Transcript Document

Eating Pooping and Growing
Hope Wills, MA, RD, CSP
L. Hope Wills, MA, RD, CSP
Objective
• Discuss the impact of constipation on
health and nutrition
• Discuss dietary and behavioral
strategies to reduce constipation
• Discuss pros and of traditional and nontraditional management
L. Hope Wills, MA, RD, CSP
Is it Constipation?
• Baby makes a face when they have a
“Poop”.
• Toddler experiences “goat turds” every
day.
• Preschooler has soft bowel movement
every other day.
• School age child becomes irritable
before they have a bowel movement.
L. Hope Wills, MA, RD, CSP
Definition of Constipation
• Infrequent and often incomplete
elimination of stool
• Hard painful stools
L. Hope Wills, MA, RD, CSP
Some facts
• Constipation affects ~10% of all children
• In children with special needs the rate can
go up > 50%
• The main site affected is the COLON
• The role of the colon is to absorb the water
from the contents in the intestine
• The large intestine is made of smooth
muscle
L. Hope Wills, MA, RD, CSP
Gut Nervous System
• Can operate separately from the
central nervous system
• Alterations in motility of the gut can
result in a primary defect of the
enteric neurons
• OR lack of coordination between the
two nervous systems
L. Hope Wills, MA, RD, CSP
Causes of Constipation
• Low muscle tone (or poor coordination
of muscles)
• Mobility
• Diet
• Hydration status
• Hormonal regulation (hypothyroid,
menstruation cycle)
L. Hope Wills, MA, RD, CSP
What do the experts say?
• Study in the J of Child Care. Jennings
et al.(2009)
• 84 children, pre adolescent
• 33% experienced constipation
• Children with higher intake of water and
fiber with less constipation (not
significant)
• Children with higher levels of activity
experienced more constipation (???)
L. Hope Wills, MA, RD, CSP
The Vicious Cycle
L. Hope Wills, MA, RD, CSP
Impact of Constipation….
• Appetite decreases
• When you are full of poop, you are not
hungry
• Sometimes children will associate foods
with abdominal discomfort and then avoid
that food
• Prolonged presence of stool in the gut,
produces GAS and BLOATING
L. Hope Wills, MA, RD, CSP
Impact of Constipation ….
• Behavior
• Increase in irritability
• Avoidance of activities that
surround “pooping”
L. Hope Wills, MA, RD, CSP
Dietary Intervention
• Fluid intake
• A fluid is anything that becomes a liquid at room
temperature
• Water always a good choice
• Juices (apple, prune, pear)
• Foods that contain a lot of water (berries,
melons, juicy fruits)
• Adding blended fruits and vegetables
L. Hope Wills, MA, RD, CSP
Dietary Intervention
• Increase Fiber intake
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Vegetables (hard sell)
Fruits
Cereals (cooked and ready to eat)
Whole grain products (enriched)
Fiber supplements
L. Hope Wills, MA, RD, CSP
Types of Fiber
• Insoluble Fiber
• Indigestible portion
• Moves bolus along the GI tract
• Food sources
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Fruits
Vegetables
Whole wheat products
Wheat bran
Corn bran
Seeds and nuts
L. Hope Wills, MA, RD, CSP
Types of Fiber
• Soluble Fiber
• Has ability to bind up fatty acids
• Water soluble forming “gel-like” substance
• Food Sources
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Oat bran
Barley
Beans
Fruits (apples, oranges, bananas)
Vegetables (okra, squash, gourds)
L. Hope Wills, MA, RD, CSP
Fiber Supplements
L. Hope Wills, MA, RD, CSP
How much fiber
• Children - Age + 5 gms per day
• Adults - 25 - 35 gms per day
• Men > women
• Insoluble > soluble (3:1)
L. Hope Wills, MA, RD, CSP
Behavioral Interventions
• MARKING time
• MAKING time (scheduled events)
• Rituals for RELAXATION
• Reading
• Music
• Movement/Massage
L. Hope Wills, MA, RD, CSP
Non Traditional
• Herbs
• Massage
• Cranio-sacral
• Abdominal massage
• Teas
• Sassafras
• Senna
L. Hope Wills, MA, RD, CSP
What are parents worried
about?
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• Pooping
independently
• Interference with
ability to absorb
nutrients
L. Hope Wills, MA, RD, CSP
Questions from Families
• Please feel free to ask questions at this
time.
• If I don’t have the answer to your
question I am happy to get your email,
look it up and get back to you.
• Please.
L. Hope Wills, MA, RD, CSP