Prevalence and clinical presentation of constipation in children with severe generalized cerebral palsy.
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.
Veugelers
Rebekka
R
Intellectual Disability Medicine, Department of General Practice, Erasmus MC, Rotterdam, the Netherlands. r.veugelers@asz.nl
Benninga
Marc A
MA
Calis
Elsbeth A C
EA
Willemsen
Sten P
SP
Evenhuis
Heleen
H
Tibboel
Dick
D
Penning
Corine
C
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
D004043:Dietary Fiber; D054368:Laxatives; D014867:Water