Constipation is a common problem in children who are fed by feeding tube. In some cases, constipation results from the type of food or formula fed, or the amount of fluid in the diet. It can also result from underlying medical problems, anatomic or structural conditions of the intestines or anus, motility problems, or a lack of physical activity in children with neuromuscular conditions.
Constipation often will slow down the entire gastrointestinal tract, causing a wide variety of symptoms. These include:
- Large stools
- Infrequent stools
- Stools that are difficult to pass
- Abdominal pain or cramping
- Vomiting or reflux
- Feeding intolerance
- Tears from passing large stools
- Blood on the outside of stools
Treating constipation and normalizing stools can have a dramatic effect on overall tolerance of feedings, as well as health and well-being in general.
There are numerous treatments for constipation. Before resorting to medication, it is best to explore your child’s diet and fluid intake levels, as many cases of constipation can be treated with simple changes. See our pages on diet and nutrition for more information.
Change formulas. You may want to try a different formula, especially one that has more fiber in it. Some children find soy-based formulas especially constipating.
Try a blenderized diet. Children on blenderized diets often have more regular, softer stools. If your child can tolerate a blened diet, it may help temendously.
Modify your blenderized diet recipes. Your child may need a blend to be customized to include more fiber, fruits, and vegetables. Get help from a dietitian skilled in blended diets. See our blenderized diet page for more help.
Increase free water. Free water is the most often forgotten component of tube feeding. While formulas provide some free water, many children require additional fluids in order to have regular stools and stay hydrated. See our page on fluid requirements for more information.
Consider adding pear or prune juice. Both pear and prune juice naturally relieve constipation in many children. Talk to your doctor about adding pear or prune juice to your tube feeding formula or blenderized recipes.
Try a medication. If diet changes don’t work, talk to your doctor about medication. There are two types of medications typically used: stool softeners and laxatives. The former simply soften stools to make them easier to pass, while laxatives actually help a child to stool.
Ask your doctor about enemas or suppositories. Some children require frequent enemas or cleanouts to handle constipation. Enemas and suppositories should only be used with your doctor’r recommendation.
Consider a surgical option. Children with severe constipation that cannot be controlled by other means can consider a surgical option. The most common procedure is called Antegrade Colonic Enema surgery. A catheter, which may be a feeding tube or another style of tube, is placed into the large intestine. Sometimes it stays in permanently, while in other cases it is removed after a month or two, leaving a continent ostomy open. It is flushed regularly to remove stool from the colon and rectum.