A 4 year old African American female came to the clinic accompanied by her mother for evaluation of constipation. Per the patient’s mother, her daughter had not had a bowel movement for 4 days and this has not happened before and her usual normal bowel pattern is every other day. Mother stated that her daughter loves to eat bread, pasta and potatoes.
Physical examination and vital signs were normal. I explained to the patient and her mother that functional constipation is a common problem in children. According to Blackmer & Farrington (2010), education should include an explanation of the pathogenesis of constipation to help families and patients better understand the problem and the treatment approach. Functional constipation is the passage of less than two large diameter stools per week with or without the presence of retentive posturing or behaviors (Blackmer & Farrington, 2010).
My ‘aha’ moment was when the patient’s mother stated that her daughter’s diet was exclusively carbohydrate based and thus had not had a bowel movement for 4 days, and this immediately connected my classroom studies to a real world clinical setting.
Since my goal of treatment was to establish a regular bowel routine, the patient and her mother were instructed to eliminate constipating foods from the diet such as pasta, potatoes and bread and to increase dietary fiber such as orange, tangerine, mango, cauliflower, berries and prunes. With my preceptor’s collaboration, patient’s mother was instructed to give the patient prunes, and to increase oral fluid. Patient also instructed to return to the clinic in 5 days if no improvement shows.
Blackmer, A. B., & Farrington, E. A. (2010). Constipation in the Pediatric patient: An
Overview and Pharmacologic Considerations. Journal of Pediatric Health Care,
24(6), 385-399. Retrieved from Walden Library Databases.
Burns, C. E., Dunn, A. M., Brady, M. A., Starr, N. B., & Blosser, C. G. (2013). Pediatric Primary Care (5th ed.). Philadelphia, PA: Elsevier.
Stanhope, R. (2000). Constitutional Delay of Growth and Puberty: A Guide for Parents and Patients. The Child Growth Foundation. Retrieved from www.childgrowthfoundation.org/CMS/FILES/10-constituitional-delay-of-growth-and-puberty.pdf