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Rajasegaran S, Ahmad NA, Tan SK, Lechmiannandan A, Mohamed OM, Cheng JQ, Hassan J, Sanmugam A, Singaravel S, Mohd Khalid H, Abdullah MY, Nah SA. Anorectal malformation and Hirschsprung's disease: a cross-sectional multicentre comparison of quality of life and bowel function to a healthy population. Arch Dis Child 2024; 109:557-562. [PMID: 38649254 DOI: 10.1136/archdischild-2023-326724] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2023] [Accepted: 04/08/2024] [Indexed: 04/25/2024]
Abstract
PURPOSE Children with anorectal malformation (ARM) and Hirschsprung's disease (HD) often experience bowel symptoms into adulthood, despite definitive surgery. This study evaluates the quality of life (QOL) and bowel functional outcome of children treated for ARM and HD in comparison to healthy controls. METHODS Between December 2020 and February 2023, we recruited patients with ARM and HD aged 3-17 years at four tertiary referral centres, who had primary corrective surgery done >12 months prior. Healthy controls were age-matched and sex-matched. All participants completed the Pediatric Quality of Life Inventory Generic Core Scales 4.0, General Well-Being (GWB) Scale 3.0 and Family Impact (FI) Module 2.0 Questionnaires. Bowel Function Score (BFS) Questionnaires were also administered. We also performed subgroup analysis according to age categories. Appropriate statistical analysis was performed with p<0.05 significance. Ethical approval was obtained. RESULTS There were 306 participants: 101 ARM, 87 HD, 118 controls. Patients with ARM and HD had significantly worse Core and FI Scores compared with controls overall and in all age categories. In the GWB Scale, only ARM and HD adolescents (13-17 years) had worse scores than controls. ARM and HD had significantly worse BFSs compared with controls overall and in all age categories. There was significant positive correlation between BFS and Core Scores, GWB Scores and FI Scores. CONCLUSION Patients with ARM and HD had worse QOL than controls. Lower GWB Scores in adolescents suggests targeted interventions are necessary. Bowel function influences QOL, indicating the need for continuous support into adulthood.
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Affiliation(s)
- Suganthi Rajasegaran
- Department of Surgery, University of Malaya, Kuala Lumpur, Wilayah Persekutuan, Malaysia
| | - Nur Aini Ahmad
- Department of Paediatric Surgery, Sabah Women and Children's Hospital, Kota Kinabalu, Sabah, Malaysia
| | - Shung Ken Tan
- Paediatric Surgery Unit, Department of Surgery, Hospital Sultanah Bahiyah, Alor Setar, Kedah Darul Aman, Malaysia
| | - Abhirrami Lechmiannandan
- Department of Paediatric Surgery, Women's and Children's Hospital Kuala Lumpur, Hospital Tunku Azizah, Kuala Lumpur, Wilayah Persekutuan Kuala Lumpur, Malaysia
| | - Omar Mazali Mohamed
- Department of Surgery, University Malaya Medical Center, Kuala Lumpur, Kuala Lumpur, Malaysia
| | - Joo Qing Cheng
- Paediatric Surgery Unit, Department of Surgery, Hospital Sultanah Bahiyah, Alor Setar, Kedah Darul Aman, Malaysia
| | - Junaidah Hassan
- Paediatric Surgery Unit, Department of Surgery, Hospital Sultanah Bahiyah, Alor Setar, Kedah Darul Aman, Malaysia
| | - Anand Sanmugam
- Department of Surgery, University of Malaya, Kuala Lumpur, Wilayah Persekutuan, Malaysia
- Department of Surgery, University Malaya Medical Center, Kuala Lumpur, Kuala Lumpur, Malaysia
| | - Srihari Singaravel
- Department of Surgery, University of Malaya, Kuala Lumpur, Wilayah Persekutuan, Malaysia
- Department of Surgery, University Malaya Medical Center, Kuala Lumpur, Kuala Lumpur, Malaysia
| | - Hazlina Mohd Khalid
- Department of Paediatric Surgery, Sabah Women and Children's Hospital, Kota Kinabalu, Sabah, Malaysia
| | - Mohd Yusof Abdullah
- Department of Paediatric Surgery, Women's and Children's Hospital Kuala Lumpur, Hospital Tunku Azizah, Kuala Lumpur, Wilayah Persekutuan Kuala Lumpur, Malaysia
| | - Shireen Anne Nah
- Department of Surgery, University of Malaya, Kuala Lumpur, Wilayah Persekutuan, Malaysia
- Department of Surgery, University Malaya Medical Center, Kuala Lumpur, Kuala Lumpur, Malaysia
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Wang Y, Cao J, Zhang W, Chen H, Li M, Liu Z, Wang J. What is needed by parents of constipated infants and toddlers: A cross-sectional study in China. Front Pediatr 2023; 11:1066355. [PMID: 37124178 PMCID: PMC10130535 DOI: 10.3389/fped.2023.1066355] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Accepted: 03/27/2023] [Indexed: 05/02/2023] Open
Abstract
Background Childhood functional constipation is a worldwide problem that affects the intestinal function of children and the quality of life of their families. Treatment and management of the disease need to be carried out at home by parents. Assessment of caregiving needs is an important link in planning and implementing the intervention. This study aimed to assess the caregiving needs of parents of FC infants and toddlers. Methods The researchers recruited convenience samples of parents from an outpatient pediatric constipation clinic of a children's medical center. Totally 211 fathers/mothers were recruited. Nursing needs were measured by a questionnaire, and associations between nursing needs and potential factors were examined using multiple regression analysis. Results The vast majority of participants (88.7%) expressed the need of receiving support from professionals, and only 44 (20.85%) had obtained help from medical staff. The needs of parents mainly include information needs, health needs, psychological needs, and social needs. Of all the needs, the highest score was for information needs (3.87 ± 0.69), followed by the dimension of health needs (3.74 ± 0.82). Results showed statistically significant differences in parental education, place of residence, age of children, duration of FC, defecation frequency, difficulty of defecation, and stool traits in nursing needs (p < 0.05). The regression model explained 64.2% of the variance of nursing needs. Conclusions Information needs were the major concern for parents, and the unmet needs of parents should be addressed during treatment and care. When developing care plans and providing health education, it should be adjusted according to the specific conditions of the child and parents to improve the compliance of the parents with treatment and care.
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Affiliation(s)
- Yuanyuan Wang
- Department of Nursing, Children's Hospital of Nanjing Medical University, Nanjing, China
| | - Jinjin Cao
- Department of Gastroenterology, Children's Hospital of Nanjing Medical University, Nanjing, China
| | - Weiying Zhang
- Department of Emergency, Children's Hospital of Nanjing Medical University, Nanjing, China
| | - Hongyu Chen
- Department of Neurosurgery, The First Hospital of China Medical University, Shenyang, China
| | - Mei Li
- Department of Nursing, Children's Hospital of Nanjing Medical University, Nanjing, China
- Correspondence: Mei Li Zhifeng Liu
| | - Zhifeng Liu
- Department of Gastroenterology, Children's Hospital of Nanjing Medical University, Nanjing, China
- Correspondence: Mei Li Zhifeng Liu
| | - Jianan Wang
- Department of Nursing, Children's Hospital of Nanjing Medical University, Nanjing, China
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Flankegård G, Mörelius E, Rytterström P. Everyday life with childhood functional constipation: A qualitative phenomenological study of parents' experiences. J Pediatr Nurs 2022; 67:e165-e171. [PMID: 35931621 DOI: 10.1016/j.pedn.2022.07.021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Revised: 07/08/2022] [Accepted: 07/19/2022] [Indexed: 10/16/2022]
Abstract
UNLABELLED Childhood functional constipation (FC) is a worldwide problem with treatment regiments affecting everyday life. AIM To explore parents´ experiences of living with a child with FC and its impact on everyday family life. METHOD A qualitative phenomenological interview study using a reflective lifeworld research approach. Interviews with 15 parents of otherwise healthy children aged 1-14 years affected by FC. FINDINGS Shame is the driving force making parents put everyday life on hold. The quest for control, self-imposed loneliness, guilt, inadequacy, and frustrating battles become essential parts of everyday life to protect it from FC-related shame. CONCLUSION FC has as great an impact on everyday life as any childhood illness. Every part of family life is affected by FC. Continuously family support and guidance are needed. PRACTICE IMPLICATIONS Healthcare professionals need to take FC more seriously, listen to the parents and try to understand their experiences of everyday life to enable custom made care plans with the family-unit in focus. Care with clinical sensitivity might help parents deal with the attendant shame and stigmatization that stem from illness beliefs about FC.
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Affiliation(s)
- Gunilla Flankegård
- Linköping University, Department of Health, Medicine and Caring Sciences, Sweden.
| | - Evalotte Mörelius
- Linköping University, Department of Health, Medicine and Caring Sciences, Sweden; School of Nursing and Midwifery, Edith Cowan University, Australia.
| | - Patrik Rytterström
- Linköping University, Department of Health, Medicine and Caring Sciences, Sweden.
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Houghton D, Arabiat D, Ireson D, Mörelius E. A Scoping Review of Non-Pharmacological Health Education Provided to Families of Children With Idiopathic Childhood Constipation Within Primary Health Care. J Prim Care Community Health 2022; 13:21501319221117781. [PMID: 36000448 PMCID: PMC9421236 DOI: 10.1177/21501319221117781] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Objectives: Idiopathic childhood constipation is a prevalent condition that initially
brings the child under the care of the primary health care team. Although it
is acknowledged that health education is crucial to reducing chronicity, the
range of evidenced-based non-pharmacological health education provided to
families has not previously been reviewed. For this scoping review, 4
research questions sought to identify papers that provide information on the
utilization of guidelines, the range of health education, who provides it,
and whether any gaps exist. Methods: Following a registered protocol and using the Preferred Reporting Items for
Systematic reviews and Meta-Analyses extension for Scoping Reviews, searches
of 10 online databases, reference lists, Google Scholar, and book chapter
references were made. Eligible papers were original research published in
English between January 2000 and December 2022. Results: Twelve worldwide studies (2 qualitative and 10 quantitative) reported that:
evidence-based guidelines are not consistently used by primary care
providers; the range of non-pharmacological health education provided is
inconsistent; the non-pharmacological health education is provided by
doctors, nurses, and pharmacists; and that gaps exist in non-pharmacological
health education provision. Conclusion: This review demonstrates that rather than a lack of guideline-awareness,
decreased specific idiopathic childhood constipation knowledge (and possibly
time) may be responsible for inconsistent non-pharmacological health
education. Inappropriate treatment and management of some children escalates
risk for chronicity. Improving health education provision however, may be
achieved through: increased collaboration; better utilization of nurses; and
through developing the child’s health literacy by involving both child and
family in all aspects of health education and decision-making.
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Affiliation(s)
- Davina Houghton
- Edith Cowan University, Joondalup, Perth, WA, Australia.,Joondalup Health Campus, Joondalup, Perth, WA, Australia
| | - Diana Arabiat
- Edith Cowan University, Joondalup, Perth, WA, Australia.,The University of Jordan, Amman, Jordan
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Leung AK, Hon KL. Paediatrics: how to manage functional constipation. Drugs Context 2021; 10:dic-2020-11-2. [PMID: 33828605 PMCID: PMC8007206 DOI: 10.7573/dic.2020-11-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Accepted: 01/06/2021] [Indexed: 12/22/2022] Open
Abstract
Background Despite being a common problem in childhood, functional constipation is often difficult to manage. This article provides a narrative updated review on the evaluation, diagnosis and management of childhood functional constipation. Methods A PubMed search was performed with Clinical Queries using the key term ‘functional constipation’. The search strategy included clinical trials, meta-analyses, randomized controlled trials, observational studies and reviews. The search was restricted to the English literature and to the paediatric population. The information retrieved from the above search was used in the compilation of the present article. Results A detailed history and thorough physical examination are important in the evaluation of a child with constipation to establish the diagnosis of functional constipation as per the Rome IV criteria and to catch ‘red flags’ suggestive of organic causes of constipation. These ‘red flags’ include delayed passage of meconium, ribbon stool, rectal bleeding/blood in the stool unless attributable to an anal fissure, failure to thrive, severe abdominal distension, absent anal wink/cremasteric reflex, tight and empty rectum on digital examination and explosive expulsion of liquid stool and gas on withdrawal of the finger, hair tuft/dimple/lipoma/haemangioma in the lumbosacral area, and an anteriorly displaced anus. For functional constipation, pharmacological therapy consists of faecal disimpaction and maintenance therapy. This can be effectively accomplished with oral medications, rectal medications or a combination of both. The most commonly used and most effective laxative is polyethylene glycol. Non-pharmacological management consists of education, behavioural modification and dietary interventions. The combination of pharmacological therapy and non-pharmacological management increases the chance of success. Conclusion Polyethylene glycol is the medication of first choice for both disimpaction and maintenance therapy. If polyethylene glycol is not available or is poorly tolerated, lactulose is the preferred alternative. Other laxatives may be considered as second-line therapy if treatment with osmotic laxatives fails or is insufficient. Maintenance treatment should be continued for at least 2 months. Early treatment will result in a faster and shorter treatment course.
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Affiliation(s)
- Alexander Kc Leung
- Department of Pediatrics, University of Calgary, and Alberta Children's Hospital, Calgary, Alberta, Canada
| | - Kam Lun Hon
- Department of Paediatrics, The Chinese University of Hong Kong, Shatin, Hong Kong.,Department of Paediatrics and Adolescent Medicine, Hong Kong Children's Hospital, Hong Kong
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Flankegård G, Mörelius E, Duchen K, Rytterström P. Experiences of parents who give pharmacological treatment to children with functional constipation at home. J Adv Nurs 2020; 76:3519-3527. [PMID: 33043491 PMCID: PMC7702076 DOI: 10.1111/jan.14539] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2020] [Revised: 06/22/2020] [Accepted: 07/29/2020] [Indexed: 12/11/2022]
Abstract
Aim The aim was to explore the lived experiences of parents who give oral and rectal pharmacological treatment to their children with functional constipation at home. Design A phenomenological design with a reflective lifeworld research approach that describes phenomena as they are experienced by individuals. Methods From January–May 2019, 15 interviews were conducted with parents of children with functional constipation with home‐based oral and rectal treatment. Parents were recruited from three different healthcare levels. Open‐ended questions were used starting from the description of a normal day with constipation treatment. Analyses were made with an open and reflective ‘bridling’ attitude. Findings Constipation treatment causes parents to question their parental identity and what it means to be a good parent. Forced treatment makes them feel abusive and acting against their will as parents. There is a conflict between doubt and second thoughts about the treatment, the urge to treat based on the child's needs and encouragement from healthcare professionals to give treatment. Conclusion As pharmacological constipation treatment can be experienced as challenging, it is important to help parents make an informed decision about how such treatment should be carried out at home. The findings reveal a medical treatment situation where parents hesitate and children resist, resulting in insecure parents who question their parental identity. Impact The findings point to the importance of supporting parents in treatment situations. Healthcare providers need to treat children with constipation with greater focus and more prompt management to prevent these families from lingering longer than necessary in the healthcare system.
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Affiliation(s)
- Gunilla Flankegård
- Division of Nursing Sciences and Reproductive Health, Department of Health, Medicine and Caring Sciences, Faculty of Health Sciences, Linköping University, Norrkoping, Sweden
| | - Evalotte Mörelius
- Division of Nursing Sciences and Reproductive Health, Department of Health, Medicine and Caring Sciences, Faculty of Health Sciences, Linköping University, Norrkoping, Sweden.,School of Nursing and Midwifery, Edith Cowan University, Joondalup, WA, Australia
| | - Karel Duchen
- Division of Children's and Women's Health, Department of Biomedical and Clinical Sciences, Faculty of Health Sciences, Linköping University, Linköping, Sweden
| | - Patrik Rytterström
- Division of Nursing Sciences and Reproductive Health, Department of Health, Medicine and Caring Sciences, Faculty of Health Sciences, Linköping University, Norrkoping, Sweden
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