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Additional
Information on Constipation in Children
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1. Pediatric Anorectal Disorders.
Subfile: Digestive Diseases
Format (FM): JOURNAL ARTICLE (24).
Language(s) (LG): English.
Year Published (YR): 2001.
Audience code (AC): HEALTH PROFESSIONALS (100).
Author (AU): Di Lorenzo, C.
Source (SO): Gastroenterology Clinics of North America.
30(1): 269-287. March 2001.
Availability (AV): Available from W.B. Saunders Company.
6277 Sea Harbor Drive, Orlando, FL 32821-9816. (800) 654-2452.
Abstract (AB): Anorectal disorders are common in children;
it is estimated that 10 percent of children are brought to medical
attention because of a defecation disorder, and constipation is
the chief complaint in 3 to 5 percent of all visits to pediatricians.
This article explores pediatric anorectal disorders, emphasizing
the differences between children and adults in terms of clinical
presentations, pathophysiology, diagnosis, and treatment. Topics
include constipation, functional nonretentive fecal soiling, Hirschsprung's
disease, other colonic neuromuscular disorders, children with neurologic
handicap (including cerebral palsy and spinal dysraphism), and imperforated
anus. The author stresses that the child's developmental stage;
the interaction between patient, family, and peers; and the presence
of behavioral and psychological comorbidity need to be assessed
carefully in any diagnosis of pediatric anorectal disorders. There
are three periods when a child is particularly vulnerable to developing
constipation: the introduction of cereals and solid food in the
diet of an infant, toilet training, and the start of school. Childhood
functional constipation is a clinical diagnosis that can be made
in most cases on the basis of a typical history and an essentially
normal physical examination. The most successful approach to a child
with functional constipation includes a combination of parental
education, behavioral modification, and medial intervention. 3 figures.
2 tables. 58 references.
Major Descriptors (MJ): Digestive System Diseases.
Children. Constipation. Incidence. Etiology. Diagnosis. Therapy.
Patient Care Management. Anorectal Disease. Functional Colonic Disorders.
Minor Descriptors (MN): Diagnostic Tests. Pathogenesis.
Physiology. Symptoms. Drug Therapy. Patient Selection. Defecation.
Fecal Incontinence. Diet Therapy. Behavior Modification. Rehabilitation.
Patient Education. Parent Education. Neurological Disorders. Hirschsprung
Disease.
Verification/Update Date (VE): 200107.
Notes (NT): CP: Yes.
Accession Number (AN): DD JA 08363.
2. Review of the Causes of Lower Gastrointestinal Tract
Bleeding in Children.
Subfile: Digestive Diseases
Format (FM): JOURNAL ARTICLE (24). REVIEW (46).
Language(s) (LG): English.
Year Published (YR): 2001.
Audience code (AC): HEALTH PROFESSIONALS (100).
Author (AU): Rayhorn, N.; Thrall, C.; Silber, G.
Source (SO): Gastroenterology Nursing. 24(2): 77-83.
March-April 2001.
Availability (AV): Available from Williams and Wilkins.
351 West Camden Street, Baltimore, MD 21201-2436. (410) 528-8555.
Abstract (AB): Bleeding may occur anywhere along the
gastrointestinal (GI) tract, which covers a large surface area and
is highly vascularized. Pediatric patients who present with blood
in their stools (bowel movements) are a special challenge for the
health care team. Seeing blood in the child's stools, the caregiver
and child may become extremely anxious, fearing a devastating diagnosis.
This article reviews the causes of lower GI tract bleeding in children.
The differential diagnosis of this symptoms in infants and children
includes numerous possibilities ranging from benign disorders, which
require little or no treatment at all, to serious diseases that
require immediate intervention. A complete history, including progression,
duration, frequency, and severity of symptoms, is essential in assessing
GI bleeding. Associated symptoms that help define the diagnosis
include vomiting, diarrhea, constipation, abdominal pain, anorexia
(lack of appetite), rash, joint pain or swelling, weight loss, fever,
irritability, history of GI bleeding, or history of hematological
or immunological disorders. Constipation with fissure (a tear in
the anus) formation is the most common cause for rectal bleeding
in toddlers and school age children. Infection is one of the more
common causes of bleeding from the lower GI tract; infections can
be due to Salmonella, Shigella, Campylobacter jejuni; Yersinia enterocolitica,
Escherichia coli, Clostridium difficile, or Entamoeba histolytica.
Other causes include swallowed blood, hemorrhoids, inflammatory
bowel disease (IBD), intussusception (a portion of the bowel turns
in on itself, creating an obstruction), polyps, lymphonodular hyperplasia,
Meckel's diverticulum, allergic colitis, Henoch Schonlein purpura,
hemolytic uremic syndrome (HUS), enterocolitis, child sexual abuse,
and Munchausen syndrome by proxy.
Major Descriptors (MJ): Digestive System Diseases.
Gastrointestinal Bleeding. Hemorrhage. Children. Etiology. Symptoms.
Diagnosis.
Minor Descriptors (MN): Infants. Diagnostic Tests.
Risk Factors. Constipation. Abdominal Pain. Diarrhea. Bacterial
Infections. Patient Care Management. Nursing Care. Fissure. Hemorrhoids.
Inflammatory Bowel Disease.
Verification/Update Date (VE): 200107.
Notes (NT): CP: Yes.
Accession Number (AN): DD JA 08368.
3. Childhood Constipation: Finally Some Hard Data About
Hard Stools! (editorial).
Subfile: Digestive Diseases
Format (FM): JOURNAL ARTICLE (24).
Language(s) (LG): English.
Year Published (YR): 2000.
Audience code (AC): HEALTH PROFESSIONALS (100).
Author (AU): DiLorenzo, C.
Source (SO): Journal of Pediatrics. 136(1): 4-7. January
2000.
Availability (AV): Available from Mosby, Inc. 11830
Westline Industrial Drive, St. Louis, MO 63146-3318. (800) 453-4351
or (314) 453-4351. Fax (314) 432-1158. Website: www.mosby.com.
Abstract (AB): It is estimated that 55 million adults
in the United States (approximately 28 percent of the population)
are constipated. Similar data are not available on the prevalence
in children, although it has been reported that 34 percent of toddlers
in the United Kingdom and 37 percent of Brazilian children younger
than 12 were considered by their parents to be constipated. This
editorial offers a review of the literature on childhood constipation,
focusing on research studies that quantified the prevalence of the
problem. The editorial also serves as an introduction to two related
articles in the same issue of Journal of Pediatrics. The author
notes that the most common cause of constipation in pediatrics is
a decision made by the child to delay defecation after experiencing
a painful or frightening evacuation. Treatment is based on addressing
all the factors that have contributed to its development. The evacuations
are made more pleasant by stool softeners. The fear of defecation
is overcome by avoiding anally invasive procedures (such as enemas)
and by using positive reinforcement to make the process less intimidating.
Key to successful treatment is a thorough understanding by the family
of the pathophysiology of childhood constipation. The author applauds
the authors of the other articles for addressing this poorly studied
subject. Progress in the understanding of colonic motility disorders
and the pathophysiologic mechanisms responsible for treatment failures
will help in the selection of patients who may benefit from the
use of cisapride and dietary changes. Development of safe prokinetics
with a more selective action on colonic motility will undoubtedly
facilitate their use in the treatment of childhood constipation.
12 references.
Major Descriptors (MJ): Digestive System Diseases.
Constipation. Children. Epidemiology. Etiology. Therapy.
Minor Descriptors (MN): Patient Care Management. Psychological
Factors. Gastrointestinal Motility. Drug Therapy. Diet Therapy.
Pathophysiology. Prevalence. Behavior Modification.
Verification/Update Date (VE): 200004.
Notes (NT): CP: Yes.
Accession Number (AN): DD JA 07575.
4. Cisapride for the Treatment of Constipation in Children:
A Double-Blind Study.
Subfile: Digestive Diseases
Format (FM): JOURNAL ARTICLE (24).
Language(s) (LG): English.
Year Published (YR): 2000.
Audience code (AC): HEALTH PROFESSIONALS (100).
Author (AU): Nurko, S., et al.
Source (SO): Journal of Pediatrics. 136(1): 35-40.
January 2000.
Availability (AV): Available from Mosby, Inc. 11830
Westline Industrial Drive, St. Louis, MO 63146-3318. (800) 453-4351
or (314) 453-4351. Fax (314) 432-1158. Website: www.mosby.com.
Abstract (AB): This article reports on a study undertaken
to determine whether cisapride is effective in treating children
with constipation. The double blind, placebo controlled study included
children with chronic constipation who were randomly assigned to
treatment with cisapride or placebo for 12 weeks. Forty children
were enrolled, and 36 completed the therapy. Treatment successes
occurred in 13 of 17 subjects in the cisapride group (76 percent)
and 8 of 19 subjects in the placebo group (37 percent). The odds
ratio for response after cisapride administration was 8.2 times
higher. During cisapride therapy, there was a significant improvement
in the number of spontaneous bowel movements per week and a significant
decrease in the number of fecal soiling episodes per day, percentage
with encopresis, number of laxative doses per week, percentage using
laxatives, and total gastrointestinal transit time. With placebo,
there were no significant changes in the number of spontaneous bowel
movements, percentage with encopresis, or total gastrointestinal
time; but there was a significant decrease in the number of fecal
soiling episodes per day and the number of laxative doses per week.
The authors conclude that cisapride was effective in treating children
with constipation. The authors note, however, that cisapride is
not recommended as the first line drug for children with constipation.
Dietary fiber and other behavior changes are recommended first.
1 figure. 2 tables. 27 references.
Major Descriptors (MJ): Digestive System Diseases.
Constipation. Children. Drug Therapy. Cisapride.
Minor Descriptors (MN): Gastrointestinal Motility.
Motility Disorders. Laxatives. Fecal Incontinence. Drug Effects.
Verification/Update Date (VE): 200004.
Notes (NT): CP: Yes.
Accession Number (AN): DD JA 07576.
5. Appendicitis in Children: New Insights Into an Old
Problem.
Subfile: Digestive Diseases
Format (FM): JOURNAL ARTICLE (24).
Language(s) (LG): English.
Year Published (YR): 2000.
Audience code (AC): HEALTH PROFESSIONALS (100).
Author (AU): Gregory, T., ed.
Source (SO): Patient Care. 34(5): 183-188, 191-195.
March 15, 2000.
Availability (AV): Available from Medical Economics.
5 Paragon Drive, Montvale, NJ 07645. (800) 432-4570. Fax (201) 573-4956.
Abstract (AB): Acute appendicitis is the most common
reason for emergency abdominal surgery in childhood. Despite strong
emphasis on early surgical intervention, the morbidity and mortality
of acute appendicitis in children remain high. This review article
clarifies the symptoms to look for in the patient's history, the
signs to assess during the physical examination, and the degree
of confidence to place in various laboratory tests and radiologic
studies. The authors reiterate that a thorough but speedy evaluation
is essential when examining a child with possible appendicitis.
Recent studies show that in ambiguous cases, computed tomography
(CT scan), especially when performed with rectal contrast, is an
excellent adjudicator. The authors review the anatomy and physiology
of the appendix, then detail each step of the physical examination.
After a discussion of the appropriate laboratory tests, the authors
remind readers of the more common pediatric illnesses that mimic
appendicitis, including gastroenteritis, constipation, mesenteric
adenitis, urinary tract infection (UTI), inflammatory bowel disease
(IBD), pelvic inflammatory disease (PID), ovarian cyst, and pneumonia.
8 figures. 2 tables. 22 references.
Major Descriptors (MJ): Digestive System Diseases.
Children. Appendicitis. Diagnosis. Diagnostic Tests.
Minor Descriptors (MN): Morbidity. Gastrointestinal
Diseases. Anatomy. Physiology. Appendix. Abdominal Pain. Symptoms.
Epidemiology. Patient Care Management. Physical Examination.
Verification/Update Date (VE): 200007.
Notes (NT): CP: Yes.
Accession Number (AN): DD JA 07704.
6. Childhood Defecation Disorders: Constipation and Soiling.
Subfile: Digestive Diseases
Format (FM): NEWSLETTER ARTICLE (35).
Language(s) (LG): English.
Year Published (YR): 2000.
Audience code (AC): PATIENT (400).
Author (AU): Hyman, P.
Source (SO): Participate. 9(3): 4-6. Fall 2000.
Availability (AV): Available from International Foundation
for Functional Gastrointestinal Disorders (IFFGD). P.O. Box 170864,
Milwaukee, WI 53217. (888) 964-2001 or (414) 964-1799. Fax (414)
964-7176. E-mail: iffgd@iffgd.org. Website: www.iffgd.org.
Abstract (AB): This article is the second in a two
part series on pediatric functional gastrointestinal (GI) disorders
that may prompt parents to bring their child to the doctor for constipation
or fecal soiling. In this article, the author focuses on non retentive
fecal soiling and functional fecal retention. Functional refers
to a disorder where the primary problem is not due to disease or
visible tissue damage or inflammation; in this article, the author
uses functional to refer to symptoms that occur within the expected
range of the body's behavior. Functional fecal retention is defined
in children by the passage of large or enormous bowel movements
at intervals less than twice per week, and the attempt to avoid
having bowel movements on purpose. Accompanying symptoms include
soiling of the underclothes, irritability, abdominal cramps, and
decreased appetite. Functional fecal retention begins when there
is a painful bowel movement and the child learns to fear the urge
to have a bowel movement. After diagnosis, treatment goals include
family and patient education, medication as necessary to assure
painless defecation, and the provision of continued availability
and interest in the child's problem. Fecal soiling refers to passage
of bowel movements into the underclothing, or other inappropriate
places. Fecal soiling commonly accompanies functional fecal retention,
or after a chronic problem with diarrhea. Functional non retentive
(not associated with fecal retention) fecal soiling is diagnosed
in children older than 4, who have bowel movements in places and
at times that are inappropriate, at least once a week for 3 months,
in the absence of a disease to explain it. Treatment goals are to
help the parent to understand that there is no medical disease,
and to accept a referral to a mental health professional. Parents
need guidance to understand that soiling is a symptom of emotional
upset, not simply bad behavior. 1 table.
Major Descriptors (MJ): Digestive System Diseases.
Constipation. Defecation. Psychological Factors. Functional Colonic
Disorders. Children. Fecal Incontinence. Impacted Feces.
Minor Descriptors (MN): Rectum. Parent Education.
Patient Education. Behavior Modification. Prevention. Drug Therapy.
Abdominal Pain. Diarrhea. Symptoms. Risk Factors.
Verification/Update Date (VE): 200104.
Notes (NT): CP: Yes.
Accession Number (AN): DD JA 08087.
7. Chronic Abdominal Pain in Childhood: Diagnosis and
Management.
Subfile: Digestive Diseases
Format (FM): JOURNAL ARTICLE (24). REVIEW (46).
Language(s) (LG): English.
Year Published (YR): 1999.
Audience code (AC): HEALTH PROFESSIONALS (100).
Author (AU): Lake, A.M.
Source (SO): American Family Physician. 59(7): 1823-1830.
April 1, 1999.
Availability (AV): Available from American Academy
of Family Physicians. 11400 Tomahawk Creek Parkway, Leawood, KS
66211-2672. (800) 274-2237. Website: www.aafp.org.
Abstract (AB): More than one third of children complain
of abdominal pain lasting 2 weeks or longer. This article discusses
the diagnosis and management of chronic abdominal pain in childhood.
The diagnostic approach relies heavily on the history provided by
the parent and child to direct a step wise approach to investigation.
If the history and physical examination suggest functional abdominal
pain, constipation, or peptic disease, the response to an empiric
course of medical management is of greater value than multiple exclusionary
investigations. A symptom diary allows the child to play an active
role in the diagnostic process. The medical management of constipation,
peptic disease, and inflammatory bowel disease involves nutritional
strategies, pharmacologic intervention, and psychological support.
The authors recommend careful followup to monitor compliance with
treatment, restoration of normal activities, and appropriate family
interventions. Support groups for the family and the child can be
invaluable. Most important, the child must feel that the family
physician understands that the pain is real, that the child's input
is as valuable as the parents', and that information shared in confidence
will be kept confidential if at all possible. One figure summarizes
the algorithmic approach to the child with probable peptic disease.
1 figure. 3 tables. 19 references.
Major Descriptors (MJ): Digestive System Diseases.
Abdominal Pain. Children. Chronic Disease. Diagnosis. Patient Care
Management.
Minor Descriptors (MN): Symptoms. Diagnostic Tests.
Patient History. Constipation. Vomiting. Peptic Ulcer. Nausea. Gastroesophageal
Reflux Disease. Inflammatory Bowel Disease. Drug Therapy. Diet Therapy.
Verification/Update Date (VE): 200108.
Notes (NT): CP: Yes.
Accession Number (AN): DD JA 07201.
8. How to Resolve Stool Retention in a Child: Underwear
Soiling is Not a Behavior Problem.
Subfile: Digestive Diseases
Format (FM): JOURNAL ARTICLE (24).
Language(s) (LG): English.
Year Published (YR): 1999.
Audience code (AC): HEALTH PROFESSIONALS (100).
Author (AU): Griffin, G.C.; Roberts, S.D.; Graham,
G.
Series (SE): (Pediatrics Series).
Source (SO): Postgraduate Medicine. 105(1): 159-161,
165-166, 172-173. January 1999.
Abstract (AB): Many parents do not realize that their
child has stool retention when they bring him or her for an office
visit. This article guides primary care providers in the diagnosis
and patient management of these children and their parents. The
authors discuss how and why stool retention gets started, and they
summarize the complaints parents often have when they bring in their
child. A complete treatment regimen is described and compiled in
a form that can be sent home with parents (a chart of strategies
for parents to use immediately and on an ongoing basis). The authors
note that stool retention is the most common cause of underwear
soiling in children who have been toilet trained. Management begins
with educating parents that leaking of liquid stool around impaction
and onto underwear is completely involuntary, so the child should
never be scolded or embarrassed. Stool retention may begin because
of unpleasant or unavailable toilet facilities, constipation, or
painful elimination and often becomes self perpetuating. The impaction
must be removed immediately; magnesium citrate solution is usually
effective. To allow the rectum to return to its normal size, which
can take a long time, stool must be kept soft and movable with administration
of mineral oil and appropriate dietary choices (e.g., fruit, juice,
fiber). Recurrence is common, so ongoing measures and followup are
important. 1 figure. 1 table. 16 references. (AA-M).
Major Descriptors (MJ): Digestive System Diseases.
Constipation. Children. Obstruction. Impacted Feces. Patient Care
Management.
Minor Descriptors (MN): Fecal Incontinence. Symptoms.
Risk Factors. Etiology. Parent Education. Drug Therapy. Prevention.
Dietary Fiber.
Verification/Update Date (VE): 200001.
Notes (NT): CP: Yes.
Accession Number (AN): DD JA 07080.
9. When 'Little Accidents' Turn Serious: Understanding
Fecal Incontinence.
Subfile: Digestive Diseases
Format (FM): JOURNAL ARTICLE (24).
Language(s) (LG): English.
Year Published (YR): 1999.
Audience code (AC): PATIENT (400).
Author (AU): Dorsky, R.; Dorsky, L.T.
Source (SO): Digestive Health and Nutrition. p. 22-25.
November-December 1999.
Availability (AV): Available from American Gastroenterological
Association. 7910 Woodmont Avenue, 7th Floor, Bethesda, MD 20814.
(877) DHN-4YOU or (301) 654-2055, ext. 650. E-mail: DHN@gastro.org.
Abstract (AB): This article discusses fecal incontinence
(encopresis) in children, delineating when this behavior becomes
a serious problem and what actions to take to correct it. Fecal
incontinence is defined as soiling of a child's underpants (or leaking
of stool) at a time when the child should be toilet trained (after
ages 2 to 3 for girls; 2 to 4 for boys). It occurs in conjunction
with chronic constipation, which results when a child does not completely
empty his or her bowel when sitting on the toilet, or refuses to
use the toilet altogether. By becoming alert to the warning signs
of encopresis, parents can often prevent the problem from worsening.
The author reviews the common schedule a child will follow for defecation;
the variety of factors that can contribute to the development of
constipation, including toilet training forced at too young an age;
not drinking enough fluids; holding back because of a particularly
painful bowel movement in the past; stress in the family such as
a birth, death, divorce, or unfamiliar surroundings; the child's
typical behavior after soiling, notably denial; and strategies for
addressing the problem of encopresis. One sidebar offers tips on
toilet training.
Major Descriptors (MJ): Digestive System Diseases.
Fecal Incontinence. Children. Constipation. Patient Care Management.
Defecation.
Minor Descriptors (MN): Parent Education. Toilet Training.
Psychosocial Factors. Fluids. Stress. Parent-Child Relations. Behavior
Modification.
Verification/Update Date (VE): 200001.
Notes (NT): CP: Yes.
Accession Number (AN): DD JA 07337.
10. Pediatric Gastrointestinal Disease. 2nd ed.
Subfile: Digestive Diseases
Format (FM): MONOGRAPH/BOOK (32).
Language(s) (LG): English.
Year Published (YR): 1999.
Audience code (AC): HEALTH PROFESSIONALS (100).
Author (AU): Wyllie, R.; Hyams, J.S., eds.
Source (SO): Philadelphia, PA: W.B. Saunders Company.
1999. 823 p.
Availability (AV): Available from W.B. Saunders Company.
Book Order Fulfillment Department, 11830 Westline Industrial Drive,
Saint Louis, MO 63146-9988. (800) 545-2522 or (314) 453-7010. Fax
(800) 568-5136 or (314) 453-7095. E-mail: wbsbcs@harcourt.com. Website:
customerservice.wbsaunders.com. PRICE: $155.00 plus shipping and
handling. ISBN: 0721674615.
Abstract (AB): This medical textbook covers all facets
of clinical pediatric gastrointestinal disease. The text emphasizes
a clinical focus and incorporates anatomy and physiology considerations
into each chapter rather than a separate section. The book is organized
into distinct sections, starting with the common clinical problems
and followed by organ specific diseases. General chapters on clinical
problems cover chronic abdominal pain of childhood and adolescence,
vomiting, diarrhea, constipation and encopresis (fecal soiling),
failure to thrive, gastrointestinal hemorrhage, eating disorders
and obesity, jaundice, ascites, caustic ingestion and foreign bodies,
abdominal masses in pediatric patients, and abdominal surgical emergencies.
Sections on diseases of the esophagus, stomach, and the small and
large bowel (intestine) are followed by chapters reviewing the clinical
facets of pediatric liver disease. Specific chapters include gastrointestinal
reflux, achalasia and other motor disorders, congenital anomalies,
gastric motility disorders, bezoars (a mass of food, hair or other
components found in the stomach or intestine), maldigestion and
malabsorption, celiac disease, short bowel syndrome, enteric parasites,
Crohn's disease, ulcerative colitis, polyps, appendicitis, hernia,
Hirschsprung's disease, neoplasms (cancerous and noncancerous),
hepatitis, gallbladder diseases, and liver transplantation. The
last two sections review diseases of the pancreas and basic nutrition
in children, including pancreatitis, cystic fibrosis, nutritional
assessment, parenteral (outside the digestive system, for example,
intravenous nutrition) and enteral nutrition, and the management
of diarrhea. Each chapter offers black and white photographs and
figures and concludes with extensive references. A detailed subject
index concludes the text.
Major Descriptors (MJ): Digestive System Diseases.
Gastrointestinal System. Children. Adolescents. Diagnosis. Therapy.
Symptoms. Patient Care Management. Pathophysiology.
Minor Descriptors (MN): Abdominal Pain. Vomiting.
Diarrhea. Constipation. Hemorrhage. Eating Disorders. Liver Diseases.
Ascites. Surgery. Drug Therapy. Congenital Anomalies. Stomach. Esophagus.
Motility Disorders. Celiac Disease. Inflammatory Bowel Disease.
Pancreas. Nutrition. Diagnostic Tests. Professional Education.
Verification/Update Date (VE): 200004.
Notes (NT): CP: Yes.
Accession Number (AN): DD BK 07495.
11. Nutritional Considerations Following Total Colectomy
for Motility Disorders.
Subfile: Digestive Diseases
Format (FM): NEWSLETTER ARTICLE (35).
Language(s) (LG): English.
Year Published (YR): 1999.
Audience code (AC): PATIENT (400).
Author (AU): Vanderhoof, J.A.
Source (SO): Messenger. 9(3): 4-7. 1999.
Availability (AV): Available from American Pseudo-obstruction
and Hirschsprung's Disease Society, Inc. 158 Pleasant Street, North
Andover, MA 01845. (978) 685-4477. Fax (978) 685-4488.
Abstract (AB): This article reviews the nutritional
considerations for patients following total colectomy (removal of
the colon) for motility disorders. The article is from a newsletter
for people with Hirschsprung's disease (HD), a motility disorder
of the large bowel caused by absence of parasympathetic ganglion
(nerve) cells. The most common symptom of HD is constipation; associated
symptoms include abdominal pain and distention, bilious vomiting,
anorexia, and failure to thrive. Once the diagnosis has been confirmed,
the only definitive treatment of children with HD is operative relief
of the functional obstruction. The author reviews colon anatomy
and physiology, the consequences of resection, the use of parenteral
nutrition (supplemental feeding that bypasses the gastrointestinal
tract), and the use of enteral feeding (tube feeding). The author
notes that the amount of bowel resected in HD is variable. Parenteral
nutrition is useful in Hirschsprung's disease, particularly total
colon Hirschsprung's disease, especially as necessary to maintain
fluid and electrolyte balance. Enteral nutrition is often initially
accomplished with tube feeding and ultimately, a modified oral nutrition
program becomes the mainstay of nutrition. Of prime importance is
a balanced nutritional program. Absolute restriction of any particular
food group should be avoided unless a direct negative correlation
with stool output is identified. 2 figures. 1 table.
Major Descriptors (MJ): Digestive System Diseases.
Hirschsprung Disease. Children. Infants. Nutrition. Postoperative
Care.
Minor Descriptors (MN): Colectomy. Postoperative Complications.
Malnutrition. Enteral Nutrition. Parenteral Nutrition.
Verification/Update Date (VE): 200004.
Notes (NT): CP: Yes.
Accession Number (AN): DD JA 07364.
12. Functional Childhood Constipation: A Practical Approach.
Subfile: Digestive Diseases
Format (FM): JOURNAL ARTICLE (24). REVIEW (46).
Language(s) (LG): English.
Year Published (YR): 1999.
Audience code (AC): HEALTH PROFESSIONALS (100).
Author (AU): Khan, S.; Di Lorenzo, C.
Series (SE): (Pediatric Functional Bowel Disorders,
Series Number 5).
Source (SO): Practical Gastroenterology. 23(12): 16,
20-22, 24-26, 33-34. December 1999.
Availability (AV): Available from Shugar Publishing,
Inc. 99B Main Street, Westhampton Beach, NY 11978. (631) 288-4404.
Fax (631) 288-4435. E-Mail: info@practicalgastro.com.
Abstract (AB): Constipation is a common childhood
problem and is frequently encountered by the primary care physician
and the pediatric gastroenterologist alike. Although the presentation
of constipation in infancy raises concerns about organic etiologies,
the large majority of infantile and childhood presentations of constipation
have a functional basis. This review article emphasizes the concepts
basic to the recognition and management of functional childhood
constipation from the perspective of a primary care physician. Data
obtained through a careful history and physical examination should
enable the physician in most cases to confidently establish the
diagnosis of functional constipation and exclude less common organic
disorders. Infants and older children with atypical features or
intractable constipation may require diagnostic investigations.
Most children recover satisfactorily after being managed with a
combination of incentive based behavior modification and stool softeners.
The authors note that early recognition and initiation of behavior
modification and pharmacotherapy in children favorably influences
prognosis. Children with intractable constipation and those suspected
of having underlying organic etiologies can therefore be identified
by the primary care physician and referred to a subspecialist for
further evaluation. 1 figure. 3 tables. 15 references.
Major Descriptors (MJ): Digestive System Diseases.
Constipation. Children. Patient Care Management. Diagnosis. Therapy.
Minor Descriptors (MN): Infants. Diagnostic Tests.
Etiology. Risk Factors. Behavior Modification. Drug Therapy. Dietary
Fiber. Psychological Factors.
Verification/Update Date (VE): 200008.
Notes (NT): CP: Yes.
Accession Number (AN): DD JA 07571.
13. What to Do When Your Child Gets Sick.
Subfile: Digestive Diseases
Format (FM): MONOGRAPH/BOOK (32).
Language(s) (LG): English. Spanish.
Year Published (YR): 1999.
Audience code (AC): PATIENT (400).
Author (AU): Mayer, G.; Kuklierus, A.
Source (SO): Whittier, CA: Institute for Healthcare
Advancement. 1999. 181 p.
Availability (AV): Available from Institute for Healthcare
Advancement. 15111 East Whittier Blvd., Suite 460, Whittier, CA
90603. (800) 434-4633. Fax (562) 907-1963. Website: www.iha4health.org.
PRICE: $14.95 plus shipping and handling; bulk copies available.
ISBN: 0828114404.
Abstract (AB): This reference book uses simple everyday
language and illustrations to provide information on common childhood
illnesses and health problems. Written in nontechnical language
designed to be accessible to adults at any reading level, the book
features 11 topical chapters: safety tips, caring for the sick child,
the newborn baby, the child's eyes, the child's ears and nose, the
child's mouth and throat, the child's breathing, the child's stomach,
bed wetting, the child's skin, and what to do when the child gets
hurt. Topics related to digestive diseases include infection, jaundice,
swallowing foreign objects, blood in the bowel movements, colic,
constipation, diarrhea, food allergies, hernia, spitting up, stomach
pain, vomiting, and poisoning. The book features extensive illustrations,
with topics simplified to key points on each page. The book's content
is simplified through the use of short, active sentences and single
syllable words where appropriate. For most of the topics, the book
follows a similar style covering a definition (what is it?), symptoms
(what do I see?), how to care for the child (what can I do at home?),
how to know when to call the doctor or nurse, and further information
(what else should I know about this condition?). The book concludes
with a word list (a glossary of terms), a subject index, and a list
of acknowledgments. The book is available in either Spanish or English.
Major Descriptors (MJ): Digestive System Diseases.
Children. Parent Education. Patient Care Management. Home Care.
Symptoms. Diagnosis.
Minor Descriptors (MN): Limited Reading Skills. Patient
Education. Delivery of Health Care. Risk Factors. Complications.
Jaundice. Constipation. Diarrhea. Vomiting. Food Allergies. Abdominal
Pain. Stomach.
Verification/Update Date (VE): 200007.
Notes (NT): CP: Yes.
Accession Number (AN): DD BK 07689.
14. Increasing Oral Fluids in Chronic Constipation in
Children.
Subfile: Digestive Diseases
Format (FM): JOURNAL ARTICLE (24).
Language(s) (LG): English.
Year Published (YR): 1998.
Audience code (AC): HEALTH PROFESSIONALS (100).
Author (AU): Young, R.J.; Beerman, L.E.; Vanderhoof,
J.A.
Source (SO): Gastroenterology Nursing. 21(4): 156-161.
July-August 1998.
Availability (AV): Available from Williams and Wilkins.
351 West Camden Street, Baltimore, MD 21201-2436. (410) 528-8555.
Abstract (AB): Increasing the amount and type of fluid
intake in children with simple constipation remains a common intervention
recommended by both the medical profession and lay consumers. However,
there is no research or physiologic basis for increasing overall
water intake and or high osmolarity liquid intake in order to produce
softer or more frequent stools. This article reports on a project
undertaken to identify whether a concerted effort to increase liquid
intake would lead to an effect on stooling characteristics. Ninety
children completed the entire study as assigned (59 girls, 31 boys).
Neither increasing water intake nor increasing hyperosmolar liquid
intake significantly increased stool frequency or decreased consistency
or difficulty with passage. The authors conclude that nurses need
to be proactive in changing commonly held thoughts regarding the
treatment of pediatric constipation. Advising new parents of what
is acceptable in stooling patterns is important. Encouraging a high
insoluble fiber intake is more beneficial in promoting healthy stool
patterns than any amount of increased liquid intake. Advising parents
of constipated children to increase liquid intake is not helpful
and should not be recommended unless history suggests that the child's
liquid intake is inadequate for a normal child of that age and activity
level. 3 figures. 4 tables. 19 references. (AA-M).
Major Descriptors (MJ): Digestive System Diseases.
Constipation. Children. Fluids. Fluid Therapy.
Minor Descriptors (MN): Dehydration. Defecation. Dietary
Fiber. Colon. Physiology.
Verification/Update Date (VE): 199907.
Notes (NT): CP: Yes.
Accession Number (AN): DD JA 07023.
15. Bowel and Bladder Management.
Subfile: Digestive Diseases
Format (FM): BOOK CHAPTER (09).
Language(s) (LG): English.
Year Published (YR): 1997.
Audience code (AC): HEALTH PROFESSIONALS (100). COMMUNITY
SERVICE PROFESSIONALS (200).
Author (AU): Blackman, J.A.
Source (SO): In: Blackman, J.A. Medical Aspects of
Developmental Disabilities in Children Birth to Three. 3rd ed. Gaithersburg,
MD: Aspen Publishers, Inc. 1997. p. 11-23.
Availability (AV): Available from Aspen Publishers,
Inc. 7201 McKinney Circle, Frederick, MD 21704. (800) 234-1660 or
(800) 638-8437. PRICE: $40.00. ISBN: 0834207591.
Abstract (AB): Many infants and young children with
developmental disabilities have complex needs related to their bowel
and bladder functions. This chapter is part of a book designed to
educate health and social service professionals about the medical
challenges presented by children (ages 1 to 3) with developmental
disabilities. The chapter discusses the management of constipation,
intestinal ostomies, and clean intermittent catheterization. For
each topic, the author provides information about cause, incidence,
medical management, course, accompanying health problems, and possible
alternative treatments or problems. The author points out that bowel
and bladder problems can interfere with education or therapy services.
Black and white photographs and line drawings illustrate some of
the concepts presented. 5 figures. 2 references. (AA-M).
Major Descriptors (MJ): Digestive System Diseases.
Constipation. Congenital Disorders. Colostomy. Ileostomy. Children.
Infants. Urination. Anus. Therapy. Equipment and Supplies. Gastrointestinal
Diseases. Colon. Catheters.
Minor Descriptors (MN): Cathartics. Hirschsprung Disease.
Diet. Enterocolitis, Pseudomembranous.
Verification/Update Date (VE): 199805.
Notes (NT): CP: Yes.
Accession Number (AN): DD BK 01863.
16. Hirschsprung's Disease.
Subfile: Digestive Diseases
Format (FM): FACT SHEET (22).
Language(s) (LG): English.
Year Published (YR): 1997.
Audience code (AC): PATIENT (400).
Corporate Author (CN): American Pseudo-obstruction
and Hirschsprung's Disease Society, Inc. (APHS).
Source (SO): North Andover, MA: American Pseudo-obstruction
and Hirschsprung's Disease Society, Inc. 1997. 2 p.
Availability (AV): Available from APHS. 158 Pleasant
Street, North Andover, MA 01845-2797. (508) 685-4477. Fax (508)
685-4488. E-mail: aphs@mail.tiac.net. PRICE: Single copy free.
Abstract (AB): This fact sheet provides basic information
about Hirschsprung's disease, its diagnosis, and treatment. Hirschsprung's
disease is a serious childhood condition caused by the absence of
nerve cells in the wall of the bowel. The portion of bowel without
these nerve cells (ganglia) does not relax and remains collapsed.
Bowel contents build up behind the obstruction. The most life-threatening
emergency in Hirschsprung's disease is enterocolitis, a severe inflammatory
condition of the bowel wall. To diagnose Hirschsprung's disease,
a barium enema xray test is used to identify the narrow collapsed
segment of bowel as well as the dilated bowel in front of the affected
regions. A biopsy is then necessary to confirm the absence of ganglia.
Treating Hirschsprung's disease requires surgery to remove the affected
bowel and then join the healthy bowel segments. The fact sheet briefly
reviews the three surgical techniques that are used to treat Hirschsprung's
disease. The fact sheet concludes that, for most children with Hirschsprung's
disease, there are no longterm complications after successful surgery.
However, a significant minority of children are troubled with persistent
constipation, encopresis (stool incontinence), or persistent enterocolitis.
(AA-M).
Major Descriptors (MJ): Digestive System Diseases.
Hirschsprung Disease. Health Education. Patient Education. Diagnosis.
Surgery. Children.
Minor Descriptors (MN): Diagnostic Tests. Symptoms.
Gastrointestinal Motility. Postoperative Complications. Physiology.
Verification/Update Date (VE): 199710.
Notes (NT): CP: Yes.
Accession Number (AN): DD DC 06046.
17. Chronic Intestinal Pseudo-Obstruction.
Subfile: Digestive Diseases
Format (FM): FACT SHEET (22).
Language(s) (LG): English.
Year Published (YR): 1997.
Audience code (AC): PATIENT (400).
Corporate Author (CN): American Pseudo-obstruction
and Hirschsprung's Disease Society, Inc. (APHS).
Source (SO): North Andover, MA: American Pseudo-obstruction
and Hirschsprung's Disease Society, Inc. 1997. 2 p.
Availability (AV): Available from APHS. 158 Pleasant
Street, North Andover, MA 01845-2797. (508) 685-4477. Fax (508)
685-4488. E-mail: aphs@mail.tiac.net. PRICE: Single copy free.
Abstract (AB): This fact sheet provides basic information
about the diagnosis and treatment of chronic intestinal pseudo-obstruction
(CIP), the name given to a number of rare disorders that cause impaired
gastrointestinal (GI) motility (movement in the digestive tract).
A diagnosis of CIP is based on symptoms and body changes that occur
when the intestine is blocked and surgery is needed. Children with
CIP often complain of poor appetite, nausea, vomiting, heartburn,
abdominal pain, and constipation. Affected children may not grow
or develop at the expected rate. There is no specific test to diagnosis
CIP. It is a diagnosis based on symptoms and findings after a physical
examination, plus the proven absence of a true bowel obstruction.
About 10 percent of affected infants improve spontaneously over
months or years. For the remaining 90 percent, there are no cures
for the neuromuscular diseases that cause CIP, but there are nutritional,
medical, and surgical options to promote normal growth and development.
The fact sheet briefly outlines each of these options. The fact
sheet concludes that the future for children severely afflicted
with CIP is brightened by the evolving promise of intestinal or
multiorgan transplantation.
Major Descriptors (MJ): Digestive System Diseases.
Children. Intestinal Pseudoobstruction. Diagnosis. Therapy.
Minor Descriptors (MN): Nutrition. Surgery. Diagnostic
Tests. Symptoms. Gastrostomy. Supplemental Feeding. Child Development.
Infants.
Verification/Update Date (VE): 199710.
Notes (NT): CP: Yes.
Accession Number (AN): DD DC 06047.
18. Stool Soiling in Children.
Subfile: Digestive Diseases
Format (FM): JOURNAL ARTICLE (24). FACT SHEET (22).
Language(s) (LG): English.
Year Published (YR): 1997.
Audience code (AC): PATIENT (400).
Corporate Author (CN): American Academy of Family
Physicians.
Source (SO): American Family Physician. 55(6): 2237-2238.
May 1, 1997.
Abstract (AB): This patient information handout helps
parents understand and manage stool soiling (messing the underwear
with stool) in children. The author emphasizes that most often,
the soiling occurs because of constipation (this type of soil is
called encopresis). In children with encopresis, formed, soft, or
liquid stools that often have a very bad smell leak from the anus
around a mass of stool that is stuck in the lower bowel. The handout
covers how stool soiling and constipation are related; the causes
of constipation in a child; the treatment options for stool soiling;
and how to know if the treatment is working. Treatment includes
changing the child's diet to include more fluids and fiber-rich
foods, having the child sit on the toilet several times a day, and
giving the child laxatives every day to help soften the stools.
The handout is designed to be photocopied and distributed by health
care providers. (AA-M).
Major Descriptors (MJ): Digestive System Diseases.
Children. Fecal Incontinence. Constipation. Patient Education. Parent
Education. Patient Care Management.
Minor Descriptors (MN): Therapy. Cathartics. Drug
Effects. Dietary Fiber. Diet Therapy. Fluids. Behavior Modification.
Verification/Update Date (VE): 199710.
Notes (NT): CP: Yes.
Accession Number (AN): DD DC 06061.
19. Pediatric Colonoscopy.
Subfile: Digestive Diseases
Format (FM): JOURNAL ARTICLE (24).
Language(s) (LG): English.
Year Published (YR): 1997.
Audience code (AC): HEALTH PROFESSIONALS (100).
Author (AU): Kay, M.; Wyllie, R.
Series (SE): (Pediatric Endoscopy Series, Article
3).
Source (SO): Practical Gastroenterology. 21(3): 7-8,
13-14, 19-20, 25-27. March 1997.
Availability (AV): Available from Shugar Publishing,
Inc. 99B Main Street, Westhampton Beach, NY 11978. (631) 288-4404.
Fax (631) 288-4435. E-Mail: info@practicalgastro.com.
Abstract (AB): This article, one in a series on pediatric
endoscopy, considers the role of pediatric colonoscopy. Colonoscopy
is now routinely performed in children with the use of intravenous
conscious sedation or general anesthesia. The indications for pediatric
colonoscopy differ from those for colonoscopy in adults. Rectal
bleeding, protracted diarrhea, suspected polyps, and inflammatory
bowel disease are the most common indications for colonoscopy in
children. Colonoscopy is not useful in the evaluation of children
with constipation and isolated recurrent abdominal pain. The technique
of colonoscopy is modified for children, with emphasis on minimal
loop formation and greater patient comfort during the procedure.
Intubation of the terminal ileum is a standard part of the pediatric
colonoscopy, and it is important for the diagnosis of Crohn's disease.
Children require close monitoring for respiratory depression during
colonoscopy. Resuscitation equipment of an appropriate size and
pediatric dosages of medications should be available during endoscopic
procedures. 8 figures. 18 references. (AA).
Major Descriptors (MJ): Digestive System Diseases.
Children. Colonoscopy. Diagnostic Tests.
Minor Descriptors (MN): Diagnosis. Risk Factors. Patient
Selection. Patient Care Management. Complications. Prevention. Crohns
Disease. Gastrointestinal Bleeding. Inflammatory Bowel Disease.
Polyps.
Verification/Update Date (VE): 200008.
Notes (NT): CP: Yes.
Accession Number (AN): DD JA 06008.
20. Gastrointestinal Hemorrhage in Children.
Subfile: Digestive Diseases
Format (FM): JOURNAL ARTICLE (24).
Language(s) (LG): English.
Year Published (YR): 1997.
Audience code (AC): HEALTH PROFESSIONALS (100).
Author (AU): Treem, W.R.
Series (SE): (Pediatric Endoscopy Series, Number 5).
Source (SO): Practical Gastroenterology. 21(7): 21-22,
27-32, 34-38. July 1997.
Availability (AV): Available from Shugar Publishing,
Inc. 99B Main Street, Westhampton Beach, NY 11978. (631) 288-4404.
Fax (631) 288-4435. E-Mail: info@practicalgastro.com.
Abstract (AB): This article, one in a series on pediatric
endoscopy, summarizes the diagnostic approach to gastrointestinal
hemorrhage in children. The author emphasizes that the approach
to gastrointestinal bleeding in infants and children requires a
knowledge of the special age-appropriate considerations that dictate
the differential diagnosis. The routine application of five pivotal
questions to each case will allow the physician to narrow the possibilities
and focus on the most likely cause of bleeding. The questions are:
Is it blood? What is the age of the patient? What is the color of
the blood? Does the patient have diarrhea or constipation? and Is
the patient sick? Careful history taking and physical examination
will then determine the most expeditious route to a diagnosis using
laboratory, radiologic, and endoscopic techniques. The author offers
tips on the management of children with gastrointestinal bleeding,
including the application of pharmacologic and endoscopic therapy
to deal with bleeding varices, ulcers, and mucosal tears. 4 figures.
5 tables. 17 references. (AA-M).
Major Descriptors (MJ): Digestive System Diseases.
Gastrointestinal Bleeding. Children. Infants. Diagnosis. Therapy.
Minor Descriptors (MN): Endoscopy. Diagnostic Tests.
Hemorrhage. Symptoms. Drug Therapy. Gastric and Esophageal Varices.
Ulcer. Mucosal Tissue. Physiopathology.
Verification/Update Date (VE): 200008.
Notes (NT): CP: Yes.
Accession Number (AN): DD JA 06118.
21. Chronic Intestinal Pseudo-Obstruction: A Guide for
Parents-Caretakers.
Subfile: Digestive Diseases
Format (FM): BROCHURE/PAMPHLET (08).
Language(s) (LG): English.
Year Published (YR): 1997.
Audience code (AC): PATIENT (400).
Corporate Author (CN): American Pseudo-Obstruction
and Hirschsprung's Disease Society, Inc.
Source (SO): North Andover, MA: American Pseudo-Obstruction
and Hirschsprung's Disease Society, Inc. 1997. 4 p.
Availability (AV): Available from American Pseudo-Obstruction
and Hirschsprung's Disease Society, Inc. 158 Pleasant Street, North
Andover, MA 01845. (978) 685-4477. Fax (978) 685-4488. E-mail: aphs@tiac.net.
PRICE: Single copy free.
Abstract (AB): This brochure provides basic information
for parents and other caregivers of children with chronic intestinal
pseudo-obstruction (CIP) and other forms of chronic gastrointestinal
(GI) motility disorder. GI motility refers to the muscle contractions
within the walls of the digestive tract and the movement of food
within the digestive system. Written in question and answer format,
the brochure addresses the causes of GI motility disorders, the
definition and cause of CIP, the incidence and diagnosis of CIP,
treatment options, enteral feeding, parenteral feeding, and the
impact of CIP on the child's development and lifespan. In pseudo-obstruction,
the symptoms are not caused by a surgically correctable tumor, or
twist or ulcer in the bowel, but rather by a problem having to do
with the strength or coordination of the contractions that move
along contents within the bowel. Children with CIP often complain
of poor appetite, nausea, vomiting, heartburn, abdominal pain, and
constipation. As a result, normal growth and development may be
affected. One treatment option, enteral feedings, consists of predigested
liquid diets which may be administered in a variety of ways, including
nasogastric tubes, gastrostomy, or jejunostomy. Another option is
total parenteral nutrition (TPN), in which a nutritional solution
is infused via an intravenous access. The brochure concludes with
a brief description of the American Pseudo-obstruction and Hirschsprung's
Disease Society (APHS), a group that offers support and information
through parent networking, publications, and educational activities.
Major Descriptors (MJ): Digestive System Diseases.
Intestinal Pseudoobstruction. Children. Diagnosis. Symptoms. Therapy.
Nutrition. Motility Disorders.
Minor Descriptors (MN): Child Development. Etiology.
Parent Education. Support Groups. Gastrostomy. Enteral Nutrition.
Parenteral Nutrition. Gastrointestinal Motility.
Verification/Update Date (VE): 199807.
Notes (NT): CP: Yes.
Accession Number (AN): DD BR 06544.
22. Recommendations of Various Authors Regarding Pediatric
Dosing of Cisapride (Propulsid).
Subfile: Digestive Diseases
Format (FM): FACT SHEET (22).
Language(s) (LG): English.
Year Published (YR): 1997.
Audience code (AC): HEALTH PROFESSIONALS (100).
Corporate Author (CN): Children's Motility Disorder
Foundation.
Source (SO): Atlanta, GA: Children's Motility Disorder
Foundation. 1997. 2 p.
Availability (AV): Available from Children's Motility
Disorder Foundation. 225 Peachtree Street, NE, Suite 1430, Atlanta,
GA 30303. (800) 809-9492 or (404) 529-9200. Fax (404) 529-9202.
E-mail: cmdf@motility.org. PRICE: Single copy free.
Abstract (AB): This fact sheet consists of a chart
that summarizes the recommendations of various authors regarding
pediatric dosing of cisapride (Propulsid). The fact sheet reminds
readers that Propulsid is not approved by the U.S. Food and Drug
Administration (FDA) for pediatric use. Therefore, a safe and effective
pediatric dose has not been established. The chart lists the researchers
of each study, the therapeutic area covered, the age of children
in the study, and the dosage of cisapride used. Therapeutic areas
include reflux (gastroesophageal reflux disease), pseudoobstruction,
intractable constipation, cystic fibrosis, reflux associated with
bronchopulmonary disease, and excessive regurgitation. Dosages ranged
from 0.1 to 0.33 mg per kilogram of body weight, three times per
day (t.i.d.). The reverse side of the fact sheet lists the bibliographic
references for each of the eleven research studies listed, as well
as for two review articles on this topic.
Major Descriptors (MJ): Digestive System Diseases.
Children. Drug Therapy. Gastroesophageal Reflux Disease. Motility
Disorders.
Minor Descriptors (MN): Intestinal Pseudoobstruction.
Cystic Fibrosis. Constipation. Drug Effects. Administration and
Dosage. Research. Gastrointestinal Motility.
Verification/Update Date (VE): 199807.
Notes (NT): CP: Yes.
Accession Number (AN): DD DC 06504.
23. Constipation and Encopresis in Children.
Subfile: Digestive Diseases
Format (FM): FACT SHEET (22).
Language(s) (LG): English.
Year Published (YR): 1997.
Audience code (AC): PATIENT (400).
Author (AU): Scagnelli, G.
Source (SO): Milwaukee, WI: International Foundation
for Functional Gastrointestinal Disorders (IFFGD). 1997. 2 p.
Availability (AV): Available from International Foundation
for Functional Gastrointestinal Disorders (IFFGD). P.O. Box 170864,
Milwaukee, WI 53217. (888) 964-2001 or (414) 964-1799. Fax (414)
964-7176. E-mail: iffgd@iffgd.org. Website: www.iffgd.org. PRICE:
$0.50 plus shipping and handling; bulk copies available. Order number:
140.
Abstract (AB): Constipation or encopresis account
for approximately 10 to 25 percent of children who are referred
to a pediatric gastroenterologist. This fact sheet reviews the problems
of constipation and encopresis (involuntary fecal soiling) in children.
The fact sheet first describes the diseases with which the symptom
of constipation is associated, also noting the role of diet and
evacuation habits in the etiology of constipation problems. All
children with constipation, but especially those with encopresis,
should be evaluated by their physicians. Evaluation may include
a thorough physical examination; blood work to include thyroid,
calcium, and lead level; and sometimes a barium enema and anal manometry.
Treatment of constipation usually involves two steps. First, enemas
are required if there is a stool mass in the rectum. The next step
is to use oral medicines to ensure a soft daily bowel movement.
Stool softeners, such as mineral oil or lactulose, are frequently
used. Diet also plays an important role in the treatment of constipation.
Since many of the children in whom constipation is a problem do
not have normal rectal sensation, they must be encouraged to sit
on the toilet at least two times a day. The best time to sit on
the toilet is after a meal, usually after breakfast and after dinner.
The fact sheet stresses that by the time constipation is perceived
as a problem it has usually been going on for some time. Treatment
will take time and patience to be effective.
Major Descriptors (MJ): Digestive System Diseases.
Children. Constipation. Fecal Incontinence. Symptoms. Therapy.
Minor Descriptors (MN): Etiology. Diet Therapy. Dietary
Fiber. Enema. Impacted Feces. Drug Therapy. Behavior Modification.
Parent Education.
Verification/Update Date (VE): 200011.
Notes (NT): CP: Yes.
Accession Number (AN): DD DC 06834.
24. Colon Manometry.
Subfile: Digestive Diseases
Format (FM): NEWSLETTER ARTICLE (35).
Language(s) (LG): English.
Year Published (YR): 1997.
Audience code (AC): PATIENT (400).
Corporate Author (CN): American Pseudo-obstruction
and Hirschsprung's Disease Society (APHS).
Source (SO): Messenger. 8(3): 8. 1997.
Availability (AV): Available from American Pseudo-obstruction
and Hirschsprung's Disease Society (APHS). 158 Pleasant Street,
North Andover, MA 01845. (978) 685-4477. Fax (978) 685-4488. E-mail:
aphs@tiac.net.
Abstract (AB): This newsletter article uses a fact
sheet approach to explain colon manometry to the parents of children
who may be undergoing this procedure. Written in a question and
answer format, the fact sheet covers gastrointestinal motility problems
in general, the technique of colon manometry, what to expect during
the procedure (including pain or discomfort), and how long the procedure
takes. Gastrointestinal motility is the movement of the food through
the entire digestive tract (about 30 feet from the mouth to the
rectum). Common examples of symptoms related to motility problems
are heartburn and constipation. The strength of muscle contractions
inside the colon are measured during colonic manometry. Colon manometry
is the measurement of pressure in the colon. The test may be used
to help doctors understand the reasons for a child's symptoms. During
the procedure, the child is sedated and then a colonoscope (a flexible
plastic tube) is inserted into the colon through the rectum. Next,
a very thin guidewire is placed through the colonoscope, and the
colonoscope is withdrawn, leaving the guidewire in the colon. The
doctor will then slide a motility tube over the guidewire, which
is subsequently removed. The motility tube has holes at regular
spaces that measure the pressure in different areas of the colon.
The colon manometry may last as little as 90 minutes or as long
as 8 hours. The child must lie in bed, but he or she can sleep,
read, or watch television; parents are allowed to stay. The child
will feel some discomfort from the IV (for the sedation), from lying
still for a long period, and possibly from injections of medicine.
4 figures.
Major Descriptors (MJ): Digestive System Diseases.
Diagnostic Tests. Colon. Manometry. Gastrointestinal Motility. Children.
Minor Descriptors (MN): Colonoscope. Motility Disorders.
Diagnosis. Physiology. Symptoms. Equipment and Supplies.
Verification/Update Date (VE): 199910.
Notes (NT): CP: Yes.
Accession Number (AN): DD JA 07128.
25. Biofeedback Training in Children with Functional Constipation:
A Critical Review.
Subfile: Digestive Diseases
Format (FM): JOURNAL ARTICLE (24). REVIEW (46).
Language(s) (LG): English.
Year Published (YR): 1996.
Audience code (AC): HEALTH PROFESSIONALS (100).
Author (AU): Loening-Baucke, V.
Source (SO): Digestive Diseases and Sciences. 41(1):
65-71. January 1996.
Abstract (AB): This article reviews the use of biofeedback
training in children with functional constipation. Many uncontrolled
studies suggest that biofeedback training is an effective adjunctive
therapy in improving the outcome of functional constipation and/or
encopresis in children. This could not be confirmed in controlled
studies. Adding biofeedback training after conventional treatment
had failed did not provide benefits. The author concludes that the
results of biofeedback treatment in children with functional constipation
and/or encopresis are disappointing. 1 figure. 2 tables. 31 references.
(AA-M).
Major Descriptors (MJ): Digestive System Diseases.
Fecal Incontinence. Children. Biofeedback.
Minor Descriptors (MN): Research. Therapy. Physiology.
Behavior Modification.
Verification/Update Date (VE): 199607.
Notes (NT): CP: Yes.
Accession Number (AN): DD JA 05327.
26. Current Management of Childhood Disorders of Colorectal
Motility.
Subfile: Digestive Diseases
Format (FM): JOURNAL ARTICLE (24). REVIEW (46).
Language(s) (LG): English.
Year Published (YR): 1996.
Audience code (AC): HEALTH PROFESSIONALS (100).
Author (AU): O'Donnell, K.A.; Caty, M.G.
Series (SE): (Large Intestine).
Source (SO): Current Opinion in Gastroenterology.
12(1): 18-25. January 1996.
Availability (AV): Available from Rapid Science Publishers.
400 Market Street, Suite 700, Philadelphia, PA 19106. (215) 574-2266.
Fax (215) 574-2292.
Abstract (AB): This article reviews the current management
of childhood disorders of colorectal motility. A number of motility
disorders in children are associated with intestinal neuronal malformations
and other anatomic defects. These disorders include Hirschsprung's
disease, neuronal intestinal dysplasia, chronic intestinal pseudo-obstruction,
and anorectal malformations. Hirschsprung's disease is now linked
to specific genetic mutations, and laparoscopic techniques hold
promise for less invasive surgical treatment. Neuronal intestinal
dysplasia is now considered an important cause of postoperative
bowel dysfunction in Hirschsprung's disease patients. Chronic intestinal
pseudo-obstruction is characterized by recurrent bouts of abdominal
distension, pain, and constipation. The surgical treatment of these
patients is relegated to the placement of feeding and decompression
tubes. For the past decade, posterior sagittal anorectoplasty has
been the preferred approach in the repair of anorectal malformations.
Long-term assessments of bowel function after the use of this procedure
are now being published and show generally good outcome. 2 figures.
57 references (34 annotated).
Major Descriptors (MJ): Digestive System Diseases.
Children. Motility Disorders. Gastrointestinal Motility. Diagnosis.
Therapy.
Minor Descriptors (MN): Hirschsprung Disease. Anorectal
Disease. Abnormalities. Surgery. Surgical Techniques. Intestinal
Pseudoobstruction. Symptoms. Review.
Verification/Update Date (VE): 199610.
Notes (NT): CP: Yes.
Accession Number (AN): DD JA 05434.
27. What Every Parent Should Know About Toilet Training.
Subfile: Digestive Diseases
Format (FM): BROCHURE/PAMPHLET (08).
Language(s) (LG): English.
Year Published (YR): 1996.
Audience code (AC): PATIENT (400).
Corporate Author (CN): Channing L. Bete Company, Inc.
Source (SO): South Deerfield, MA: Channing L. Bete
Company, Inc. 1996. 15 p.
Availability (AV): Available from Channing L. Bete
Company, Inc. 200 State Road, South Deerfield, MA 01373-0200. (800)
628-7733. Fax (800) 499-6464. PRICE: $1.25 each for 1-24 copies;
discounts available for larger orders.
Abstract (AB): This patient education booklet provides
parents with guidelines for helping their children with toilet training.
After a definition of toilet training and a rough guide as to when
to expect toilet training to succeed, the booklet covers steps toward
independence for the child; the developmental stages that must be
completed before a child can succeed in toileting regularly; the
basics of toilet training; signs of readiness for toilet training;
changing from diapers to training pants; readiness for nighttime
training; common toilet training issues; and problems with constipation.
Parents are encouraged to make toilet training a positive experience
for their children. The booklet is illustrated with cartoon line
drawings of children and their families.
Major Descriptors (MJ): Digestive System Diseases.
Psychosocial Factors. Patient Education. Self-Care. Children.
Minor Descriptors (MN): Emotions. Fecal Incontinence.
Constipation. Parent-Child Relations.
Verification/Update Date (VE): 199701.
Notes (NT): CP: Yes.
Accession Number (AN): DD BR 05621.
28. When Your Child is Constipated.
Subfile: Digestive Diseases
Format (FM): FACT SHEET (22). JOURNAL ARTICLE (24).
Language(s) (LG): English.
Year Published (YR): 1996.
Audience code (AC): PATIENT (400).
Corporate Author (CN): American Academy of Family
Physicians.
Source (SO): American Family Physician. 54(2): 627.
August 1996.
Abstract (AB): This patient education handout helps
parents manage their child's constipation. Three sections discuss
symptoms; causes; and management options, including diet, bowel
habit training, and drug therapy. The handout is designed to be
photocopied and distributed to parents by health care providers.
Major Descriptors (MJ): Digestive System Diseases.
Constipation. Children. Parent Education.
Minor Descriptors (MN): Patient Education. Diet Therapy.
Drug Therapy. Fluids. Dietary Fiber. Behavior Modification.
Verification/Update Date (VE): 199701.
Notes (NT): CP: Yes.
Accession Number (AN): DD DC 05643.
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