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L. Hope Wills, MA, RD, CSPL. Hope Wills, MA, RD, CSP
Eating Pooping and Growing
Hope Wills, MA, RD, CSP
Eating Pooping and Growing
Hope Wills, MA, RD, CSP
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L. Hope Wills, MA, RD, CSPL. Hope Wills, MA, RD, CSP
ObjectiveObjective
• Discuss the impact of constipation on health and nutrition
• Discuss dietary and behavioral strategies to reduce constipation
• Discuss pros and of traditional and non-traditional management
• Discuss the impact of constipation on health and nutrition
• Discuss dietary and behavioral strategies to reduce constipation
• Discuss pros and of traditional and non-traditional management
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L. Hope Wills, MA, RD, CSPL. Hope Wills, MA, RD, CSP
Is it Constipation?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.
• 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.
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L. Hope Wills, MA, RD, CSPL. Hope Wills, MA, RD, CSP
Definition of ConstipationDefinition of Constipation
• Infrequent and often incomplete elimination of stool
• Hard painful stools
• Infrequent and often incomplete elimination of stool
• Hard painful stools
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L. Hope Wills, MA, RD, CSPL. Hope Wills, MA, RD, CSP
Some factsSome 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
• 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
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L. Hope Wills, MA, RD, CSPL. Hope Wills, MA, RD, CSP
Gut Nervous SystemGut 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
• 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
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L. Hope Wills, MA, RD, CSPL. Hope Wills, MA, RD, CSP
Causes of ConstipationCauses of Constipation
• Low muscle tone (or poor coordination of muscles)
• Mobility• Diet• Hydration status• Hormonal regulation (hypothyroid,
menstruation cycle)
• Low muscle tone (or poor coordination of muscles)
• Mobility• Diet• Hydration status• Hormonal regulation (hypothyroid,
menstruation cycle)
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L. Hope Wills, MA, RD, CSPL. Hope Wills, MA, RD, CSP
What do the experts say?
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 (???)
• 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 (???)
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L. Hope Wills, MA, RD, CSPL. Hope Wills, MA, RD, CSP
The Vicious CycleThe Vicious Cycle
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L. Hope Wills, MA, RD, CSPL. Hope Wills, MA, RD, CSP
Impact of Constipation….
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
• 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
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L. Hope Wills, MA, RD, CSPL. Hope Wills, MA, RD, CSP
Impact of Constipation ….
Impact of Constipation ….
• Behavior• Increase in irritability• Avoidance of activities that surround “pooping”
• Behavior• Increase in irritability• Avoidance of activities that surround “pooping”
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L. Hope Wills, MA, RD, CSPL. Hope Wills, MA, RD, CSP
Dietary InterventionDietary 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
• 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
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L. Hope Wills, MA, RD, CSPL. Hope Wills, MA, RD, CSP
Dietary InterventionDietary Intervention
• Increase Fiber intake• Vegetables (hard sell)• Fruits • Cereals (cooked and ready to eat)• Whole grain products (enriched)• Fiber supplements
• Increase Fiber intake• Vegetables (hard sell)• Fruits • Cereals (cooked and ready to eat)• Whole grain products (enriched)• Fiber supplements
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L. Hope Wills, MA, RD, CSPL. Hope Wills, MA, RD, CSP
Types of FiberTypes 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
• Insoluble Fiber• Indigestible portion• Moves bolus along the GI tract
• Food sources• Fruits• Vegetables• Whole wheat products• Wheat bran• Corn bran• Seeds and nuts
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L. Hope Wills, MA, RD, CSPL. Hope Wills, MA, RD, CSP
Types of FiberTypes 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)
• 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)
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L. Hope Wills, MA, RD, CSPL. Hope Wills, MA, RD, CSP
Fiber SupplementsFiber Supplements
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L. Hope Wills, MA, RD, CSPL. Hope Wills, MA, RD, CSP
How much fiberHow much fiber
• Children - Age + 5 gms per day
• Adults - 25 - 35 gms per day• Men > women• Insoluble > soluble (3:1)
• Children - Age + 5 gms per day
• Adults - 25 - 35 gms per day• Men > women• Insoluble > soluble (3:1)
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L. Hope Wills, MA, RD, CSPL. Hope Wills, MA, RD, CSP
Behavioral Interventions
Behavioral Interventions
• MARKING time• MAKING time (scheduled events)• Rituals for RELAXATION• Reading• Music• Movement/Massage
• MARKING time• MAKING time (scheduled events)• Rituals for RELAXATION• Reading• Music• Movement/Massage
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L. Hope Wills, MA, RD, CSPL. Hope Wills, MA, RD, CSP
Non Traditional Non Traditional
• Herbs• Massage• Cranio-sacral • Abdominal massage
• Teas • Sassafras • Senna
• Herbs• Massage• Cranio-sacral • Abdominal massage
• Teas • Sassafras • Senna
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L. Hope Wills, MA, RD, CSPL. Hope Wills, MA, RD, CSP
What are parents worried about?
What are parents worried about?
• • Pooping
independently• Interference
with ability to absorb nutrients
• • Pooping
independently• Interference
with ability to absorb nutrients
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L. Hope Wills, MA, RD, CSPL. Hope Wills, MA, RD, CSP
Questions from Families
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.
• 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.