Objective: Severe constipation in children is associated with rectal overdistension and insensitivity. Treatment typically involves three phases: disimpaction (days to weeks), laxative use (months), and a high-fiber diet (lifelong). The purpose of this survey is a discussion of therapies that recognize the unique problems that children with severe constipation have.
Methods: Four-day diet logs were obtained from children who had no history of chronic bowel disease. Their intake of dietary fiber was determined from the logs and was compared with the dietary fiber ingested by children who had chronic constipation. These data sets were compared in light of our current understanding of the need for dietary fiber.
Results: Approximately half of the children from families who were health conscious enough to request dietary evaluation still fell below the age + 5 guidelines for grams of dietary fiber intake per day. The children referred to use with chronic constipation had all been instructed "to eat a high-fiber diet." Those constipated patients were consuming less than one fourth of the recommended fiber intake.
Conclusions: This survey underscored the difficulties in beginning and in maintaining high-fiber diets in children. When families receive advice to administer a high-fiber diet, they are unable to accomplish this unless they receive intensive and ongoing dietary counseling. Even among health-conscious families, only half of the children received the recommended amounts of dietary fiber. Further public education in this regard is warranted.