title: Prevalence and clinical presentation of constipation in children with severe generalized cerebral palsy.
abstract: OBJECTIVE
  Our aim was to study the prevalence and characteristics of constipation in children with profound multiple disabilities, as data in this area are scarce.
  
  
  METHODS
  A cross-sectional observational study was performed in specialized day-care centres and schools in the Netherlands. The study included 152 children (81 males, 71 females; mean age 9 y 6 mo, SD 4 y 6 mo). Intellectual disability ranged from moderate (7%) to profound (52%) in all participants who also had severe motor disabilities (83% classified at Gross Motor Function Classification System level V). We collected data on defaecation characteristics, food and fluid intake, and laxative consumption using standardized bowel diaries and interviews. Constipation was defined as (1) scybalous, pebble-like, hard stools in over a quarter of defaecations in combination with a defaecation frequency of less than three times per week during a 2-week study period; (2) large stools palpable on abdominal examination; or (3) laxative use or manual disimpaction of faeces.
  
  
  RESULTS
  Of the studied population, 57% were constipated and 55% used laxatives, 27% of whom showed symptoms of constipation. Daily intakes of water and fibre were below the required standards in 87% and 53% of participants respectively, without a proven relation to constipation.
  
  
  CONCLUSIONS
  Constipation is a common problem in children with severe disabilities. Laxative use is high but dosing is frequently inadequate to prevent symptoms.
authors.affiliation: Intellectual Disability Medicine, Department of General Practice, Erasmus MC, Rotterdam, the Netherlands. r.veugelers@asz.nl
authors.forename: Rebekka
authors.initials: R
authors.lastname: Veugelers
authors.forename: Marc A
authors.initials: MA
authors.lastname: Benninga
authors.forename: Elsbeth A C
authors.initials: EA
authors.lastname: Calis
authors.forename: Sten P
authors.initials: SP
authors.lastname: Willemsen
authors.forename: Heleen
authors.initials: H
authors.lastname: Evenhuis
authors.forename: Dick
authors.initials: D
authors.lastname: Tibboel
authors.forename: Corine
authors.initials: C
authors.lastname: Penning
mesh_terms: D002547:Cerebral Palsy / Q000453:epidemiology*; D002648:Child; D002656:Child Day Care Centers; D015331:Cohort Studies; D015897:Comorbidity; D003248:Constipation / Q000188:drug therapy / Q000453:epidemiology*; D003430:Cross-Sectional Studies; D004043:Dietary Fiber / Q000008:administration & dosage; D020820:Dyskinesias / Q000453:epidemiology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008607:Intellectual Disability / Q000453:epidemiology; D007407:Interviews as Topic; D054368:Laxatives / Q000627:therapeutic use; D008297:Male; D008499:Medical Records; D009426:Netherlands; D015995:Prevalence; D012720:Severity of Illness Index; D014867:Water / Q000008:administration & dosage
chemical_list: D004043:Dietary Fiber; D054368:Laxatives; D014867:Water