Center for Disabilities and Development
Nationally
designated as Iowa’s University Center for Excellence on Disabilities
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Center for Disabilities and
Development |
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877-686-0031 (toll-free, voice) |
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877-686-0032 (toll-free, TTY) |
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319-353-6900 (local) |
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WINTER 2004
CenterLines
Front and Center with useful news for families!
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In this issue
When the going gets tough:
Constipation and encopresis
Finding help with your child’s health care
costs
BREAKING NEWS - The Ketogenic
Diet
QUESTIONS, COMMENTS, SUGGESTIONS
Knowing where to FIND the answers
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Constipation, encopresis, and your child
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Constipation
and encopresis are common problems in childhood. If your child complains of stomachache,
never seems to be hungry, or is often crabby, constipation may be the
culprit. Put simply, constipation means a child is not having bowel movements
often enough. How much is
“enough”? Most children should have a bowel movement every day, or at least
three times a week. This is important for keeping the child’s colon
functioning like it should. A bowel
movement that is very hard or that hurts is a sign of constipation. When it
hurts to go to the bathroom, a child may try to have fewer bowel movements.
Though it looks as though he is trying to go to the bathroom, he may actually
be squeezing hard not to go, so it won’t hurt. Over time, stools get bigger
and harder. This makes it hurt even more when the child finally does go to
the bathroom. Now he will be even less willing to have another bowel
movement. And so the problem keeps getting worse. |
Stomach-ache
+ Poor
appetite
+
Crabbiness
______________
May = constipation!
Encopresis
With continued
constipation, a child’s colon can get so stretched that it can’t push out the
stool very well. Its nerves can be affected, so the child can’t tell it’s time
to go to the bathroom. Sometimes softer stools leak out around the hard stool
and onto the child’s underwear. When the stool finally gets so big the colon
can’t hold it, it can “fall out” into the child’s underwear, often without the
child even knowing. When a child who is old enough to be toilet trained has
bowel accidents like this, it is called encopresis.
Children with
encopresis don’t have accidents because they are lazy, or to be naughty. They
can’t help the accidents. They have a physical condition that affects how their
colon and its nerves work.
What should you do
if your child is constipated?
First, have
your youngster sit on the toilet and try, pushing hard, to have a bowel
movement for 5 to 10 minutes after every meal. Talk with her teachers, so that
she also goes to the bathroom after every meal at school. Have her try to have a
bowel movement for 5-10 minutes after each meal, even if she has already gone
to the bathroom that day.
While she is
sitting on the toilet trying to have a BM, it may help if she puts her feet up
on a footstool. This can help her keep her balance and push hard. To help her
push, you can ask her to take a deep breath, tighten her stomach muscles, and
push while she counts to ten. Then have her relax (blowing soap bubbles can
help with this). Or have her bend over and touch her knees with her nose, take
a deep breath, and push while counting to ten.
After each
toileting session, reward your child with praise or with a small treat. Make
sure your child understands that constipation isn’t their fault, and that you
know they are trying hard.
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Preventing
constipation What a child
eats is especially important if they have constipation or encopresis. The Big
Three - fiber, fluid, and exercise - can really help. To learn more about the
Big Three, see the table below. First, make
sure your youngster is drinking enough, usually about 5 cups of liquid each
day. Encourage them to eat high fiber foods like raisins, fresh fruits and
vegetables, and whole grain foods. Avoid high fat foods that can make
constipation worse. Exercise is also key. Limit the number of hours your
child spends sitting, and encourage them to walk, play in school sports, and
do other kinds of physical activity. |
Get more help if you
need to
Children who
are badly constipated or have encopresis may need extra help. You can talk with
your family doctor or nurse about laxatives, enemas, or suppositories. These
can be used in combination with the routine described above to help a child
return to healthy bowel habits.
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Prevent constipation
with
THE BIG 3: FLUIDS,
FIBER, and EXERCISE!
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1. Fluids |
5 cups per day
water, prune juice, apple juice, apricot juice (2-4 oz per day) avoid soft
drinks (pop) and juices with sugar added |
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2.
Fiber |
Fruits - 2
servings Apples, raisins,
prunes, apricots, peaches Veggies - 3
servings Potatoes,
beans, carrots Whole grain
cereals bran cereals, shredded wheat, oatmeal, granola Whole grain
breads, pasta, muffins |
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3.
Exercise |
Running, outdoor
sports, skating, swimming, walking the dog |
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Cut
down on: |
High fat foods |
Fried food,
lunch meats, bacon, cheese |
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Are you worried
about constipation and your child?
We may be able to help. Contact:
Joni Bosch,
Family Nurse Practitioner
319-356-4686
June Masbruch, RN
319-354-7375
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Finding
Help with Your Child’s
Health Care Costs
Do you worry
about how to pay for health care for your child with special needs? Iowa’s
Medicaid waiver programs may be what you’re looking for.
Waiver
programs were created to help families get essential services for their
children with special needs. If your child meets certain guidelines, these
programs may be able to help you - even if you aren’t poor.
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MEDICAID MYTHS |
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MYTH #1: You can get Medicaid only if you’re
poor. |
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MYTH #2: You can get Medicaid only if you
don’t have health insurance. |
Three Iowa
Medicaid waivers focus specifically on helping families get care for a child
with special needs. Each has its own set of guidelines:
Brain Injury (BI) Waiver
• A
medical diagnosis of brain injury
• Medical
records must show the BI occurred during or after birth, not during pregnancy
Ill
and Handicapped (IH) Waiver
• Presence
of special needs such as nursing care, tube feeding, physical therapy,
occupational therapy, speech therapy, etc.
Mental
Retardation (MR) Waiver
• A
psychologist’s diagnosis of mental retardation affecting mental ability and
daily living skills
• IQ
must fall within certain range
You CAN have
other insurance coverage and still get Medicaid coverage as well as waiver
benefits. It makes sense to apply early for waiver services. Medicaid coverage
can’t begin until the waiver services begin, and waiver services may have
waiting lists.
We understand
that costs are a real concern for many families. Our CDD Benefits Specialist
can help you investigate your options. This specialist will work with you to
determine eligibility, help you with application paperwork, and monitor your
application.
Last year,
more 655 applications from CDD families were filed, and to date 55% have been
approved, and 25% are still pending or on waiting lits. In addition to the
three waiver programs above, the CDD Benefits Specialist can also talk with you
about Social Security Disability, Supplemental Security Income, Health
Insurance Premium Program (HIPP), and HAWK-I.
If you would like to learn more about
Medicaid waivers and other benefit programs, call
Kristi
Lynch, Health Care Benefits Specialist
319-384-6281
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The Ketogenic Diet:
When it comes to
treating seizures, something old is new again
CDD’s new Ketogenic
Diet Service helps children who suffer from seizures that don’t respond well to
medication. The service is provided in partnership with the Department of
Pediatric Neurology.
Based on an
updated version of an 80-year-old therapy, the ketogenic diet has proven
effective for many children whose seizures are poorly controlled by medication.
A ketogenic diet can also help children who have significant problems with the
side effects of seizure medications.
This diet is
high in fat, low in carbohydrates, and adequate in protein. A child who follows
it will burn fat for energy, rather than carbohydrates. When fats are burned,
the body produces chemicals called ketones. For reasons we don’t entirely
understand, ketones help prevent or lessen seizures.
Treatment in
our Ketogenic Diet Service begins with a 3- to 5-day hospitalization at CDD. A
parent or other caregiver accompanies the child, and stays in the same room as
their youngster. In addition to CDD professionals, the child will see staff
from Pediatric Neurology at the Children’s Hospital of Iowa. After the child
returns home, we provide follow-up and support through outpatient visits and
phone calls.
If you would
like to know more about the CDD Ketogenic Diet Service, contact:
Cheryl Stimson
319-356-1414
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Questions? Comments? Suggestions?
Knowing where to
FIND the answers
These days the
important thing is not to KNOW all the answers (impossible!) but to know where
to FIND the answers. Did you know that CDD also offers a variety of free
resources that can help you find the information you want? These include:
CDD Disability Resource Library
800-272-7713
www.medicine.uiowa.edu/cdd/drl/
Free to folks
with disabilities and their families. You can check out materials in person, by
phone, or by e-mail. Browsing the virtual shelves at their web site, you’ll find books, videos, software, and
other materials. Or call to speak with the DRL librarian.
CDD Web Site
The place to
go if you want to know more about CDD services, to find a map that will get you
to our front door, or to read up on selecting a wheelchair (among many other
topics!).
Iowa COMPASS
800-779-2001
www.medicine.uiowa.edu/iowacompass/
COMPASS information
specialists can give you detailed information about 6,000 local Iowa services,
answer your questions on assistive technology, and direct you to a wide range
of funding resources.
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The role of the information in this newsletter is not to
provide diagnosis or treatment of any illness or condition. We strongly
encourage you to discuss the information you find here with your health care
and other service providers.
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CenterLines, the newsletter of the Center for
Disabilities and Development at the University of Iowa Hospitals and Clinics,
is published three times a year. It provides families with current information
on child and adult development, issues affecting people with disabilities, and
CDD resources available to them and their families. The newsletter is available
in print, and also online at http://www.uihealthcare.com/cdd
and then click on Centerlines for Families.
Newsletter
staff
Editors
Susan
Eberly
Elayne
Sexsmith
Graphics
editor
Lori
Popp
Editorial
board
Joni
Bosch
Barbara
Nidey
For
correspondence relating to the newsletter, or to request permission to
reproduce information from it, please contact:
Barb Nidey
Center for Disabilities and Development
University of Iowa Hospitals and Clinics
100 Hawkins Drive
Iowa City, IA 52242-1011