Young et al., 19981111 Young RJ, Beerman LE, Vanderhoof JA. Increasing oral fluids in chronic constipation in children. Gastroenterl Nurs. 1998;21:156-161.
90 North-American children with intestinal constipation aged between 2 and 12 years. |
After one week of fluid intake recording, 108 patients with constipation were divided into three groups: 1. Control, 2. Increase in water intake by 50% in relation to baseline, 3. Increase in the supply of hyperosmolar fluid (> 600 mOsm/L). Diet was assessed by a three-day food diary. The frequency of bowel movements and stool consistency were recorded. The intervention lasted two weeks. |
The study was completed by 90 patients. No statistically significant variation was observed in any of the three groups at the end of the second and third weeks of intervention regarding bowel movement frequency, stool consistency, and difficulty to evacuate. |
Kuhl et al., 20092626 Kuhl ES, Felt BT, Patton SR. Brief report: adherence to fluid recommendation in children receiving treatment for retentive encopresis. J Pediatr Psychol. 2009;34:1165-9.
26 North-American children aged 3-11 years with fecal incontinence due to stool retention (retentive encopresis). |
Five to six sessions of behavioral intervention were carried out, covering the following topics: physiology of retentive encopresis, medications, importance of dietary fiber and clear liquids, toilet training, and treatment maintenance. Recommendation on fluid intake: first session, explanation on the importance of consumption and recommendation of intake ([age + 5 g of fiber] × 28 mL [1 ounce]) and the second session: recommendation of fluid intake ([age + 10 g of fiber] × 28 mL [1 ounce]). Diet was assessed through a food diary. |
Bowel movement frequency increased from 12.0 to 16.1 per week, when comparing the first and last weeks of treatment. The mean fluid intake increased significantly from 480 mL to 720 mL, comparing the first with the last weeks of treatment (p ≤ 0.001). There was no control group for comparison. |
Kuhl et al., 20102929 Kuhl ES, Hoodin F, Rice J, Felt BT, Rausch JR, Patton SR. Increasing daily water intake and fluid adherence in children receiving treatment for retentive encopresis. J Pediatr Psychol. 2010;33:1144-51.
37 North-American children aged 4-12 years with retentive encopresis. |
Two types of treatment were compared for six to seven weeks: 1. Behavioral intervention and 2. Behavioral intervention plus fluid intake encouragement, session 3 = (age [in years] + 5) × 28 mL (1 ounce) and session 5 = (age [in years] + 10) × 28 mL (1 ounce). Clinical and dietary data were obtained by: review of medical records (retrospective, 2005 and 2007); behavioral intervention and encouragement to increase water intake (prospective, 2008 and 2009). The recommendations for water volume intake were explained with games and activities adapted to the child's age. The children received a 450-mL bottle to help them to control fluid intake. |
Fluid intake was higher in the group receiving a specific encouragement to increase intake at the intermediate treatment stage (448 mL vs. 224 mL) and at the final stage (532 mL vs. 280 mL; p ≤ 0.001) The frequency of bowel movements and fecal incontinence episodes in the first week was the same in both groups. When comparing the beginning and the end of the treatment, the group with intervention and encouragement showed a decrease in the occurrence of fecal incontinence (p ≤ 0.05) and tendency to increase the evacuation frequency (p = 0.08). |
Bae et al., 20102727 Bae SH, Son JS, Lee R. Effect of fluid intake on the outcome of constipation in children: PEG 4000 versus lactulose. Pediatr Int. 2010;52:594-7.
27 Korean children aged between 2 and 14 years with intestinal constipation |
The medical records of children who were on medication (Polyethylene glycol 4000 and lactulose) were selected for maintenance of intestinal constipation control. The medication dose was stable for over three months and the participants had a bowel movement diary containing information on evacuation frequency, stool consistency, and amount of fluids consumed. Fluid recommendation was based on body weight. The evaluation of bowel movement frequency and stool consistency was performed using a scoring system. |
The group treated with polyethylene glycol 4000 (n = 14) showed a higher bowel movement frequency during the period of higher fluid intake, when compared to the period of lower fluid intake (medians of 27.7 and 25.1, respectively, p = 0.009) and lower stool consistency (medians of 20.0 and 15.0, respectively, p = 0.002). In the group treated with lactulose (n = 13), these differences were not observed. |
Karagiozoglou-Lampoudi et al., 20123232 Karagiozoglou-Lampoudi T, Daskalou E, Agakidis C, Savvidou A, Apostolou Am, Vlahavas G. Personalized diet management can optimize compliance to a high-fiber, high-water diet in children with refractory functional constipation. J Acad Nutr Diet. 2012;112:725-9.
86 Greek children aged 1-11 years with intestinal constipation according to the NASPGHAN criteria (2006)77 Constipation Guideline Committee of the North American Society for Pediatric Gastroenterology, Hepatology and Nutrition. Evaluation and treatment of constipation in infants and children: recommendations of the North American Society for Pediatric Gastroenterology, Hepatology and Nutrition. J Pediatr Gastroenterol Nutr. 2006;43:e1-13.
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Participants were randomized into two groups. Both groups were treated with lactulose. One group received written instructions on the diet, recommended by the gastroenterologist and in the other group, a dietitian prescribed a personalized diet for seven days, calculating the energy, nutrient, water, and dietary fiber needs. Food evaluation was carried out with the use of two 24-hour food recalls, on the first visit and after one month, respectively. |
After one month of treatment a favorable response was observed (bowel movement frequency ≥3 times per week, absence of painful evacuation and absence of hard stools) in both groups. The group that received a personalized diet showed an increase in energy, carbohydrate, lipid, fiber, and water consumption, while the other group showed only fiber consumption increase (p = 0.013). The group with individualized dietary intervention had a higher increase in dietary fiber (0.83 g/kg/day versus 0.24 g/kg/day, p = 0.001) and water intake (29.9 mL/kg/day versus 1.89 mL/kg/day, p < 0.001) when compared with the other group. |