Constipation is a common problem for many children with cerebral palsy. The cause is not always clear. It may be due to reduced mobility, certain medications, not enough fluid intake or related to difficulty eating enough fibre. If your child does have constipation the following tips may help.

Encourage foods that contain fibre

• Soluble fibres found in fruits, vegetables and oats are the best source of fibre in the management or prevention of constipation.
• Encourage some of the following high -fibre foods on a daily basis:
  • Wholegrain cereals (e.g. porridge, wheat biscuits)
  • Wholemeal pasta and rice (may be eaten whole or ground)
  • Fresh, stewed or canned fruits
  • All vegetables – raw, cooked, mashed or pureed (leave the   skin on)
  • Baked beans, lentils, dried peas and beans

These foods can be eaten whole, mashed or pureed depending on your child’s feeding ability.

• Avoid unprocessed bran as this is too harsh on a young child’s digestive system and can make constipation worse.
• Some children with eating and drinking difficulties may not be able to eat enough high fibre foods regularly and fibre supplements may be required. Talk to your doctor or dietitian about which fibre supplements may be suitable for your child.
• If your child is fed using a gastrostomy, a commercial formula with fibre may be useful. Talk to your dietitian about a formula that may be suitable for your child.

Fluid

• Encourage a good intake of fluid. The amount of fluid your child requires depends on how old they are (refer to fluid information sheet for more detail). Thicken drinks as required and remember thickened fluids are just as hydrating as thin fluids.
• Pear juice or prune juice may help with relieving constipation.
• Good sources of fluid include: water, milk, juice, formula, ice, iceblocks, jelly, yoghurt, custard, ice cream.

Activity

• Limit periods of inactive sitting time as much as possible.
• Assist or encourage your child or change positions regularly to include lying in different positions, sitting and standing. Encourage your child to participate in ‘huff and puff’ activities for a minimum of 60 minutes per day.
• Your physiotherapist will be able to suggest individualised activities your child can participate in and recommend a range of exercises that assist trunk and pelvic movement; this may include flexing the hips fully up and down, ‘running the legs’, trunk rotation and active trunk flexion.

How much fibre is enough?

Infants

• 0-6 months – No recommendation has been set
• 7-12 months – No recommendation has been set

Children and adolescents

• 1-3 yr – 14g/day
• 4–8 yr – 18g/day
• 9-13 yr (Girls) – 20g/day
• 0-13 yr (Boys) – 24g/day
• 14-18 yr (Girls) – 22g/day
• 14-18 yr (Boys – 28g/day

Toileting

Ask your occupational therapist how to personalize a toileting program for your child. The following principles can be applied:

• Maintain a regular toileting schedule that includes sufficient time for your child to sit on the toilet (up to 10 minutes).
• For many children, the bowel is activated by eating or sitting in water. 15 minutes after a meal or straight after the bath can be a good time to encourage toileting.
• To optimize balance on the toilet and assist with adequate muscle contraction and sphincter release, children should be seated on a toilet or potty with an appropriately sized seat (reducer rings that fit under the normal toilet seat are stable). They should also have their feet supported (e.g on a small step or stool).
• For children with balance difficulties, a rail to hold onto will keep them more secure and allow them to concentrate on their toileting.
• As much as possible, children should sit with their backs straight and leaning slightly forwards. Some children need to be taught to push and require verbal prompts to “squeeze the muscles in their tummies”.

Medications

• Sometimes children with CP will require medication to assist with maintaining regular bowel habits.
• Talk to your doctor to find out if medication may be suitable for your child.

Fibre content of common foods

Contact us

Queensland Paediatric Rehabilitation Service
Queensland Children’s Hospital
Level 6, 501 Stanley Street, South Brisbane 4101
t: 07 3068 2950
t: 07 3068 1111 (general enquiries)
f: 07 3068 3909
e: qprs@health.qld.gov.au

In an emergency, always call 000.

If it’s not an emergency but you have any concerns, contact 13 Health (13 43 2584). Qualified staff will give you advice on who to talk to and how quickly you should do it. You can phone 24 hours a day, seven days a week.

References

1. Benninga MA, et al. J Paed Gastroent Nutr. 2004.  2. Clayden G, Keshtgar AS, J Postgrad Med. 2003;79:616-21. 3. Shaw, V., Lawson, M., 2007. Clinical Paediatric Dietetics.  3rd  Edition, Blackwell Sciences Ltd., London.  4. English, R., Lewis, J., 1997, ANZFA, Food for Health, Nutritional Values for Australian Foods, Australian Government Publishing Service, Canberra.  5. Department of Health & Ageing National Health and Medical Research Council, 2005, Nutrient Reference values for Australia and New Zealand. Australian Government Publishing Service, Canberra.