1. L. Hope Wills, MA, RD, CSP Eating Pooping and Growing Hope Wills, MA, RD, CSP

2. 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 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

3. 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. 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.

4. L. Hope Wills, MA, RD, CSP Definition of Constipation Infrequent and often incomplete elimination of stool Hard painful stools Infrequent and often incomplete elimination of stool Hard painful stools

5. 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 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

6. 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 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

7. 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) Low muscle tone (or poor coordination of muscles) Mobility Diet Hydration status Hormonal regulation (hypothyroid, menstruation cycle)

8. 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 (???) 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 (???)

9. L. Hope Wills, MA, RD, CSP The Vicious Cycle

10. 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 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

11. L. Hope Wills, MA, RD, CSP Impact of Constipation …. Behavior Increase in irritability Avoidance of activities that surround “pooping” Behavior Increase in irritability Avoidance of activities that surround “pooping”

12. 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 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

13. 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 Increase Fiber intake Vegetables (hard sell) Fruits Cereals (cooked and ready to eat) Whole grain products (enriched) Fiber supplements

14. 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 Insoluble Fiber Indigestible portion Moves bolus along the GI tract Food sources Fruits Vegetables Whole wheat products Wheat bran Corn bran Seeds and nuts

15. 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) 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)

16. L. Hope Wills, MA, RD, CSP Fiber Supplements

17. 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) Children - Age + 5 gms per day Adults - 25 - 35 gms per day Men > women Insoluble > soluble (3:1)

18. L. Hope Wills, MA, RD, CSP 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

19. L. Hope Wills, MA, RD, CSP Non Traditional Herbs Massage Cranio-sacral Abdominal massage Teas Sassafras Senna Herbs Massage Cranio-sacral Abdominal massage Teas Sassafras Senna

20. L. Hope Wills, MA, RD, CSP What are parents worried about? Pooping independently Interference with ability to absorb nutrients Pooping independently Interference with ability to absorb nutrients

21. 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. 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.