TREATMENT FOR YOUR CHILD’S CONSTIPATION PARENT/ PATIENT INSTRUCTIONS
Reema Gulati, M.D., FAAP Robert Needlman, M.D. A patient friendly Pediatric Gastroenterology, Pediatric Developmental and interactive educational Hepatology and Nutrition Behavioral Medicine handout created by: Assistant Professor of Pediatrics, Professor of Pediatrics, Case Case Western Reserve Western Reserve University Constipation in Children
Full Colon Your child’s large bowel (colon) is full of poop
Colon with overflow incontinence (encopresis)
When colon gets completely backed up with poop, newer, softer poop leaks out as ‘poop accidents’
Empty Colon Bowel clean out
Check out this new, child and family-friendly video “The Poo in You”
Resources: www.naspghan.org “The Poo in You Video” by NASPGHAN (Available on www.gikids.org) 1 MEDICINES:
Polyethylene Glycol 3350 is a white powder which comes in a bottle with a cap or in individual packets. It makes the poop softer. 17gm
Lactulose is a sweet liquid to make poop soft.
Bisacodyl is a laxative pill. It helps your child’s bowel to squeeze the poop out.
Senna is a laxative which comes in both liquid and pill form. It helps your child’s bowel to squeeze the poop out.
Magnesium Citrate is a laxative liquid. It helps to clear the poop out of your child’s bowels.
Milk of Magnesia is a laxative liquid that helps to clear poop out of your child’s bowel.
Enema is a liquid medicine given in the child’s bottom. It helps to clean the poop out.
Rectal Suppository is a soft solid medicine which is given in the child’s bottom. Once inside, it melts, and helps push poop out.
TREATMENT FOR YOUR CHILD’S CONSTIPATION PARENT/ PATIENT INSTRUCTIONS 2 BOWEL CLEANOUT Follow the instructions the OPTIONS doctor has given for your child
Option A - Polyethylene Glycol 3350 Option B - Bisacodyl
Directions:
17gm Option C - Senna In a jar or big bottle mix __ capful(s) of Polyethylene LIQUID Glycol 3350 in __ ounces Directions: of a clear fluid like Gatorade.
TABLET If the Gatorade is at room temperature, Senna Directions: Polyethylene Glycol 3350 will mix well. You can always add ice to cool it later.
Make your child drink the whole solution within 6 hours. CHEWABLE Directions:
IMPORTANT TIPS 2 Stay at home and close to the bathroom during the clean out.
1 Your child should drink clear liquids throughout the 3 Pull-ups are perfect cleanout. No food at all. for your young child Examples of clear liquids are: Gatorade, Apple juice, clear to reduce mess. broth, Sprite, ginger ale, 7Up, Jello, popsicles, KoolAid.
3 Option D - Magnesium Citrate Option G - Enema
Directions:
Directions:
Option E - Milk of Magnesia Option H - Rectal Suppository Directions:
Directions:
Option F - Lactulose What should you expect during the bowel clean out? Directions:
During a bowel clean out your child’s poop should go from:
and finally hard/firm to soft to loose clear watery poop
4 Your child may feel If this happens- the bowel slightly sick to the clean out is successful! Hurray! stomach during the clean out. Don’t GO TO DAILY TREATMENT PLAN worry, that’s normal. If not, CALL YOUR DOCTOR’S OFFICE
TREATMENT FOR YOUR CHILD’S CONSTIPATION PARENT/ PATIENT INSTRUCTIONS 4 DAILY TREATMENT PLAN FOR YOUR CHILD’S CONSTIPATION
Your child needs stool softener or laxative medicines EVERY DAY to have regular, soft poop.
To pass easy, soft poops once or twice on most days.
Polyethylene Glycol 3350 Senna LIQUID Directions: __ capful(s) of Polyethylene Glycol 3350 in __ ounces of a clear fluid.
TABLET If poops are hard (Bristol type 1,2) or your Senna Directions: child goes > 2-3 days without pooping – increase dose of Polyethylene Glycol 3350 by ½ a cap or more as needed to get to Bristol 3,4 or 5 poop types. If poop becomes too runny (Bristol type CHEWABLE 7) reduce by ½ a capful at a time to get Directions: to 3,4 or 5. Use the Bristol Stool Chart to track your child’s stool form. Polyethylene Glycol 3350 is not habit forming and currently there’s no scientific proof for any serious side Bisacodyl effects of Polyethylene Glycol 3350. Reference https://www.naspghan.org/content/119/en/advocacy/regulatory- Directions: updates/issues/fda-regulations
Lactulose Directions: Magnesium Citrate Directions:
Docusate Sodium LIQUID Milk of Magnesia Directions: Directions:
TABLET Other Directions:
5 OTHER THINGS TO KEEP THE POOP SOFT AND REGULAR: Drink plenty of water everyday! Eat a balanced meal! Water (Cups/Day) Age Range 5 4 to 8 years 8 9 to 13 years Data are from Institute of Medicine of the National 8-10 14 to 18 years Academies. 1 cup is 8 Oz Foods “P fruits that make you POOP” - Pears, Prunes, Peaches, Plums, Pineapples and APricots
Toilet time Have your child sit on the toilet (for up to 5 minutes) two times a day - after meals is best because your body feels like pooping after eating. Use a stool to raise your child’s legs, if needed.
Bristol Stool Form Scale
Type 1 Separate hard lump
Type 2 Sausage-shaped but lumpy
Type 3 Like a sausage but with cracks on its surface
Type 4 Like a sausage or snake, smooth and soft
Type 5 Soft blobs with clear-cut edges
Type 6 Fluffy pieces with ragged edges, a mushy stool
Type 7 Watery, no solid pieces. Entirely Liquid
TREATMENT FOR YOUR CHILD’S CONSTIPATION PARENT/ PATIENT INSTRUCTIONS 6 MY GOAL STATEMENT CHILD My goal is
PARENT My goal is
*Please check the day(s) you reached your personal (child/parent) goal. 1 2 3 4 5 6 7
8 9 10 11 12 13 14
15 16 17 18 19 20 21
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29 30 31
Next Appointment:
Notes:
Questions to ask the Doctor:
This program is partially funded by the MEDTAPP Healthcare Access (HCA) Initiative and utilizes federal financial participation funds through the Ohio Department of Medicaid. Views stated in this presentation are those of the researchers only and are not attributed to the study sponsors, the Ohio Department of Medicaid or to the Federal Medicaid Program. MEDTAPP HCA Initiative funding supports teaching and training to improve the delivery of Medicaid services and does not support the delivery of Medicaid eligible services. © 2018 by Reema Gulati, M.D. and The MetroHealth System.