Elimination Disorders in Children

  • Medical Author:
    John Mersch, MD, FAAP

    Dr. Mersch received his Bachelor of Arts degree from the University of California, San Diego, and prior to entering the University Of Southern California School Of Medicine, was a graduate student (attaining PhD candidate status) in Experimental Pathology at USC. He attended internship and residency at Children's Hospital Los Angeles.

  • Medical Editor: David Perlstein, MD, MBA, FAAP
    David Perlstein, MD, MBA, FAAP

    David Perlstein, MD, MBA, FAAP

    Dr. Perlstein received his Medical Degree from the University of Cincinnati and then completed his internship and residency in pediatrics at The New York Hospital, Cornell medical Center in New York City. After serving an additional year as Chief Pediatric Resident, he worked as a private practitioner and then was appointed Director of Ambulatory Pediatrics at St. Barnabas Hospital in the Bronx.

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What is the treatment for elimination disorders in children?

Successful treatment of elimination disorders includes reestablishing an appropriate bowel evacuation regimen and development of a program to ensure maintenance of such a stool elimination pattern. A program that may include the use of laxatives, changes in diet, toileting behavior adjustments, and close follow-up has been shown to provide the highest rate of success. The therapeutic approach is often defined by the age of the child. Breastfed infants are less likely to have stooling problems when compared with their formula-fed peers. Diluted prune juice (50:50 with water) will promote a softer and increased volume stool. Rectal stimulation with either a rectal thermometer or glycerin suppository may be an appropriate technique to address a stool-impacted infant. Mineral oil is not recommended for infants due to the possibility of gastroesophageal reflux (GER) and possible lung pathology if aspirated. Careful attention to the child's stooling pattern is worthwhile when solid foods are introduced into the young infant's diet.

Preschoolers, grammar-school-age, and older children with elimination disorders are generally approached in a similar fashion. If the child is chronically impacted, the use of an orally administered cathartic (for example, magnesium citrate) will "clean out" the colon. Colonic enemas have fallen out of favor due to the emotional stress that may be associated with their use. Follow-up daily use of water retaining laxatives (for example, polyethylene glycol without electrolytes marketed as PEG-3350 or Miralax) is common. This approach allows the chronically distended colon to gradually return to a normal volume -- thus allowing redevelopment of stretch receptors to respond to the local rectal/anal enlargement associated with stool arrival to the area. These water-retaining laxatives may be needed for several months before considering a gradual tapering. A thorough review of the child's diet is important. Avoidance of large amounts of constipating items is paramount. Such foods would include excessive milk/dairy products, starches (bread, pasta, etc.), and "fast foods," which are often high in saturated fats. Grandmother's suggestion to "eat your fruits and vegetables" has solid medical credence. An adequate intake of water as well as daily vigorous physical activity will also promote colonic health. Establishment of a daily routine of "toilet time" has been shown to be very helpful. Spending between five to 10 minutes on the toilet is a generally accepted goal. For young children, a reward system is often helpful. The reward should be a response for sitting on the toilet for the allotted time -- not the production of stool. Passage of a daily normal character stool without discomfort is the intended goal of bowel reeducation.

The use of probiotics has received scientific study in the last few years. Pediatric studies are less convincing than those utilizing adult patients and many studies present conflicting results. There has been no documentation of a deleterious effect of probiotic usage in children or adults.

Medically Reviewed by a Doctor on 3/11/2016

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