Meconium plug or meconium ileus cystic fibrosis

Meconium plug or meconium ileus (cystic fibrosis)
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Constipation in Infancy
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Often related to diet
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Constipation in exclusively breastfed infants is almost unknown
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Infrequent stool may occur because of minimal residue from digested breast milk
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Formula-fed infants may develop constipation
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Nursing management
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Infancy – usually related to diet
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Transition to cow milk
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Medical conditions – GERD, cleft palate, CP
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Constipation in Childhood

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Often a result of environmental changes or control over body functions
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Encopresis is inappropriate passage of feces, often with soiling
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May result from stress
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Relationship to urinary tract infections
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Nursing management
Toddlers and Preschoolers
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Diet
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Painful bowel movements (stool toileting refusal)
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Withholding stool – accumulates in and dilates rectum
School-age and Adolescent – results in overflow fecal incontinence, may present with recurrent
UTIs or enuresis
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Clinical manifestations; Formation of hard, dry stools, Oozing of liquid stool past a
collection of hard, dry stool
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Diagnosis; History and PE, Abdominal x-ray
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Clinical Therapy
Dietary and fluid management
Infants – Ps – pears, peaches, prunes, peas
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High fiber foods (whole grains, raw fruits and veggies
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Increase fluid intake in older infants and children
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Withhold constipating foods (bananas, rice, carrots, cheese)
Toileting: Allow adequate time
Medications – first soften, then facilitate evacuation
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Stool softeners –
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Laxatives: Miralax, Senekot, lactulose
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MiraLax (polyethylene glycol 3350) is a laxative solution that increases the amount of
water in the intestinal tract to stimulate bowel movements.
Evacuation of stool
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Stressful
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Enemas and suppositories
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Oral – Golytely or miralax (electrolyte free)
Long-term: stimulant laxative – Senekot
Behavior modification
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Younger children – rewards for toileting, Routine times of toileting
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Older children ; Rewards, Psych referral if relevant
 Minimal daily fluid requirement formula
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Calculate the child’s weight in kilograms
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Allow 100 ml/kg for the first 10 kg of body weight
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Allow 50 ml/kg for the second 10 kg of body weight
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Allow 20 ml/kg for the remaining kilograms of body weight
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Child weighs 32 kg
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100 x 10 for the first 10 kg of body weight =
1000 ml
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50 x 10 for the second 10 kg of body weight = 500 ml

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20 x 12 for the remaining body weight = 240 ml
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1000 + 500 + 240 = 1740 ml/24 hr
 Cleft palate
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4 th most common birth defect in US
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More common in Native Americans and Asians
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Multifactorial causes
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Cleft lip (1:750) ( ⬆ incidence in Asian children), Maxillary processes fail to fuse,
Apparent at birth
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Cleft palate (1:2000) – less obvious, Continuous opening b/t mouth and nasal cavity,
Unilateral or bilateral
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Feeding:
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Education lactation consult
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Pump if breastfeeding difficult
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Special feeding bottles
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May require additional time to feed
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Keep head and chest elevated
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Frequent burping**
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Needed due to excessive swallowing of air
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Monitor growth
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Surgical correction;
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Closure of the lip defect precedes correction of the palate
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Z-plasty to minimize retraction of the scar
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