Stooling problems are common in children with feeding tubes, often due to their underlying conditions, but in some cases related to diet and feeding intolerance. This page discusses the two most common stooling problems, constipation and diarrhea.

Constipation

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.

Treating Constipation

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.

Diarrhea

Diarrhea happens to all of us, but if it is frequent or persistent, it may be something that needs to be addressed. Diarrhea can cause a tremendous loss of nutrients, and can also cause dehydration. Children with feeding tubes, especially those who are still catching up on growth and nutrition, should be treated for diarrhea to prevent further nutritional consequences.

Symptoms of Diarrhea

  • Loose, watery stools
  • Frequent stools
  • Urgency with stooling
  • Blood in the stool
  • Stool that is particularly unpleasant smelling
  • Abdominal cramps or pain

Causes of Diarrhea

ILLNESS OR INFECTION

Viral illness, bacterial infection, or parasitic infection are the most common causes of diarrhea. Viral diarrheas and some bacterial diarrheas are typically short-lived and resolves on its own after a few days, though children need to be monitored closely for dehydration. Severe bacterial and parasitic infections usually require treatment from a physician. Especially common in children with complex medical issues is a bacterial infection called C. diff or Clostridium difficile, which causes particularly foul-smelling diarrhea.

MOTILITY PROBLEMS

Some children have erratic motility, which may include fast motility in the intestines, or intestinal spasms. These can lead to diarrhea, since the food or formula passes too quickly for water and nutrients to be absorbed.

SURGICAL COMPLICATION

Children who have had a pyloromyotomy or pyloroplasty, as well as some children who have fundoplication surgery, may develop dumping syndrome, in which food or formula is “dumped” too quickly into the intestines. This condition causes diarrhea and can also cause blood sugar fluctuations. Other surgeries on the GI tract, especially removal of any portion of the bowel, may also cause diarrhea.

OTHER CAUSES

In young children, a common culprit for diarrhea is diet. Children who are receiving too much fruit, fruit juice, sweeteners, or artificial sweeteners may have diarrhea. In addition, allergies and intolerances are common causes of diarrhea. Lactose intolerance is likely the most common, but children may be sensitive or allergic to almost any food or ingredient. Too much fiber can also lead to diarrhea.

Medications such as antibiotics frequently cause diarrhea. Sometimes this is due to the medication itself, and other times it is due to the effect of the medication on the good bacteria in the gut.

Inflammatory bowel diseases, including Crohn’s and colitis, also frequently cause diarrhea. Functional bowel disorders, such as irritable bowel syndrome, may also cause diarrhea or constipation.

Other medical conditions that often cause diarrhea include disorders that affect absorption such as cystic fibrosis, metabolic disorders, and endocrine or pancreas conditions.

Treating Diarrhea

During periods of acute diarrhea, the most important treatment is adequate hydration. Your child may require Pedialyte or increased free water to make up for all the stool losses. If you use a blenderized diet, you may want to change the blend to include more simple foods like bananas, rice, and simple cereals. If diarrhea continues for more than a few days, becomes severe, or dehydration occurs, see your child’s doctor.

The treatment of chronic diarrhea will depend entirely on the cause. The following are typical treatments:

  • Changes in diet, such as changing formulas or the ingredients in a blenderized diet to account for intolerances, allergies, sugar content, fat content, and fiber levels
  • Using probiotics
  • Treating dumping syndrome by administering corn starch with feeds
  • Treating absorption issues with enzymes
  • Anti-diarrheal or motility slowing medications, only in certain chronic conditions
  • Treating functional disorders such as irritable bowel syndrome
  • Stopping or reducing medications that cause diarrhea
  • Appropriate treatment for inflammatory bowel diseases and other underlying medical conditions
  • Antibiotics or antiparasitics for infectious diarrhea