title: Assessment of constipation in children with tracheostomy.
abstract: OBJECTIVE
  To determine the prevalence of constipation among children with tracheostomy tubes compared with children without tracheostomy tubes. We theorize that patients with tracheostomy may be unable to achieve adequate subglottic pressure for the Valsalva maneuver, which may contribute to constipation.
  
  
  METHODS
  Prospective cohort study.
  
  
  METHODS
  Tertiary care children's hospital.
  
  
  METHODS
  Consecutive series of 36 children with tracheostomy and 72 general pediatric otolaryngology patients without tracheostomy.
  
  
  METHODS
  A pediatric constipation questionnaire (from previously published references) was given to parents of the study participants. Data were collected regarding patient medications, neurological status, and use of positive pressure airway assistance, speaking valves, and feeding tubes. Data were evaluated using chi(2) and t tests. Logistic regression analysis was used to search for independent variables impacting presence of constipation.
  
  
  RESULTS
  The mean ages for the tracheostomy and control groups were 6.8 and 4.7 years, respectively (P = .07). A history of constipation was elicited in 60% of children with tracheostomy compared with only 16.7% of controls (P < .001). More patients with tracheostomy tubes (80.0%) than controls (20.8%) were taking medication to treat constipation (P < .001). Constipation was also significantly associated with older age (P = .02), use of medications with constipation as a known adverse effect (P = .02), and the presence of neurodevelopmental impairment (P < .001). Constipation was still independently associated with the presence of a tracheostomy tube when correcting for age and the use of constipation-causing medications. When controlling for neurodevelopmental impairment, the presence of a tracheostomy tube was not proven to be an independent predictor of constipation.
  
  
  CONCLUSIONS
  Children with tracheostomy tubes are more likely to have a history of constipation, although a causal relationship between tracheostomy and constipation could not be determined due to the potentially confounding variable of neurodevelopmental delay.
authors.affiliation: Department of Pediatric Otolaryngology, Children's Hospital of Pittsburgh of the University of Pittsburgh Medical Center, Children's Hospital Drive, 45th Street and Penn Avenue, Pittsburgh, PA 15201, USA. jeffrey.simons@chp.edu
authors.forename: Jeffrey P
authors.initials: JP
authors.lastname: Simons
authors.forename: Deepak
authors.initials: D
authors.lastname: Mehta
authors.forename: David L
authors.initials: DL
authors.lastname: Mandell
mesh_terms: D016022:Case-Control Studies; D016009:Chi-Square Distribution; D002648:Child; D002675:Child, Preschool; D003248:Constipation / Q000453:epidemiology* / Q000517:prevention & control; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D010414:Pennsylvania / Q000453:epidemiology; D015995:Prevalence; D011446:Prospective Studies; D012307:Risk Factors; D011795:Surveys and Questionnaires; D014139:Tracheostomy