Treating constipation in children with additional needs

The main message for parents and professionals about constipation management in children with a learning disability is to treat them the same as you would any other child. Their bowel is not disabled.

The aim should still be for them to pass soft stools between three times a day and four times a week.

It is worth noting that the prevalence of constipation is much higher in children with additional needs. Why is this?

They may have communication difficulties, mobility problems.

They may have a limited diet, either self-imposed, for instance, choosing only beige foods or perhaps due to tube feeds.

Their fluid intake may be less than ideal.

Constipation may be a side effect of their essential medication.

They may have particular sensory difficulties.

Anxiety may prove a significant obstacle potentially leading to increased stool withholding lack of toileting, and also crucially because of assumptions that the disability is affecting the bowel and therefore acceptance of the bowel habit as part of the child's condition.

Too often parents get very concerned that the number of nappies they're allocated is inadequate because their child is pooing 10 times a day. The answer is not to provide more nappies; it's to question why the child is pooing.

So frequently our constipation alarm bells should be ringing is what they're seeing overflow. So the child with a learning disability should be assessed just the same as their mainstream peers. Look back on video two, on recognising the symptoms of constipation and video three, on treating constipation.

The symptoms to look for and the ideal treatment are the same regardless of any special needs note, it is just as important to do the physical examination. No assumption should be made that the symptoms are due to the learning disability.

The first line treatment should still be a macrogol laxative following all the guidance given in video four. However, we have to recognise the fact that it can be very difficult to get some of our children to consume sufficient fluids at all, let alone extra drinks containing macrogols.

And we have to remember that as the macrogol water is not absorbed, it cannot be counted as a drink. So what should we do? Fundamentally, all constipated children need to consume large doses of laxative.

We can start with macrogols and assist the parent to be imaginative, thinking of different ways to make it acceptable to the child. If the amount they manage is insufficient, then other laxatives should be added. Docusate, sodium sna, lactulose, sodium pico sulphate responding to the child's individual needs.

The aim should still be to get the poo in the loo, even if the child is not yet toilet trained. A regular toilet sit will help to keep the poo moving. It's an important part of constipation treatment.

Follow the same six steps outlined in video five. Considering the child's individual needs, do they need an OT assessment to identify a suitable toilet chair? Is smearing an issue? If so, check out the ERIC resource on smearing.

Is anxiety proving an obstacle? Suggest reading toilet anxiety and toilet phobia.

In children, it may take the child with additional needs longer to master pooing in the loo, but it's a hugely worthwhile investment of time, a life skill.

It may well be harder for them to interpret the signal of needing a poo, so they may never indicate the need to go, but that need not stop the poo going in the loo. Untreated or undertreated, constipation is a major obstacle to toilet training. So once it's well managed and potty or toilet practice is established, it should be time to consider toilet training.

The child with additional needs is a child, so treat them like a child and aim for timely potty training. Tools like the ERIC Bladder Bowel Assessment and Toilet Readiness Assessment will help to guide parents and professionals to decide the right time and resources like sensory needs and toileting, and the toilet visual schedule will help to shape their journey towards continence.