title: Effectiveness of using a behavioural intervention to improve dietary fibre intakes in children with constipation.
abstract: BACKGROUND
  Functional constipation is common in childhood; diets in affluent industrialised countries may be a significant contributory factor as a result of inadequate fibre content. Only a few intervention studies have been reported where childhood constipation has been treated by increasing dietary fibre. The present study aimed to demonstrate that dietary fibre intakes of children with constipation can be increased using a specifically-designed behaviour modification technique with a self-monitoring and reward system.
  
  
  METHODS
  Forty-three children, aged 2-14years, with functional constipation (defined as less than three bowel movements per week with hard stools and difficulty or delay in defecation) were randomised to one of two treatment groups: Control (n=20), receiving general advice on increasing dietary fibre intake, or Intervention (n=23), using the intervention tool. Fibre intake, laxative use and stool frequency were assessed at baseline, and at 3, 6 and 12months, using parent-filled diaries.
  
  
  RESULTS
  A behavioural intervention method significantly increases the fibre intakes of children with constipation at 3 months compared to standard dietary treatment (P=0.005), remaining so after adjusting for baseline fibre intake (P=0.007). Follow-up at 6 and 12months showed no further increase. No significant benefit in terms of a reduction in laxative use or increased stool frequency associated with additional fibre intake was demonstrated.
  
  
  CONCLUSIONS
  The findings confirm the difficulties encountered in beginning and maintaining high-fibre diets in children.
authors.affiliation: Department of Paediatrics, Level 2, Children's Hospital, John Radcliffe Hospital, University of Oxford, Oxford, UK. peter.sullivan@paediatrics.ox.ac.uk
authors.forename: P B
authors.initials: PB
authors.lastname: Sullivan
authors.forename: N
authors.initials: N
authors.lastname: Alder
authors.forename: B
authors.initials: B
authors.lastname: Shrestha
authors.forename: L
authors.initials: L
authors.lastname: Turton
authors.forename: B
authors.initials: B
authors.lastname: Lambert
mesh_terms: D000293:Adolescent; D001521:Behavior Therapy / Q000379:methods*; D002648:Child; D002652:Child Behavior; D002675:Child, Preschool; D003248:Constipation / Q000178:diet therapy / Q000628:therapy*; D003672:Defecation; D004043:Dietary Fiber / Q000008:administration & dosage*; D005260:Female; D005500:Follow-Up Studies; D015438:Health Behavior; D006801:Humans; D054368:Laxatives / Q000627:therapeutic use; D008297:Male; D012201:Reward
chemical_list: D004043:Dietary Fiber; D054368:Laxatives