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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 • • • • • 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 • • • • • • 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 • • • • • 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? • • 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