet's Enema or Magnesium citrate, 2 - 4
ml/k on multiple occasions on the weekend to "clean the child
out.” Three doses should be given every two hours on the weekend days to
produce bowel movements that would evacuate the colonic contents (the bowel).
|
Magnesium Citrate dosing |
|
|
5 pounds |
1-2 tsp |
|
10 pounds |
2-4 tsp |
|
20 pounds |
4 tsp - 2.5 ounces |
|
40 pounds |
2.5 - 5 ounces |
|
60 pounds |
5 - 10 ounces |
Bran Muffins!!!!
|
|
3 c All-bran cereal |
|
Servings: 40 |
6)
Avoiding constipating foods - dairy products such as milk and cheese (this
includes pizza) as well as the actual fruit of the
pear, apple, and bananas.
7) Other prescription medications include wetting agents such as Ducosate (Colace) and
Problems that can appear to be Constipation
1. Hypothyroidism
a.
Abnormal levels of thyroid hormone. A blood test can be
performed.
2. Malrotation
a.
During development the bowel is outside the body cavity.
Abnormal folding into to abdomen can cause obstruction.
3. Hirschprung’s
Disease
a.
Abnormal migration of neural tissue into the bowel. The
portion of the bowel without neural tissue doesn’t move causing constipation. A
barium enima can be performed.
4. Anismus
a.
An anal verge (opening) that is too tight.
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Dr.
Michael Dick & Dr. Todd Dillon nips@med-web.com |