19 It is essential to provide parents and child with good explanations regarding the aetiology, prevalence and pathophysiology of constipation. In doing so, it may be helpful to illustrate with drawings that faecal incontinence does not occur intentionally. Explain to the child and parent the signs of constipation and how that effects the function of the rectum and the normal defecation patterns. By using anatomical models and child oriented short films, it can be made understandable for even smaller children. Use the POO factory. For example, start by showing the normal function of the rectum on an anatomical model and how the child gets signal and feels when it is time to poop. Then explain the different findings and what they mean for the function of the rectum and how that effects the child. This information is vital for adherence to treatment which can be distressing for the family with medication and struggling with routines at home. By explaining about the defecation signal, the child can understand why it is important to go to the toilet when they feel the urge to poop. Parents should be encouraged not to punish the child but rather approach it positively. It should also be explained that constipation is recurrent in nature, which means that it is often accompanied by good and bad periods. In addition, dietary advice should be given with regard to a normal fluid and fibre intake. Pharmacotherapy Disimpaction of old stool It is recommended to use either enema once a day for at least 4 days in a row, or a high dose of Polyethylene glycol (PEG or Macrogol) for 4-6 days. According to ESPGHAN guidelines, the dose is 1-1,5 g/kg/day. For example, a 20 kg child gets 3-4 sachet a day. Enemas often make a good and direct effect, but the drawback is that it must be given rectally which some children and parents find distressing.
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