Constipation Action Plan - NICHQ

Constipation A

Doing Well: Patient Zone
Stooling regularly Example Medications
without straining
or pain. Stool is PEG 3350 (Miralax)
o (6 mo-1 yo): 8.5g mixed in
soft. o (1-6 yo): 8.5g mixed in 4oz
o (>6 yo): 17g mixed in 8oz w
Constipation
worsening: 2-3 **Continue stool softeners, high fiber d
days of no stool, intake, exercise and scheduled toilet bre
some pain, or hard
In addition to your Green Zone med
stools.
Increase your Miralax & Water: (Dis
o >6 mo - 1y: 8.5g in 2oz water
o 1-6 yo: 17g in 4oz water 2x/d
o >6 yo: 34g in 8oz water 2x/d

If your symptoms do not return to t
days of treatment then add:

Glycerin Suppository: (<6 yo) PR
suppository, (>6 yo) PR Adult Gly

Medical Alert! First, Take Fleets normal saline enem
Severe pain,
stomach bloating, 300ml) or mineral oil enema (10ml/k
vomiting, or no o 2-5 yo: Give ½ Pediatric Flee
stool >5 days. o 5-11 yo: Give Pediatric Fleet
o >12 yo: Given adult Fleet ene

Second, call your doctor now for he
o If symptoms persist for more

red zone, go to your local em

Management of Constipation in Children and Adolescents with ASD: Pediatrics 2012; 130;S9
Constipation Action Plan Developed by: B. Stafford MD, A. Deavenport DrPH, MCHES, H. Wi
General Pediatrics. Los Angeles: CA; 2012.

Action Plan Doctor Instructions

es
s for Use

2oz water/d
z water/d
water/d

diet, increased fluid
eaks everyday.

dicine, you can:

simpaction: 1.5g/kg/d)
r 2x/d x 3days
d x 3days
x3days

the GREEN zone after 3

R Infant Glycerin
ycerin suppository

ma (10ml/kg up to
kg to max 240ml);
et enema (33mL) PR x1
enema (66mL) PR x1
ema (133mL) PR x1
elp
e than two hours in the
mergency room

98.
ills, MA,RD,CSP, J Punati, MD, L. Yin MD, MSPH. Children’s Hospital Los Angeles, Division of

©2012 Children’s Hospital Los Angeles. All rights Reserved.

Tips and Recipes

Average Bowel Movements per day (Adapted from Fontana M, Bianch C, Cata
o 0-3 months: about 2-3/d
o 6-12 months: 2/d
o 1-3 years: 1-2/d
o >3 years: 1/d

Behavior:
o Go to the bathroom after meals
o Provide a visual schedule as a reminder to use the bathroom. Hav

be afterschool, or after a bath is also a good time
o Implement a reward system for each day stool is passed using stic

become an issue. Stooling IS the issue but putting the behaviors in

make the poop happen. Reward those behaviors. Bring the calend
o Make sure to walk or be active everyday for at least 30minutes

Diet
o Drink plenty of water, at least 5 glasses of water per day (great to u
o Eat a balanced diet that includes whole grains, fruits, and vegetabl

Recipes that can help with constipation:

Black Bean, Corn and Stewed pears (serves 6-12)
Tomato Salad (serves 10- ½ -6 pears peeled (any type is
c) fine)
1 – 12 oz can of diced -2 cups of apple or pear juice
tomatoes (no Salt Added) -1 stick cinnamon and 3- 5
1 – 12 oz can of black bean cloves
1 lb of frozen corn Directions:
1 tbsp chopped garlic Place pears bottom down in a
½ - 1 tbsp. Cumin powder sauce pan.
½ cup chopped cilantro -Add juice and spices.
¼ cup of lime juice - Cook on a low heat until you

Mix ingredients together in a can pierce the pears easily with
large bowl. a fork.
Let it sit for at least 2 hours -Serve warm or cold with
before serving. vanilla yogurt.

Mango Salsa

Ingredients (~ 2 cups)
- 1 mango diced into small pieces, -1/4 cup lime juice, -1 tomato finely chopped, -3
green onions, chopped, -2 tbsp fresh cilantro (chopped), -2 fresh garlic cloves

(chopped), -1/4 tsp chile or curry powder, salt to taste, sugar to taste
Directions:

-Chop garlic, green onions and cilantro and place in bowl/container.
-Add chopped tomato, mango and lime juice.
-Add chile (or curry) powder.

-Add salt and sugar to taste.
-Keep refrigerated until needed.

s for Constipation

aldo F, et al. Bowel frequency in healthy children. Acta Paediatr Scan 1987:78:682-4)

ve a consistent time when the child can sit and relax, sometimes it can

ckers and a calendar. If stooling becomes the focus, straining can
n place (sitting consistently, eating high fiber foods, water intake) can
dar on visits to the doctor as a point for positive reinforcement

use a sticker chart for this)
les

Brown Rice Pudding (serves Chicken Fruit Salad
8-10) Ingredients (serves 6)
-2 cups uncooked brown rice 2 cups of diced chicken breast
-4 cups of water 2 medium size apples diced
-1 stick cinnamon (sweeter apples like macintosh or
-½ tsp nutmeg red delicious work best)
-¼ tsp salt 1 cup pineapple chunks (fresh or
-1 cup raisins or chopped canned packed in juice)
dates 1/2 c dried cranberries (craisins)
-1 12 oz can of sweetened 3 tbsp of mayonnaise (or plain low
milk fat yogurt)
-2 cups of lowfat milk 3/4 tsp curry powder
1/2 c chopped almonds or walnuts
Rinse rice. Soak rice in water (0ptional)
for 30 minutes. -Add salt to taste
cinnamon, nutmeg and salt to Directions:
rice and water.
-Bring rice to a boil (~ 5min) 1. Dice chicken breast ,
then turn down the heat and apples and pineapple (if
simmer (20 min) until the rice necessary) into small
is cooked. pieces (1/2” x 1/2”).
-Add dried fruit and Make sure the pieces are
condensed milk to cooked small enough for little
rice. mouths.
-Add low fat milk slowly until
the mixture starts to thicken 2. Add raisins, mayonnaise,
up. curry powder and nuts
-Serve warm or cold. (optional) and stir. Little
helpers make great
stirrers.

3. Add salt to taste.
4. Chill in refrigerator before

serving.

Instructions for Implementation of the Constipation Action Plan

This is an action plan for children with chronic constipation. The primary medical doctor can
complete the form and give it to parents or the caregiver as a plan for home monitoring and
treatment of chronic constipation.

 If the patient is in the Green Zone, the primary doctor may provide only dietary
instructions or maintenance medication to prevent constipation.

 If the patient is in the Yellow Zone, the primary doctor may increase the dose of a
daily medication, add a different medication or do both.

 If the patient is in the Red Zone, other management may be needed such as an
enema. The primary doctor may also give specific instructions on when the family
should seek additional medical care.

The middle boxes, Patient Zones and Example Medications for use: The medications listed
are some examples of typical medications used in the treatment of constipation by physicians.
The physician may choose a different medication or plan.

The third column of boxes, Doctor Instructions: are for the primary medical doctor to write in
their specific instructions to the patient, parent or caregiver.