Nov. 7, 2023
19 | The Scoop on Poop: Managing Constipation in Kids
Do you work with children struggling with constipation? We've got answers. Join us for a riveting discussion with Emily Dollar, a certified registered nurse anesthetist and family nurse practitioner. Known as the "Enco Expert" on Instagram, Emily brings to the table a wealth of practical advice on tackling constipation in children. I know you're thinking, "Colleen, I already know how to manage constipation." But stay with me, because we're going beyond the typical recommendation of "drink more water, eat more fiber."
What you'll learn today:
- How to know if a child is actually constipated and the various symptoms of constipation. Did you know that a child can poop daily and still be constipated?
- How bladder accidents, like bed wetting, can actually be related to constipation.
- Knowing the limits of a physical exam and when to order an x-ray.
- Dietary solutions and hydration strategies for managing constipation.
- When to initiate a stool softener
I know you'll find something you can walk away with today that will improve the health of your patients! If you have a colleague or friend who struggles with knowing how to discuss nutrition or weight with their patients, and you think they might benefit from my podcast, I would love if you could share this episode with them. My goal is to help as many clinicians as possible realize that nutrition matters and it is possible to educate our patients toward a healthy lifestyle, despite all the barriers we face.
Connect with us on Instagram! =============================
Exam Room Nutrition IG: ➡︎@examroomnutrition
Emily IG: ➡︎ @encoexpert
Watch videos on YouTube =================
https://youtube.com/@examroomnutrition
Connect with Colleen:
Instagram
LinkedIn
Sign up for the Nutrition Wrap-Up Newsletter - Nutrition hot-topics and professional growth strategies delivered to your inbox each week.
Support the show!
If you love the show and want to help me make it even better, buy me a coffee to help me keep going! ☕️
Disclaimer: This podcast is a collection of ideas, strategies, and opinions of the author(s). Its goal is to provide useful information on each of the topics shared within. It is not intended to provide medical, health, or professional consultation or to diagnosis-specific weight or feeding challenges. The author(s) advises the reader to always consult with appropriate health, medical, and professional consultants for support for individual children and family situations. The author(s) do not take responsibility for the personal or other risks, loss, or liability incurred as a direct or indirect consequence of the application or use of information provided. All opinions stated in this podcast are my own and do not reflect the opinions of my employer.
WEBVTT
00:00:00.119 --> 00:00:11.311
Technically, constipation is having infrequent bowel movements, but you can also have a bowel movement every day, and if it's uncomfortable, then that technically, is constipation as well.
00:00:11.311 --> 00:00:18.841
So you can in fact have a child that's having, you know, regular bowel movements and then surprisingly be full of stool, are you?
00:00:18.900 --> 00:00:22.952
ready to transform the way you communicate about nutrition with your patients.
00:00:22.952 --> 00:00:25.246
Welcome to Exam Room Nutrition.
00:00:25.246 --> 00:00:26.562
The podcasts were.
00:00:26.562 --> 00:00:29.992
The worlds of nutrition, medicine and communication collide.
00:00:29.992 --> 00:00:34.851
Whether you're a seasoned physician or a healthcare student, this podcast is for you.
00:00:34.851 --> 00:00:39.610
So stick around and let's make our patients healthier, one Exam Room at a time.
00:00:40.161 --> 00:00:42.567
Welcome back to the Exam Room Nutrition podcast.
00:00:42.567 --> 00:00:44.192
I'm your host, colleen Sloan.
00:00:44.192 --> 00:00:46.948
I'm a registered dietitian and pediatric PA.
00:00:46.948 --> 00:00:58.389
I'm so excited for our conversation today because this topic always gets my patients giggling and squirming when we talk about it, because it can sometimes be embarrassing, but it's a topic that everybody does.
00:00:58.389 --> 00:01:00.627
So what is our mystery topic for today?
00:01:01.462 --> 00:01:10.289
We are talking all about who we're going to help you answer your patient when they ask you my child is so constipated, what do I do?
00:01:10.289 --> 00:01:19.170
I know you're thinking, colleen, I already know how to manage constipation, but before you tune me out, I promise you'll learn something new.
00:01:19.170 --> 00:01:25.533
Today we're going way beyond the basic recommendation of drink more water and eat more fruits and vegetables.
00:01:25.533 --> 00:01:31.253
I think it's really important for you to understand exactly what the definition of constipation actually is.
00:01:31.253 --> 00:01:37.153
Today you're going to learn helpful questions to ask your patients to determine if a child is actually constipated.
00:01:37.153 --> 00:01:45.629
We're also going to be talking about the link between bedwetting and constipation and what you might find on physical exam and when an abdominal x-ray is warranted.
00:01:45.629 --> 00:01:53.287
Of course, we're going to get into the dietary interventions and hydration goals for constipation relief and which medication you can prescribe.
00:01:53.287 --> 00:01:55.432
That would be extremely helpful for your patients.
00:01:55.432 --> 00:02:01.912
You don't want to miss the end of today's episode, where we discuss the worst thing to say to patients struggling with constipation.
00:02:01.912 --> 00:02:06.772
Didn't I tell you this episode is full of practical strategies that you won't want to miss.
00:02:07.260 --> 00:02:15.925
Before I introduce my guests, I have a favorite to ask If you have a friend that struggles with finding the words to say around nutrition or weight, could you please share this episode with them?
00:02:15.925 --> 00:02:18.091
Grab the link and shoot them a text.
00:02:18.091 --> 00:02:20.388
I love for them to listen as well.
00:02:20.388 --> 00:02:31.532
My goal is to help as many clinicians as possible realize that nutrition matters and it is possible to educate our patients toward a healthy lifestyle despite all the barriers that we face.
00:02:31.532 --> 00:02:34.707
Well, I'm so excited for you guys to meet our guest today.
00:02:34.707 --> 00:02:37.649
She's known on Instagram as the Enco Expert.
00:02:38.300 --> 00:02:39.466
Emily Dollar is with us.
00:02:39.466 --> 00:02:43.491
She's both a certified registered nurse anesthetist and a family nurse practitioner.
00:02:43.491 --> 00:02:56.312
She has a telehealth practice that helps children struggling with constipation, stool accidents and bedwetting, and she sees clients all over the world and helps children find relief and allow them to live full lives accident-free.
00:02:56.312 --> 00:03:00.150
Emily, thank you for being here today and I appreciate the gift of your time.
00:03:00.150 --> 00:03:01.861
Welcome to the show, thank you.
00:03:01.861 --> 00:03:23.532
Thank you for having me, so let's jump right in, and I think it's really important that we actually define what constipation is, because although our parents might say my daughter or my son is constipated, and then we ramble off all these suggestions and guidelines and maybe medication and diet changes, I think it's important to really know if we are truly dealing with a constipated child or not.
00:03:23.532 --> 00:03:28.331
So can you help us define constipation and maybe explain what normal stooling patterns look like?
00:03:28.939 --> 00:03:29.161
Sure.
00:03:29.161 --> 00:03:34.271
So technically constipation is having infrequent bowel movements.
00:03:34.271 --> 00:03:41.429
But you can also have a bowel movement every day and if it's uncomfortable then that technically is constipation as well.
00:03:41.429 --> 00:03:55.319
So you can in fact have a child that's having regular bowel movements and then surprisingly be full of stool and that kid's going to have chronic tummy aches or incomplete emptying where they're having multiple bowel movements today.
00:03:55.319 --> 00:04:05.120
So you're like how in the world can this kid be constipated if they're having five poops a day but they're just actually not able to eliminate it all effectively in one sitting?
00:04:05.120 --> 00:04:08.939
So it can be a wide range of symptoms that look like constipation.
00:04:09.080 --> 00:04:12.300
Poops should never be difficult for any of us, adults or kids.
00:04:12.300 --> 00:04:17.422
You should be able to feel the urge to have a bowel movement, sit down on the toilet and it come out.
00:04:17.422 --> 00:04:20.971
There should never be any straining or much effort or whatnot.
00:04:20.971 --> 00:04:24.309
So there are some red flags for constipation.
00:04:24.309 --> 00:04:30.863
When parents say things like they're having huge stools that are just large and they clog the toilet Constipation.
00:04:30.863 --> 00:04:37.036
If they're only having a poop, you know, two to three or even four times a week constipation.
00:04:37.036 --> 00:04:45.612
If they're describing their poop says hard or small, like little pebbles or even like dried and kind of cracked constipation.
00:04:45.612 --> 00:04:47.872
But it can also swing the other way.
00:04:47.872 --> 00:04:54.250
If they're having those frequent, three to five times a day having diarrhea, that can also be a red flag.
00:04:54.884 --> 00:04:59.975
So I know I like to ask my older patients when I'm assessing how their stilling pattern is.
00:04:59.975 --> 00:05:06.177
I can ask them when you go to the bathroom to go poop, is it easy or is it painful?
00:05:06.177 --> 00:05:12.535
Is that a good way to frame that question, or can you suggest a different way to maybe pull some more information out from the child?
00:05:12.886 --> 00:05:21.053
No, I think that's a great question and you can just ask them like is it comfortable, is it easy or does it take a lot of work for you to have your poops?
00:05:21.053 --> 00:05:24.754
Or sometimes they also to have withholding symptoms.
00:05:24.754 --> 00:05:33.033
So it comes across as like they always have a poop emergency or a pee emergency right, or they never get much warning if they have to go.
00:05:33.033 --> 00:05:45.747
So those are red flags too for the parent to say they always seem to have to go urgently and so urgency and then, like you said, painful or difficult stools are also all signs of constipation.
00:05:46.464 --> 00:05:50.435
So I know you talked a little bit about urgency with urinating or voiding.
00:05:50.435 --> 00:05:52.649
Is constipation and bedwetting?
00:05:52.649 --> 00:05:53.672
Are those two related?
00:05:54.052 --> 00:05:54.875
So they really are.
00:05:55.165 --> 00:06:04.235
We tell our patients that you know they're going to outgrow bedwetting or it's kind of a normal up until they're like five and six and then maybe up to like seven.
00:06:05.485 --> 00:06:13.353
But children that really struggle with constipation have such a higher incidence of daytime accidents but urine accidents but then also bedwetting.
00:06:13.353 --> 00:06:21.531
So there's a huge correlation there and really until you kind of resolve some of the constipation they don't have much opportunity to outgrow the bedwetting.
00:06:21.531 --> 00:06:27.377
And then you're looking at kids that are seven, eight, nine, 10, even 12, you know having bedwetting.
00:06:27.377 --> 00:06:31.615
At that point you really kind of got to get an x-ray and see what's going on.
00:06:31.615 --> 00:06:38.918
I think we rely a lot on abdominal palpation and kind of their symptomology, how they tell us it's going.
00:06:38.918 --> 00:07:02.836
But especially if you have an unresolved and ongoing bedwetting after the age of six or even seven, you really kind of got to investigate a little further and you don't really have to have a urology consult so much as just get a quick x-ray to kind of see if there's quite a bit of stool sitting there in the rectum which is pushing on the bladder, which makes it super irritable and decreases its capacity to hold urine overnight.
00:07:03.425 --> 00:07:07.355
I like to describe this to my parents as a poop baby.
00:07:07.355 --> 00:07:10.913
Especially to moms, you know, we kind of it clicks immediately when they're like how?
00:07:10.913 --> 00:07:13.571
I don't understand, how is my child wetting themselves?
00:07:13.571 --> 00:07:15.134
Related to that, they're constipated.
00:07:15.134 --> 00:07:18.935
And then I will describe it like look, they've got literally a poop baby that's sitting on their bladder.
00:07:18.935 --> 00:07:23.591
When you were pregnant and you had a baby sitting on your bladder, you kind of had a difficult time or you urinated more often.
00:07:23.591 --> 00:07:28.276
So it's kind of a fun silly way to kind of connect the two.
00:07:28.276 --> 00:07:30.673
Now I know you talked about abdominal x-ray.
00:07:30.673 --> 00:07:34.415
How about how we can physically assess for constipation?
00:07:34.415 --> 00:07:36.531
Walk us through a little bit more on the physical exam.
00:07:37.346 --> 00:07:38.572
It can look very different.
00:07:38.572 --> 00:07:47.209
You can have skinny kids with like six pack abs and you can palpate their abdomen and it's kind of unreliable when we go back and look.
00:07:47.209 --> 00:07:58.410
We're about 85% of the time inaccurate when we compare our physical abdominal palpation exam versus an x-ray to see if they have mild, moderate or severe constipation.
00:07:58.410 --> 00:08:02.862
So I think we depend on the physical palpation a lot more than we should.
00:08:02.862 --> 00:08:11.908
Even those of us with skilled hands, you know, are not very reliable when we compare that to the actual X-ray and to like.
00:08:11.927 --> 00:08:21.598
The rectum is so far down right in the pelvis If they have erectile impactions it's too far below where we're palpating anyway to kind of be able to feel that.
00:08:21.598 --> 00:08:29.178
Now you can feel fairly reliably if they're having stool all the way back up into the cecum in the right upper quadrant.
00:08:29.178 --> 00:08:36.038
A lot of times you can feel a bulge there, but it's just unreliable and their body habituses are so different.
00:08:36.038 --> 00:08:41.576
Right, we have these thin little athletic kids versus these kind of pudgy kids that might even be a little bit bloated.
00:08:41.576 --> 00:08:46.456
So when in doubt we always recommend getting at least an initial X-ray.
00:08:46.985 --> 00:08:48.071
That's extremely helpful.
00:08:48.071 --> 00:09:02.855
So now that we've had the conversation with our parent and the child because if the child is I think personally, at least over five, they can explain if it hurts their bottom when they try to push the poop out Now we know we have a child who is constipated, in fact.
00:09:02.855 --> 00:09:14.078
So let's move into the nutrition portion, so giving our parents and patient some form of relief and guiding them on how foods can help or can harm.
00:09:14.078 --> 00:09:21.759
So are there certain foods that we should initially talk about that might help relieve constipation?
00:09:22.345 --> 00:09:22.605
Yes.
00:09:22.605 --> 00:09:30.099
So the most important which is not really a food but it's the first thing we recommend is water and hydration.
00:09:30.099 --> 00:09:40.065
You can totally revitalize and revamp and just completely change their nutrition, but if you don't ensure that they're adequately hydrated it's all for naught.
00:09:40.065 --> 00:09:47.075
So the single most important thing that we can do is recommend enough water, and most parents, and certainly kids, have no idea how much water is enough.
00:09:47.075 --> 00:09:51.395
So we recommend at least a half an ounce per body weight for the kid.
00:09:51.395 --> 00:09:56.576
So like for an average three year old, that's about like 12 to 14 ounces of fluid a day.
00:09:56.576 --> 00:10:02.977
For average five year olds you're looking at a little closer to 20 ounces and all enough from there.
00:10:02.977 --> 00:10:12.073
They always seem to have their favorite cups or thermoses or whatever that they kind of drag around with them every day or they take within the school or practice or whatnot.
00:10:12.073 --> 00:10:22.153
So just kind of know how many ounces is that, and then you and the kiddo, especially if they're older than five or six, can kind of know and they can tell it, report back to the parent.
00:10:22.153 --> 00:10:28.077
I've already had one and probably a half of my thermoses today until you kind of know where the kid is.
00:10:28.077 --> 00:10:34.192
But you kind of got to have a mental goal in mind, at least of where you're trying to shoot for, and that's minimum hydration.
00:10:35.105 --> 00:10:43.994
But there are also other foods, fruits that start with a pea All those are excellent to help with tummies, like prunes, obviously.
00:10:43.994 --> 00:10:48.749
Plums, pineapples are full of water, so very good fruits.
00:10:48.749 --> 00:10:56.879
Any kind of citrus fruit is really good, certainly a kiwi, they say three kiwis a day keeps the doctor away.
00:10:56.879 --> 00:11:00.335
But kiwi has such good soluble and insoluble fiber.
00:11:00.335 --> 00:11:15.258
It is the first fruit that I recommend and it's not a common one that a lot of kids are getting, so it can kind of be a fun one for them to start experimenting with and it really does a great job of keeping them not only hydrated but with both types of fiber to help them.
00:11:15.605 --> 00:11:19.956
That's so interesting because we typically jump to like prune juice or prunes.
00:11:19.956 --> 00:11:30.155
Now, are there any certain foods that families should avoid or that maybe we need to ask a little bit more questions to see if they're overeating certain food groups that might be contributing to their constipation?
00:11:30.565 --> 00:11:30.985
For sure.
00:11:30.985 --> 00:11:33.908
So you know, dairy seems to get a bad rap in my field.
00:11:33.908 --> 00:11:42.116
With peach GI it's kind of widely regarded as like an inflammatory type food and so they're struggling with constipation.
00:11:42.116 --> 00:11:45.599
That's kind of one of the first things you can suggest as well.
00:11:45.599 --> 00:11:50.942
And you know, in our day and age we're super fortunate where there are a lot of easy substitutes for dairy.
00:11:50.942 --> 00:11:55.961
So it's not like they're not able to have any kind of mac and cheese anymore, even pizzas.
00:11:55.961 --> 00:11:58.619
They have all kinds of dairy-free options for that.
00:11:59.029 --> 00:12:01.118
So those are kind of some simple substitutions.
00:12:01.118 --> 00:12:16.196
They make Ripple brand makes a P-milk which is pretty readily available in the United States, pretty much in a grocery store and it has a super fun kids you know packaging, but it has quite a bit of protein in it when it's a non-dairy supplement.
00:12:16.196 --> 00:12:28.515
And then you can also do just super easy run-of-the-mill stuff too, like almond milk or oat milk or whatnot, to kind of have them with their cereal or whatever before they go to bed if they still like to have a little glass of milk.
00:12:28.515 --> 00:12:31.158
And then there's lots of dairy-free cheeses too.
00:12:31.158 --> 00:12:42.801
That dye a brand is super common and they make all kinds of stuff like the pizzas I was talking about or like mac and cheese, so they can still kind of have their fun favorites, kind of decrease some of that inflammatory dairy.
00:12:43.991 --> 00:12:46.139
Now, how much milk would you say is too much?
00:12:46.139 --> 00:12:54.421
I tend to ask this question kind of right out the get-go when I'm trying to collect information about the child's diet to see if that could be contributing to it.
00:12:54.421 --> 00:13:00.662
So I tend to ask them how many sippy cups or cups of milk does your child drink in 24 hours?
00:13:00.662 --> 00:13:05.610
For you know your typical let's call it your five-year-old what would be the red flag?
00:13:05.610 --> 00:13:07.397
Would it be like okay, yeah, that's too much dairy.
00:13:08.529 --> 00:13:11.239
I would say about eight ounces, just one cup a day.
00:13:11.239 --> 00:13:15.342
But if they're really, if they're having mild constipation, I wouldn't think too much about it.
00:13:15.342 --> 00:13:17.269
I wouldn't really recommend that they change that.
00:13:17.269 --> 00:13:26.582
But if they're having moderate to severe constipation or they're having to take a stool softener every day, I would recommend just eliminating that, if you can, that's really helpful.
00:13:26.990 --> 00:13:31.522
We know our toddlers love milk, so that's a common age for them to come in with constipation.
00:13:31.522 --> 00:13:37.898
Is the you know 15 months or the 18-month-old to have just transitioned over to milk and they're still drinking excesses amount of milk.
00:13:37.898 --> 00:13:48.221
So let's leave our listeners with, maybe, what you educate or prescribe for your patients, at least initially, when we've got a constipated kid.
00:13:48.221 --> 00:13:50.611
You've talked about the importance of hydration.
00:13:50.611 --> 00:13:53.500
Maybe you're going to substitute some of these milk alternatives.
00:13:53.500 --> 00:13:55.332
What would be your next step?
00:13:55.332 --> 00:14:00.557
As, like the nutrition prescription portion of it, do you go into any fiber supplements?
00:14:00.557 --> 00:14:07.034
Do you put them on a stool softener or do you initially just really focus on increasing those fruits and vegetables?
00:14:07.470 --> 00:14:10.820
I really like to go ahead and add a stool softener.
00:14:10.820 --> 00:14:12.174
They're seeking my help.
00:14:12.174 --> 00:14:17.716
They've already usually done all the other things that you've recommended, which most of us providers are pretty good at doing right.
00:14:17.716 --> 00:14:22.607
Stay hydrated, stay active, do some jumpings and bicycling, swimming, you know.
00:14:22.607 --> 00:14:24.676
Increase your healthy fruits and vegetables.
00:14:24.676 --> 00:14:26.937
They've kind of already done all that by the time they get to me.
00:14:26.937 --> 00:14:30.077
So an easy first line is a stool softener.
00:14:30.669 --> 00:14:34.796
A Mirolax is readily available here in the United States, so that's kind of an easy one.
00:14:34.796 --> 00:14:40.214
It's fairly tasteless, so you can add it just to water or whatnot and have them have some of that every day.
00:14:40.214 --> 00:14:44.600
Some parents are a little bit hesitant about the Mirolax, which is totally fine with me.
00:14:44.600 --> 00:14:47.279
There are lots of other healthy alternatives.
00:14:47.279 --> 00:14:51.898
So there's some magnesium products over the counter that are easy to do.
00:14:51.898 --> 00:14:54.136
There's a million of them in Target.
00:14:54.136 --> 00:14:57.038
There's PDLX chewable tablets.
00:14:57.038 --> 00:15:01.160
There's some Dolcolax chews that are kind of fun that they can have.
00:15:01.160 --> 00:15:04.919
There's some that are kind of a little bit harder, like a Minto type kind of texture.
00:15:04.919 --> 00:15:09.240
Some of our kids struggle with autism or sensory processing disorder or whatnot.
00:15:09.240 --> 00:15:24.760
They're a little bit averse to different textures of things, so there are a lot of different textures of the softeners for them to try, some that are not detectable, like the Mirolax you can mix pretty easily in water, and then other things that they can chew, or gummies or whatnot, over the counter.
00:15:25.190 --> 00:15:28.582
And then for, let's just say it may be a mildly constipated child.
00:15:28.582 --> 00:15:35.313
Do you start slow with these stool softeners, like once a day, and then they can increase it if they don't notice an improvement?
00:15:35.313 --> 00:15:39.102
How do you recommend the medication management aspect of it?
00:15:40.047 --> 00:15:42.176
We go by what's on the back of the product.
00:15:42.176 --> 00:15:44.465
So that's a pretty reliable source for these medications.
00:15:44.465 --> 00:15:54.465
You know, it'll say on the back of those, the PDL-AX tuibles or the Dulk-ALEX tubes, it'll say like between one and three depending on their age, and it gives like an age recommendation.
00:15:54.465 --> 00:16:03.360
So you can certainly start with one of those a day and if they're still not going every day or they're struggling, then you can certainly increase that up to the maximum.
00:16:03.360 --> 00:16:10.445
On the back of the bottle, all those over the counterwinds that I mentioned are magnesium products, so you wouldn't want to go over the recommended amount of that.
00:16:10.445 --> 00:16:12.410
And then the MIRLAX.
00:16:12.410 --> 00:16:18.730
If you kind of get to a certain point it can kind of backfire on you a little bit and start causing even two loose stools.
00:16:18.730 --> 00:16:20.235
So it can be a little difficult.
00:16:20.686 --> 00:16:25.465
How long do you recommend that they stay on a daily stool often, or is it two weeks?
00:16:25.465 --> 00:16:26.879
Is it months?
00:16:26.879 --> 00:16:27.445
Is this lifelong?
00:16:27.445 --> 00:16:29.375
Because I know I get this question all the time.
00:16:29.375 --> 00:16:31.465
Well, how long does my child have to keep taking this medicine?
00:16:32.448 --> 00:16:37.395
I tell them forever An ounce of prevention is worth a pound of cure.
00:16:37.395 --> 00:17:08.332
So if we, especially in this young patient population like you were talking about, like the 15 months once we're introducing solid foods and then certainly through potty training and then again whenever it's another risk time frame when they're entering into pre-K4 or kindergarten, so they can be prone to constipation and have those painful stools, so if we can sort of keep them on a softener, at least for six months, then you can sort of lean back a little bit and if they're struggling again I put them right back on it, no problem, and I don't feel guilty about that at all.
00:17:08.332 --> 00:17:18.444
I think it's important for them to prevent constipation and prevent having any kind of painful stools that can kind of make them backtrack and have some significant physical symptoms.
00:17:18.444 --> 00:17:19.588
We don't want that for them.
00:17:20.746 --> 00:17:34.361
Yeah, I noticed that a lot and it is that cycle of stool holding because it hurt and then it just compiles and worsens the situation of hard poop so that the next time it hurts them so they're going to hold it even more.
00:17:34.361 --> 00:17:36.393
I had a kid who was just so stubborn.
00:17:36.393 --> 00:17:41.876
He held it for a good like three weeks and poor boy was in so much pain.
00:17:41.876 --> 00:17:49.358
So I think I'd like to close with the severe end of constipation, that extremely constipated child who's a really bloated.
00:17:49.358 --> 00:17:53.674
You can feel stool all over the different quads and some of the abdominal exam.
00:17:53.674 --> 00:17:59.376
How can we provide them relief without having to send them to the emergency room, maybe like a bowel clean out?
00:17:59.376 --> 00:18:01.846
What do you recommend for a situation like that, so you can?
00:18:01.887 --> 00:18:04.464
do one of two or both things.
00:18:04.464 --> 00:18:07.273
You can prescribe an oral clean out.
00:18:07.273 --> 00:18:23.424
We usually do between four and even eight caps of mirror locks in about four ounces of fluid per cap and you can do that in a shorter timeframe so that it's most effective like within four to five hours, and you can give them one or two X-Lex.
00:18:23.424 --> 00:18:34.464
So it's kind of like you and I having to do like a colonoscopy prep, but it mirror lets is a great job of pulling all that water into the stool and making it all easy to pass so they get that quicker relief.
00:18:35.165 --> 00:18:42.898
Some kids are totally fine with doing a little suppository or an enema and that won't clean them out like that meralax will.
00:18:42.898 --> 00:18:47.298
But if they have a rectal impaction it can give them some pretty immediate relief.
00:18:47.298 --> 00:18:48.553
It's pretty instant.
00:18:48.553 --> 00:18:50.894
Usually within 10 minutes they'll have a bowel movement.
00:18:50.894 --> 00:18:54.780
So they make the liquid glycerin suppositories.
00:18:54.780 --> 00:19:03.156
They're way more effective than the solid suppository and for children under five there's the Petylaxx sprain which has the little penguin on the box.
00:19:03.156 --> 00:19:20.555
But for children five and older they would just have the regular ones which are the fleet brand liquid glycerin suppositories and they can do those in addition to the oral clean out at the same time if they need to give quick relief on a child that's just super miserable and nauseated and have poor appetite, you know.
00:19:21.150 --> 00:19:27.836
Yeah, I feel so bad for these kids because you know they're so uncomfortable and it really is so much fear and pain that they've had to deal with.
00:19:27.836 --> 00:19:37.476
So I really love educating parents on the importance of the things that you've discussed and really it's just so amazing to see that they can get relief.
00:19:37.476 --> 00:19:39.797
So thank you for explaining all that.
00:19:39.797 --> 00:19:40.834
It was extremely helpful.
00:19:40.834 --> 00:19:50.720
What I like to finish and close out with is kind of a fun question of more along the lines of what not to do when we're educating our parents and patients.
00:19:50.720 --> 00:19:59.236
So what would be the worst thing we as clinicians could say to our parents or patients struggling with constipation that they're just gonna grow out of it.
00:19:59.710 --> 00:20:01.636
Just give them time and it'll get better.
00:20:01.636 --> 00:20:13.019
And it's so common with their age group and you just kind of send them on their way, telling them to be hydrated and fruits and veggies, and that is a great first line, certainly response.
00:20:13.019 --> 00:20:21.576
But if they come back to you again, I think it's important to be more aggressive than we all are, generally speaking, than the average provider is.
00:20:21.576 --> 00:20:23.897
It's okay to be aggressive If they're coming back.
00:20:24.351 --> 00:20:28.173
Constipation is like the second most common reason for Pied's visits.
00:20:28.173 --> 00:20:43.656
It's so common and they're just going back home and doing those things, those moderate and mild things that we recommended, and then they're not getting any relief but they're just continuing to do that and then, unbeknownst to us, they're kind of continuing to suffer and be miserable.
00:20:43.656 --> 00:20:48.659
So if they come back to you on a second visit, I really do advocate for an X-ray.
00:20:48.659 --> 00:20:49.795
See what you're working with.
00:20:49.795 --> 00:20:51.978
You'd be surprised at the amount of stool in there.
00:20:51.978 --> 00:21:01.740
So I think they deserve to have a little bit more investigation and a little bit more intensive approach and it's okay to consult them out to Pied's GI early.
00:21:01.740 --> 00:21:06.016
It's fine, they're used to seeing it and they can manage it a little bit more closely.
00:21:07.210 --> 00:21:09.431
Emily, thank you so much for being here Again.
00:21:09.431 --> 00:21:11.558
I am so grateful for the gift of your time.
00:21:11.558 --> 00:21:16.974
I can't give you this time back, so I truly appreciate your expertise and you sharing everything with us.
00:21:16.974 --> 00:21:22.714
But in the meantime, guys, during clinic, be sure you're asking your patients about their bowel movements.
00:21:22.714 --> 00:21:23.972
Are they soft?
00:21:23.972 --> 00:21:25.096
Are they pooping every day?
00:21:25.096 --> 00:21:26.153
Is it painful?
00:21:26.153 --> 00:21:27.156
Do they have to push?
00:21:27.156 --> 00:21:28.375
Are they not going every day?
00:21:28.375 --> 00:21:32.797
And for the older kids elementary school kids are they maybe stuelling in their underpants?
00:21:32.797 --> 00:21:35.137
Cause those are telltale signs of constipation.
00:21:35.137 --> 00:21:40.217
And today we learned some extremely useful strategies where you can provide your patients with relief.
00:21:40.217 --> 00:21:42.276
Emily, thanks again for being here.
00:21:42.276 --> 00:21:43.594
Thank you, colleen.
00:21:43.594 --> 00:21:46.355
All right, guys, now it's time for my nutrition notes.
00:21:47.150 --> 00:21:53.497
In this segment, I like to share nutrition tips, an interesting quote or a unique case that I think might add value to your day.
00:21:53.497 --> 00:22:09.435
So today I'm actually going to share with you a nutrition tip, as Emily talked about at the importance of hydration, and she did touch a little bit as well on the fruits that can help with hydration and that have added fiber, those fruits that start with a pea, which I thought was extremely helpful.
00:22:09.435 --> 00:22:13.779
Today I wanted to leave you with some hydrating vegetables.
00:22:13.779 --> 00:22:24.137
These vegetables have tons of water in them, so for those kiddos who maybe don't like to drink water or you're struggling with getting them to drink adequate fluids, this is a good way to get some more fluids into their diet.
00:22:24.137 --> 00:22:26.957
So cucumber is 96% fluids.
00:22:26.957 --> 00:22:29.255
Iceberg lettuce is 96%.
00:22:29.255 --> 00:22:31.800
Romain lettuce has 95% water.
00:22:32.349 --> 00:22:38.820
Tomatoes are a great source of fluid as well Asparagus, bell peppers, cabbage, cauliflower and spinach.
00:22:38.820 --> 00:22:45.655
These foods can be eaten raw, so you might be surprised that your toddler likes raw cucumber or raw tomatoes.
00:22:45.655 --> 00:22:49.535
Cut it up onto the plate and give it to them and see if they go for it.
00:00:00.119 --> 00:00:11.311
00:00:11.311 --> 00:00:18.841
00:00:18.900 --> 00:00:22.952
00:00:22.952 --> 00:00:25.246
00:00:25.246 --> 00:00:26.562
00:00:26.562 --> 00:00:29.992
00:00:29.992 --> 00:00:34.851
00:00:34.851 --> 00:00:39.610
00:00:40.161 --> 00:00:42.567
00:00:42.567 --> 00:00:44.192
00:00:44.192 --> 00:00:46.948
00:00:46.948 --> 00:00:58.389
00:00:58.389 --> 00:01:00.627
00:01:01.462 --> 00:01:10.289
00:01:10.289 --> 00:01:19.170
00:01:19.170 --> 00:01:25.533
00:01:25.533 --> 00:01:31.253
00:01:31.253 --> 00:01:37.153
00:01:37.153 --> 00:01:45.629
00:01:45.629 --> 00:01:53.287
00:01:53.287 --> 00:01:55.432
00:01:55.432 --> 00:02:01.912
00:02:01.912 --> 00:02:06.772
00:02:07.260 --> 00:02:15.925
00:02:15.925 --> 00:02:18.091
00:02:18.091 --> 00:02:20.388
00:02:20.388 --> 00:02:31.532
00:02:31.532 --> 00:02:34.707
00:02:34.707 --> 00:02:37.649
00:02:38.300 --> 00:02:39.466
00:02:39.466 --> 00:02:43.491
00:02:43.491 --> 00:02:56.312
00:02:56.312 --> 00:03:00.150
00:03:00.150 --> 00:03:01.861
00:03:01.861 --> 00:03:23.532
00:03:23.532 --> 00:03:28.331
00:03:28.939 --> 00:03:29.161
00:03:29.161 --> 00:03:34.271
00:03:34.271 --> 00:03:41.429
00:03:41.429 --> 00:03:55.319
00:03:55.319 --> 00:04:05.120
00:04:05.120 --> 00:04:08.939
00:04:09.080 --> 00:04:12.300
00:04:12.300 --> 00:04:17.422
00:04:17.422 --> 00:04:20.971
00:04:20.971 --> 00:04:24.309
00:04:24.309 --> 00:04:30.863
00:04:30.863 --> 00:04:37.036
00:04:37.036 --> 00:04:45.612
00:04:45.612 --> 00:04:47.872
00:04:47.872 --> 00:04:54.250
00:04:54.884 --> 00:04:59.975
00:04:59.975 --> 00:05:06.177
00:05:06.177 --> 00:05:12.535
00:05:12.886 --> 00:05:21.053
00:05:21.053 --> 00:05:24.754
00:05:24.754 --> 00:05:33.033
00:05:33.033 --> 00:05:45.747
00:05:46.464 --> 00:05:50.435
00:05:50.435 --> 00:05:52.649
00:05:52.649 --> 00:05:53.672
00:05:54.052 --> 00:05:54.875
00:05:55.165 --> 00:06:04.235
00:06:05.485 --> 00:06:13.353
00:06:13.353 --> 00:06:21.531
00:06:21.531 --> 00:06:27.377
00:06:27.377 --> 00:06:31.615
00:06:31.615 --> 00:06:38.918
00:06:38.918 --> 00:07:02.836
00:07:03.425 --> 00:07:07.355
00:07:07.355 --> 00:07:10.913
00:07:10.913 --> 00:07:13.571
00:07:13.571 --> 00:07:15.134
00:07:15.134 --> 00:07:18.935
00:07:18.935 --> 00:07:23.591
00:07:23.591 --> 00:07:28.276
00:07:28.276 --> 00:07:30.673
00:07:30.673 --> 00:07:34.415
00:07:34.415 --> 00:07:36.531
00:07:37.346 --> 00:07:38.572
00:07:38.572 --> 00:07:47.209
00:07:47.209 --> 00:07:58.410
00:07:58.410 --> 00:08:02.862
00:08:02.862 --> 00:08:11.908
00:08:11.927 --> 00:08:21.598
00:08:21.598 --> 00:08:29.178
00:08:29.178 --> 00:08:36.038
00:08:36.038 --> 00:08:41.576
00:08:41.576 --> 00:08:46.456
00:08:46.985 --> 00:08:48.071
00:08:48.071 --> 00:09:02.855
00:09:02.855 --> 00:09:14.078
00:09:14.078 --> 00:09:21.759
00:09:22.345 --> 00:09:22.605
00:09:22.605 --> 00:09:30.099
00:09:30.099 --> 00:09:40.065
00:09:40.065 --> 00:09:47.075
00:09:47.075 --> 00:09:51.395
00:09:51.395 --> 00:09:56.576
00:09:56.576 --> 00:10:02.977
00:10:02.977 --> 00:10:12.073
00:10:12.073 --> 00:10:22.153
00:10:22.153 --> 00:10:28.077
00:10:28.077 --> 00:10:34.192
00:10:35.105 --> 00:10:43.994
00:10:43.994 --> 00:10:48.749
00:10:48.749 --> 00:10:56.879
00:10:56.879 --> 00:11:00.335
00:11:00.335 --> 00:11:15.258
00:11:15.605 --> 00:11:19.956
00:11:19.956 --> 00:11:30.155
00:11:30.565 --> 00:11:30.985
00:11:30.985 --> 00:11:33.908
00:11:33.908 --> 00:11:42.116
00:11:42.116 --> 00:11:45.599
00:11:45.599 --> 00:11:50.942
00:11:50.942 --> 00:11:55.961
00:11:55.961 --> 00:11:58.619
00:11:59.029 --> 00:12:01.118
00:12:01.118 --> 00:12:16.196
00:12:16.196 --> 00:12:28.515
00:12:28.515 --> 00:12:31.158
00:12:31.158 --> 00:12:42.801
00:12:43.991 --> 00:12:46.139
00:12:46.139 --> 00:12:54.421
00:12:54.421 --> 00:13:00.662
00:13:00.662 --> 00:13:05.610
00:13:05.610 --> 00:13:07.397
00:13:08.529 --> 00:13:11.239
00:13:11.239 --> 00:13:15.342
00:13:15.342 --> 00:13:17.269
00:13:17.269 --> 00:13:26.582
00:13:26.990 --> 00:13:31.522
00:13:31.522 --> 00:13:37.898
00:13:37.898 --> 00:13:48.221
00:13:48.221 --> 00:13:50.611
00:13:50.611 --> 00:13:53.500
00:13:53.500 --> 00:13:55.332
00:13:55.332 --> 00:14:00.557
00:14:00.557 --> 00:14:07.034
00:14:07.470 --> 00:14:10.820
00:14:10.820 --> 00:14:12.174
00:14:12.174 --> 00:14:17.716
00:14:17.716 --> 00:14:22.607
00:14:22.607 --> 00:14:24.676
00:14:24.676 --> 00:14:26.937
00:14:26.937 --> 00:14:30.077
00:14:30.669 --> 00:14:34.796
00:14:34.796 --> 00:14:40.214
00:14:40.214 --> 00:14:44.600
00:14:44.600 --> 00:14:47.279
00:14:47.279 --> 00:14:51.898
00:14:51.898 --> 00:14:54.136
00:14:54.136 --> 00:14:57.038
00:14:57.038 --> 00:15:01.160
00:15:01.160 --> 00:15:04.919
00:15:04.919 --> 00:15:09.240
00:15:09.240 --> 00:15:24.760
00:15:25.190 --> 00:15:28.582
00:15:28.582 --> 00:15:35.313
00:15:35.313 --> 00:15:39.102
00:15:40.047 --> 00:15:42.176
00:15:42.176 --> 00:15:44.465
00:15:44.465 --> 00:15:54.465
00:15:54.465 --> 00:16:03.360
00:16:03.360 --> 00:16:10.445
00:16:10.445 --> 00:16:12.410
00:16:12.410 --> 00:16:18.730
00:16:18.730 --> 00:16:20.235
00:16:20.686 --> 00:16:25.465
00:16:25.465 --> 00:16:26.879
00:16:26.879 --> 00:16:27.445
00:16:27.445 --> 00:16:29.375
00:16:29.375 --> 00:16:31.465
00:16:32.448 --> 00:16:37.395
00:16:37.395 --> 00:17:08.332
00:17:08.332 --> 00:17:18.444
00:17:18.444 --> 00:17:19.588
00:17:20.746 --> 00:17:34.361
00:17:34.361 --> 00:17:36.393
00:17:36.393 --> 00:17:41.876
00:17:41.876 --> 00:17:49.358
00:17:49.358 --> 00:17:53.674
00:17:53.674 --> 00:17:59.376
00:17:59.376 --> 00:18:01.846
00:18:01.887 --> 00:18:04.464
00:18:04.464 --> 00:18:07.273
00:18:07.273 --> 00:18:23.424
00:18:23.424 --> 00:18:34.464
00:18:35.165 --> 00:18:42.898
00:18:42.898 --> 00:18:47.298
00:18:47.298 --> 00:18:48.553
00:18:48.553 --> 00:18:50.894
00:18:50.894 --> 00:18:54.780
00:18:54.780 --> 00:19:03.156
00:19:03.156 --> 00:19:20.555
00:19:21.150 --> 00:19:27.836
00:19:27.836 --> 00:19:37.476
00:19:37.476 --> 00:19:39.797
00:19:39.797 --> 00:19:40.834
00:19:40.834 --> 00:19:50.720
00:19:50.720 --> 00:19:59.236
00:19:59.710 --> 00:20:01.636
00:20:01.636 --> 00:20:13.019
00:20:13.019 --> 00:20:21.576
00:20:21.576 --> 00:20:23.897
00:20:24.351 --> 00:20:28.173
00:20:28.173 --> 00:20:43.656
00:20:43.656 --> 00:20:48.659
00:20:48.659 --> 00:20:49.795
00:20:49.795 --> 00:20:51.978
00:20:51.978 --> 00:21:01.740
00:21:01.740 --> 00:21:06.016
00:21:07.210 --> 00:21:09.431
00:21:09.431 --> 00:21:11.558
00:21:11.558 --> 00:21:16.974
00:21:16.974 --> 00:21:22.714
00:21:22.714 --> 00:21:23.972
00:21:23.972 --> 00:21:25.096
00:21:25.096 --> 00:21:26.153
00:21:26.153 --> 00:21:27.156
00:21:27.156 --> 00:21:28.375
00:21:28.375 --> 00:21:32.797
00:21:32.797 --> 00:21:35.137
00:21:35.137 --> 00:21:40.217
00:21:40.217 --> 00:21:42.276
00:21:42.276 --> 00:21:43.594
00:21:43.594 --> 00:21:46.355
00:21:47.150 --> 00:21:53.497
00:21:53.497 --> 00:22:09.435
00:22:09.435 --> 00:22:13.779
00:22:13.779 --> 00:22:24.137
00:22:24.137 --> 00:22:26.957
00:22:26.957 --> 00:22:29.255
00:22:29.255 --> 00:22:31.800
00:22:32.349 --> 00:22:38.820
00:22:38.820 --> 00:22:45.655
00:22:45.655 --> 00:22:49.535