All posts by CHOC Children's

Once a CHOC Oncology Patient, Now an Oncology Nurse

As a typical, happy-go-lucky six-year-old, Shaina was playing outside with her brother before dinner time, when her back started hurting.

She laid down on the couch to rest, but when her mom called her for dinner, she was too weak to even make it to the table. A trip to a local emergency room followed, and kidney stones were suspected. She was eventually transferred to CHOC Children’s. After additional testing, Shaina was diagnosed with neuroblastoma, a cancer that often starts in the tissue of the adrenal glands, on top of the kidneys. What they thought originally might be kidney stones, was actually the pain of her kidneys being crushed by a tumor that was growing inside her.

She underwent emergent surgery two days later to remove the tumor and one of her kidneys, and overcame the odds that were stacked against her.

choc oncology
Shaina at age 6, as a patient at CHOC

“I was so young when I was diagnosed, so I don’t remember a lot of the scary parts of that time, but ever since, my family has been telling me stories about how wonderful my physicians and nurses were to our whole family during that time,” she says.

Those stories are part of the reason that six-year-old Shaina grew up to be a hematology/oncology nurse with the Hyundai Cancer Institute, in same hospital that saved her life almost two decades ago.

After surgery, Shaina was in and out of the hospital for chemotherapy treatments and a stem cell transplant. The first one hundred days after such a transplant are crucial to ensure a patient’s health and safety, and her family had to be abundantly cautious that her environment was as clean and safe as possible. At the end of those hundred days, her family threw a big party at their house to celebrate making it over the hump.

She relapsed a few months later.

Experimental treatment at various hospitals throughout Southern California followed, and three years later, she was cancer free for good.

Even during this time, Shaina knew she would return to CHOC someday.

choc oncology
As a child fighting cancer, Shaina knew should would return to CHOC someday as a nurse.

Fast forward a few years and Shaina was a high school student. Searching for volunteer hours as part of her curriculum, she sought out volunteer opportunities at CHOC as a way to say thank you to the hospital that saved her life as a child.

She joined the Child Life team as a play room volunteer, helping normalize the hospital environment for patients utilizing the same play rooms she had sought an escape in while she was a patient.

She now works alongside some of the same physicians and nurses that cared for her as a child.

One of her primary oncology nurses, Dana Moran, gives her a big hug whenever they pass each other in the hallways.

“Shaina was so little when she was a patient here- she was so fragile and scared, but she was a strong kid with a strong personality, and that helped her get through her challenges,” Dana says. “Now it makes me proud to see her happy and healthy and back at CHOC caring for other kids.”

Her pediatric oncologist, Dr. Lilibeth Torno, keeps a photo from Shaina’s nursing school graduation on the desk in her office.

“I am really proud to have seen her grow and mature as a person and as a colleague in oncology,” Dr. Torno says. “I have seen her strength as she overcame challenges that cancer survivors go through and she did it successfully!”

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A Pediatrician’s Tips for Sunburn Remedies

Summer may be coming to a close, but in Southern California, sunburns can be a year-round issue in our sunny climate. Even though trips to the beach and afternoons spent at the pool have given way to soccer practice and school playgrounds, sun safety is as important as ever.

sunburn remedies
Dr. Daniel Mackey, a CHOC Children’s pediatrician

Sunscreen Safety Reminders

  • Everyone should wear sunscreen whenever they’re outdoors, no matter what season we’re in or what the temperature is. Since babies under six months old have skin that is especially susceptible to sun damage, they should be kept out of the sun whenever possible.
  • Apply sunscreen every two hours that has SPF 30 or higher. Reapply more often if you’re swimming or sweating.
  • Wear a wide-brimmed hat and sunglasses for extra protection.
  • Double-check your family’s medications, since some may cause an increased sensitivity to sunlight.

But what happens when you do your best to protect yourself and your family from the sun, but sunburn still happens? We spoke to Dr. Daniel Mackey, a CHOC Children’s pediatrician, for a physician’s tips for sunburn remedies.

  • Use ibuprofen as needed for pain for the first few days after an especially uncomfortable sunburn.
  • A cold compress can help cool the skin. Either a damp cloth with cool water, or taking a cool shower or bath can work for this.
  • To help relieve the sting sunburn can leave behind; apply a 0.5 percent or 1 percent hydrocortisone cream to the damaged skin.
  • Aloe vera gel, or a product containing aloe vera, can help with the skin healing.
  • Drink extra fluids during recovery. On a typical day, kids up to age 8 should drink the number of 8 oz. cups of water equal to their age. For example, a five-year-old should drink five 8-oz. glasses of water every day.
  • Avoid further sun exposure while the skin is healing.

If the pain is getting worse or the skin is becoming more red or tender in the days following a sunburn, it is best to seek medical care, as your child might be experiencing an infection. Find a provider near you.

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CHOC Children’s Breaks Ground on Pediatric Mental Health Unit

As part of the transformative mental health initiative that CHOC and other Orange County leaders launched in May 2015, CHOC celebrated the start of construction on the first inpatient mental health center in Orange County.

choc mental health
Designs for CHOC’s inpatient mental health center.

To commemorate the important milestone, more than 150 leaders from CHOC and the community, including elected officials and members of the mental health task force, gathered for a ceremony at CHOC in support of the initiative, which will ensure children and adolescents with mental illness get the health care services and support they need. Speakers included Kimberly Cripe, CHOC ’s president and chief executive officer, Dr. Heather Huszti, CHOC’s chief psychologist, and Rick and Kay Warren, co-founders of Saddleback Church. The event included a brief tour of the inpatient mental health center currently under construction, highlighted by Kim Cripe breaking down a mock brick wall, as a symbolic display of breaking down barriers associated with mental health.

choc mental health
Designs for CHOC’s inpatient mental health center.

Scheduled to open in early 2018, the center – located on the third floor of CHOC’s Research Building on the main campus in Orange – will provide a safe, nurturing place for children ages 3 to 18, and specialty programming for children younger than 12. The center’s innovative floor plan was designed with guidance from national experts and incorporates elements of several exemplary programs. It will feature 18 private patient rooms in a secure and healing environment including an outdoor playground area to promote exercise and movement. Additional amenities include a multipurpose room, classroom, and a variety of rooms that support activities for children of different ages and needs.

choc mental health
Designs for CHOC’s inpatient mental health center.

Since the announcement of CHOC’s initiative last year, CHOC has made tremendous progress including the launch of an outpatient co-occurring clinic, in conjunction with Orange County Behavioral Health Services, for patients whose physical conditions are complicated by mental health challenges; the launch of mental health screenings for all 12-year-olds at their well child visits in the primary care setting; and through a grant, CHOC’s cystic fibrosis (CF) program expanded its social worker’s availability and has a designated psychologist to help patients and caregivers. CHOC is also completing a pilot in the primary care clinics where a psychologist is present to help the medical team screen for and address mental health issues, and help families address childhood obesity.

Staff training and recruitment is currently underway.

Learn more about how CHOC is changing the way pediatric mental health is treated in Orange County.

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Debunking Myths on Over-the-Counter Medication Safety

By Giang Lam, clinical pharmacist at CHOC Children’s

Over-the-counter (OTC) medications provide quick access to treatment options for a variety of minor ailments. They enable patients to self-treat many symptoms with relatively low cost, and avoid unnecessary visits to the doctor’s office. Unfortunately, the accessibility and affordability of OTC medications has also led to many misconceptions regarding over-the-counter medication safety.

Many consumers believe that OTC medications are completely safe with no risk of side effects. Since they don’t require a physician visit or a prescription, many people think OTCs are harmless. The truth is many of these OTC medications start out as prescription medications before going over the counter. The way that they work in our body is exactly the same as the prescription version and has the same potential for harmful side effects when not taken properly.

Some consumers believe that it is safe to take larger doses or to take the medication more frequently when the recommended dose doesn’t seem to work, instead of seeking a consultation with their pharmacist or physician. The product is often taken as long as symptoms persist. Active ingredients, warnings, and recommended dosing listed on the product label are often ignored due to the perceived safety of OTC medications. Many OTC medication labels will not provide dosing until your child is a certain age or weight since they are not approved or studied in younger children.

One of the most frequent complications faced when evaluating over-the-counter medication safety is the duplication of ingredients. The same active ingredient can often be found in prescription and OTC formulations. For example, acetaminophen is a common pain reliever and fever reducer that is often combined with other ingredients. It can be found in narcotic pain relievers, cough and cold medications, and sleep aids. Duplicating an ingredient such as this one can result in an accidental overdose with serious and dangerous consequences. Download a copy of A Parent’s Guide to Acetaminophen for Children.

Brand name manufacturers will list all the active ingredients in the product label on the side of the box, but, the ingredients may not always appear on the front label. It is essential to compare product labels when taking multiple OTC and prescription medications to prevent duplicating ingredients. Over-the-counter medication safety is crucial, as they can still have interactions with prescription medications so it is important to discuss with your pharmacist or physician.

Keep these tips in mind to ensure your family is taking medications safely:

  1. Read the product label. Know what you’re taking or giving to your child, how to take it and possible side effects.
  2. Try to avoid products with multiple ingredients or mixing of OTC products if possible.
  3. Discuss risks and benefits of OTC and prescription medications with your pharmacist and physician.
  4. Seek medical attention if symptoms persist or worsen.
  5. Like prescription medications, store OTC medications safely and out of the reach of children.

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Sibling Caretaker Becomes CHOC Hematology/Oncology Nurse

She was barely through her first year of high school, but Emily Gruendyke was determined to be a nurse. A pediatric oncology nurse, specifically. The young teen carefully mapped the steps she would take to achieve her career goal. Nothing was going to stand in her way. And, sure enough, today Emily is a hematology/oncology nurse at the Hyundai Cancer Institute at CHOC Children’s.

Emily’s family supported her calling from day one, especially her younger sister Amanda. Better than anyone, Amanda knew Emily would be a great oncology nurse. She experienced Emily’s nurturing care often, especially after being diagnosed with a type of cancer called neuroblastoma. The diagnosis—delivered when Amanda was 9 and Emily was 14—affected the entire family. Emily quickly learned just how isolating the disease could be — not just for the patient, but for parents and siblings.

choc hematology/oncology
Emily and her late sister Amanda, at Disneyland.

“During the first year of Amanda’s treatment, she and my mom spent 200 nights at the hospital, which was about an hour from our home. I would only get to see them on weekends. And, as much as my friends cared, they didn’t really understand what we were all going through,” explains Emily.

When Emily was able to visit Amanda at the hospital, she noted the impact nurses had on her mom and sister.

“My hospital visits really opened my eyes to what nursing could do. I witnessed the difference a good nurse had on my mom and Amanda,” says Emily.

One experience was particularly impactful for Emily.

“The first night my mom and sister were home, following the start of her treatment, a nurse stopped by the house to show my mom how to hook up all of the medical equipment. Though I don’t blame the nurse, she breezed through all of the steps and didn’t really make sure my mom was comfortable with what she had to do. Later in the evening, I remember my mom crying at not being able to recall everything. Another nurse came out and did an amazing job educating my mom. More than that, the nurse empowered my mom as a caregiver. I knew that was the kind of nurse I wanted to be,” shares Emily.

As a CHOC hematology/oncology nurse, Emily is steadfastly dedicated to providing her patients’ families with the knowledge and confidence to take care of their children. She works hard to help her patients and families get through treatment and adjust to their “new normal.”  And, just as she was inspired by her sister’s strength, she admires the inspiring resiliency of her patients. She also takes the time to acknowledge her patients’ siblings.

“A cancer diagnosis is tough on everyone and sometimes siblings can get inadvertently left out. I understand siblings’ point of view. I take time to not only ask if they have questions about cancer and involve them in the care—if that’s what they want—but I also ask them about their own interests,” says Emily, who is proud to be part of a team committed to patient- and family-centered care.

Emily’s sister lost her battle to cancer after a brave 12-year fight. Emily had been CHOC hematology/oncology nurse for four years at that point, of which Amanda was very proud. And despite the difficulties that came with having a sister with cancer, Emily’s family was grateful that she found a calling that would positively impact so many other hurting families. Emily can’t imagine doing anything else.

“Even though my sister passed away from her cancer, which was devastating to our family, I feel so strongly that being a pediatric oncology nurse is what I was made to do. I would not want any other job in the world. And I know Amanda wouldn’t want me doing any other job either,” says Emily.

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Spiritual Care Available to CHOC Children’s Patients, Families

While CHOC Children’s is committed to providing the highest quality medical care to children, we recognize the importance of supporting the spiritual needs of our patients and their families as well.  The Spiritual Care team at CHOC is made up of chaplains and volunteers of various faith traditions that spiritually and emotionally support our patients and their families.

Norm Jeune, lead chaplain, regularly meets with patients and families to understand any spiritual practices or preferences that are important to them.

CHOC chaplains use different methods of spiritual and emotional support to assist each patient based on the particular family, and what is important to them during their time of need. Some families may find strength in traditional prayers from their religious practices, while others may find that mindfulness techniques, meditation, or simple discussion to release burdens is most helpful. Unique to pediatrics, families sometimes find comfort in ritual practices for their children, such as baby dedications, baptisms, First Communion, or Confirmation.

spiritual care
Norm Jeune, Lead Chaplain

“For a family to know that these milestones can still be shared in a hospital setting is very special to many parents and children,” says Jeune.

Recently, an increased focus on holiday offerings has meant that more patients and families have easy access to religious and cultural celebrations that are important to them while they’re in the hospital. In addition to weekly spiritual gatherings for Catholic, Jewish, Christian, and Muslim faiths, patients can attend organized holiday observances throughout the year.

“In addition to celebrating religious holidays, observing cultural holidays such as cooking demonstrations or book readings, can serve as learning opportunities to patients and families,” says Jeune.

The Meditation & Prayer Room is another spiritual resource for CHOC families. Located on the second floor of the Bill Holmes Tower, it is a quiet and sacred place designed to accommodate people of all faith traditions.

Learn more about the spiritual care program at CHOC, including information on weekly services.

 

Meet Dr. Hoang “Wayne” Nguyen

CHOC Children’s wants its patients and families to get to know its specialists. Today, meet Dr. Hoang “Wayne” Nguyen, a child and adolescent psychiatrist. Dr. Nguyen attended medical school at Texas A&M Health Sciences Center and completed a psychiatry internship at University of California Irvine. He completed his residency training in child and adolescent psychiatry and pediatrics at the University of Utah Health Science Center.  He has been on staff at CHOC for over 16 years and is currently serves as director of psychiatry and the chair of the physician well-being committee.

Dr. Hoang “Wayne” Nguyen
Dr. Hoang “Wayne” Nguyen

Q: What are your special clinical interests?
A: Psychosomatic medicine including eating disorders, psycho-oncology, tic disorders, and Autism spectrum disorder and intellectual disability.

Q: What are some new programs or developments within your specialty?
A: Our most exciting program is the building of an inpatient child and adolescent mental health unit. We are also involved in integrating psychiatric care and mental health in various outpatient specialty clinics.   We are also a provider for the county’s Medi-Cal program for patients with co-occurring medical illnesses and psychiatric disorders.

Q: What are your most common diagnoses?
A: Anxiety, depression, ADHD

Q:  What inspires you most about the care being delivered here at CHOC?
A: It’s comprehensive and we are always striving to do better.

Q: Why did you decide to become a doctor?
A: At the age of 19 and having graduated from college, I was working as a software engineer at a startup, and there was a realization that there was more to life than what I was doing.

Q: If you weren’t a physician, what would you be and why?
A:  Ideally, a rock and roll star, but most likely a software entrepreneur because I like to create new solutions.

Q: What are your hobbies/interests outside of work?
A: I enjoy being with my five children and participating in their activities. I’m also very active in practicing my faith. In my spare time, I enjoy outdoor activities and playing tennis.

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Melon Mania!

By Stephanie Prideaux, Dietetic Technician, Registered

Children are mostly back in school, the fair has packed up its things, and summer, I’m afraid, is coming to a close. Although we might not have all the free time or outdoor movies in the park, we can hold on to summer through many of our favorite foods that are still in season. Melons, the snack I brought to almost every single gathering this year, are in season through as late as November, depending on the variety. Seasonal fruit means budget-friendly prices. Use this opportunity to sample melons you may have never heard of, such as canary melon or Santa Claus melon (also known as piel de sapo).

Melons are one of the ultimate warm weather snacks for their juiciness and refreshing mildly sweet flavor. In fact, melons like watermelon and honeydew are made of about 90 percent water. Their natural sweetness is a great substitute for sugary desserts or sugary beverages. Melons can even be transformed into delicious drinks with little to no added sugar, such as in the style of aguas frescas. Healthy frozen desserts such as snow cones or popsicles can be made from melons, such as in the recipe below. When in a pinch for time, skewered melon chunks are an easy option that kids love—and it’s a great way to taste test new types of melon.

You don’t have to be a culinary artist to transform melons into amazing things. With a little experimentation, or a recipe like the one below, melons can be used in ways that may not commonly come to mind. Never underestimate the deliciousness of any fruit with some lemon juice and chili powder. Melons can even be made into salsas and soups, or grilled or pickled.. Their mild but distinct flavor allows them to be served with fish, chicken, in tacos, as a dip, or in countless other ways.

Adding melon to main dishes is a unique and colorful way to pack in extra nutritional value, too. Melons are notorious for being great sources of vitamin C, which is perfect for children. Vitamin C is an antioxidant that protects their growing bodies against damage from the sun, air pollution, cigarette smoke and more. . This vitamin is also used to make collagen, which can help heal wounds from playtime cuts and scrapes. Iron deficiency is a common condition affecting children, but vitamin C can combat this by increasing the amount of iron their bodies absorb when eaten at the same time as meat, fish, poultry, beans, lentils, spinach, peas, nuts or raisins.

Melons are also good sources of dietary fiber, which prevents constipation and promotes heart health. Cantaloupe and watermelon, with their bright red and orange colors, are also good sources of vitamin A. This vitamin plays key roles in normal vision, immunity, future reproduction, as well as normal organ function. Potassium, essential for brain and nerve function, muscle growth and function, in addition to water balance, can also be easily found in cantaloupes. The list goes on and on. All melons are well-rounded and scrumptious sources of nutrients essential for growth, energy, normal function.

MELONS & FOOD SAFETY

Melons are nutrition powerhouses, but improperly handled food can spoil the fun. Remember, melons grow in the ground sitting on dirt. This is why melons should always be washed and scrubbed prior to slicing into it. If not, we risk moving any illness-causing bacteria from the outside of the melon to the inside. Be sure to wash your hands and never use an unwashed knife or cutting board–especially if it was used for meat. Once cut, keep melon cold or else discard after two hours of being at room.

RECIPES

Honeydew Avocado Salsa

zest of one lime

2 tbsp lime juice

1 tbsp olive oil

2 ½ cups honeydew melon, diced

avocado, diced

salt and pepper, to taste

Simply toss ingredients together and enjoy!

Variations:  toss diced melon and/or any other fruit with lime juice, green onions, chiles and herbs for versatility.

Minted Watermelon Popsicles

4 cups seedless watermelon, diced

2 tbsp sugar

¼ cup mint leaves, minced

2 tsp    lemon zest, finely grated

pinch of salt

Puree watermelon with sugar in a blender or food processor until smooth. Stir in remaining ingredients and pour into ice cube trays or popsicle molds. Freeze until hard, about three hours, inserting popsicle sticks halfway through freezing.

Variations:  cantaloupe with lemon juice; honeydew with lemon juice and cinnamon; watermelon with lime juice and cayenne

Recipe Sources:  Food & Wine

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Lessons Learned During a Senior Year Spent Fighting Cancer

aya

By Claire Nakaki, CHOC Children’s patient

Hello there! My name is Claire Nakaki. I am a freshman in college, but a little over a year ago, I was a soon-to-be high school senior when I was diagnosed with osteosarcoma, a type of bone cancer. I was a healthy, active volleyball player and I could not understand why this had happened to me. The initial shock was debilitating; cancer had never been something I saw in my future and certainly not my present. I began chemotherapy the month before school started, knowing that I was going to be completing my senior year of high school from a hospital bed. However, after my head and heart had cleared from the turmoil that my diagnosis had brought upon me, I realized that the upcoming year was really just a year. While cancer was something that I knew was going to affect me for the rest of my life, I refused to let it control my life. My surgeon Dr. Nassif asked me before my big surgery (which removed the tumor and replaced the bone with a prosthesis) to set some goals for the upcoming year. Two prominent goals immediately came to mind: I wanted to walk at graduation with my class, on time, without a walker, a wheelchair, or crutches, and I wanted to attend a four-year university after that. These goals did not seem far off, but I unknowingly delved into the hardest year of my life.

I found myself wanting to meet other patients my age almost immediately, begging the Child Life staff to introduce me to any other teens on the floor. I found so much comfort in knowing that there were other teenagers like me experiencing something similar. While no one’s story is identical, discussing the things we do have in common definitely helps soothe an anxious mind. I attended an AYA (Adolescent and Young Adult) support group meeting in my first few months of treatment and then the next following few months, then as often as I could. I had no idea it was even a support group until almost six months in. It felt more like a group of friends who coincidentally have this one big thing in common rather than a solemn meeting to talk about our hardships. Sure, we occasionally brought up things we were going through when someone needed support, but other than that it was just a safe space to be accepted with open arms. This AYA group has become like a second family to me, a fun group of people in all different stages of treatment and survivorship with whom I feel comfortable discussing anything and everything with. I do not know where I would be in my survivorship without this group of people, as well as the entire Child Life staff and AYA facilitators.

I am often asked if the experience was difficult and if I am sad that I missed my senior year of high school. I always have the same answer. Yes, of course it was difficult. I had no idea how difficult it would be. And I am painfully aware that my treatment went much smoother than most. I stayed on the same treatment plan and had very few bumps along the road. I am sure that my classmates enjoyed their senior year at school, but I would not trade this past year for any other situation. I truly mean that. I have learned so much from the genuinely kind and empathetic people that I met at CHOC, both patients and staff members. I reiterate time and time again that I feel so lucky to have had 17 years of life before cancer entered my life and I know that I have many more to come. I met so many younger kids during my stay at CHOC, mainly just a “hello” in the hallway, but there were a small few that I really got to know personally. These kids hold such a special place in my heart. I served as somewhat of a mentor to a few, due to my age and stage in my treatment, what kinds of procedures I had undergone, and what kinds of machines I was attached to. The kids I got to know made such a huge impact on my general attitude towards life and I truly hope that I made a positive impact on them. One piece of advice that I want everyone who goes through cancer to grasp is that no matter how bad you feel or how hard it is to meet your daily goals, your journey is always just one day at a time. It is so important to remind yourself that every day is just 24 hours. All you have to do is just get through the day. Take every step of the way just one day at a time. Soon enough, you will begin to see the light at the end of the tunnel.

aya

As I mentioned in the beginning of the post, I am now a first-year college student, which means that yes, I did meet my goals. I finished the last step of my treatment and was released from the hospital on June 9th and walked at my graduation without a wheelchair, a walker, or crutches one week later. I was accepted to college in the middle of my treatment, and completed all of my required courses in order to attend in the fall. I achieved these goals with a year of incredibly difficult work and with the unconditional support from my family, friends, and CHOC staff. There will always be things I cannot do because of what happened to me and I still go to physical therapy twice a week and have to take extra precautions in almost everything I do, but I am so happy to be back in the real world, living my new normal.

 Learn more about the Hyundai Cancer Institute at CHOC Children’s.

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Remedies for Constipation in Children

Constipation in children is an all-too-common ailment, accounting for nearly five percent of all pediatric visits each year and one out of every four pediatric gastroenterology visits. More than 90 percent of constipated children have “functional” constipation, meaning constipation without any underlying disease.

Although symptoms may vary for each patient, common signs to look for include:

  • Infrequent bowel movements (less than three per week)
  • Stool leakage
  • Withholding behavior
  • Difficult, painful or hard bowel movements
  • Abdominal pain
  • Urine accidents
  • Blood-coated stools

The most common cause of constipation in  children is withholding due to past experience with painful passage of stools, says Dr. Ashish Chogle, pediatric gastroenterologist at CHOC Children’s. Other leading factors relate to water and food intake.

constipation in children
Dr. Ashish Chogle, pediatric gastroenterologist at CHOC

Stool leakages in the underwear are often encountered in children with long standing constipation. Most children will not feel the stools passing accidently, as feeling in the rectum decreases as a result of the stretching that takes place from being constipated for a long time.

There are several things parents can try at home to alleviate the problem of constipation, he says. First, if your child is not usually a keen water drinker, increase their water intake to normal levels. CHOC recommends one full eight ounce glass of fluids per year in age every day. Increasing their fiber intake can also help relieve mild cases of constipation in children. Good sources of fiber include whole grains, whole wheat items, beans, green leafy vegetables and fruit. The minimum amount of fiber for children is equal to your child’s age plus five grams. For example, a child who is 5 years old should eat 10 grams of fiber each day (5 years + 5 = 10 grams). If the child isn’t better after trying these methods at home, consult your pediatrician. Your pediatrician may recommend a treatment plan or refer you to a pediatric gastroenterologist.

Treatment plans may include a stool softener regimen such as laxative therapy, or lifestyle changes, depending on the severity and underlying causes of the constipation. If your child has significant stool back up in the colon, the doctor might recommend a bowel clean out with Miralax.

Parents may worry that their child will become dependent on a stool softener if given for an extended duration, and thus may stop the laxatives sooner than advised by their physician.

“By stopping a laxative therapy plan too soon, the child can bounce back to being constipated,” says Dr. Chogle. “The treatment needs to last long enough that the colon fully recovers from the stretching that has occurred due to constipation. Parents don’t need to worry about their children becoming dependent, as long as they follow their physician’s treatment plan and have an understanding that it can take months for the colon to recover and function properly.”

The length of the regimen will vary depending how long the child has been constipated. There are some patients with an inherently slow colon (those with slow transit constipation). These patients will likely require laxatives long term, says Dr. Chogle.

Older children or teens with chronic constipation issues may actually be suffering from pelvic floor dysfunction, especially if they spend a long time straining on the toilet or pass only small amounts of stools each time. This could be due to an incoordination in pelvic floor muscles, also known as anal dyssynergia. Muscles tighten instead of opening up while attempting to pass a bowel movement- similar to trying to squeeze out toothpaste from a tube with the cap half open. Your child’s doctor may order a test called an anorectal manometry to determine anal pressures and pelvic floor coordination if they do not respond to other treatment options. Physical therapy, specifically anal biofeedback therapy, may be recommended for some patients.

Learn more about constipation from the gastroenterology experts at CHOC.

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