Constipation is a very frequent issue. This seems to be due to a combination of factors. Contributing to this is a decrease in actual physical movements of the body with less crawling, rolling, walking and moving around in general. Decrease in liquid intake is a frequent contributor whether due to incoordination of swallowing, inability to ask for a drink, inability to get a drink for one's self or even to a conscious desire to minimize drinking so that there would be less need to urinate. There may be changes in the musculature involved in the gastrointestinal tract.
Several steps may be useful for intervening in bowel problems. First, having satisfactory intake of water and juice can sometimes take care of this problem. Sometimes, this is by mouth and sometimes this is from a feeding tube. Also increasing fiber intake by trying to have cereals, fruits, vegetables and grains in the diet can improve bowel movement. Classically, prunes or prune juice can also be of value. Each family will usually find what works for their particular situation and hopefully it will be something that is enjoyable to eat or drink as well. If this cannot be improved by juices, sometimes lying on the left side with the knees curled up towards the body can be a useful position to help the bowels empty.
Medications are frequently used for this as well, including Colace as a softener. Senna is used as a bowel stimulant, which is relatively gentle. Dulcolax tablets or Miralax can be used as more vigorous bowel stimulants. The use of a pediatric glycerin suppository may also be effective intermittently. The occasional use of an enema may be required and effective but should not be used on a frequent basis for small children due to potential electrolyte disturbances. When working on a bowel program, it is useful to remember that babies frequently have a bowel movement after they feed. This is due to the gastrocolic reflex.
This reflex is useful in trying to set up a good bowel program in almost anyone. This means that it is easier to train the body to have a bowel movement right after one has a meal and it is important to choose the same meal at about the same time every day (or every other day). Families frequently use a bowel program where they have the child sit on the potty chair approximately 30 minutes after the evening meal to try to have a bowel movement at that time. Having a child blow bubbles or a similar activity results in a Valsalva maneuver, which tightens the abdominal musculature and is useful in having a bowel movement?
Sleep Disturbance
Sleep disturbances are also commonly reported in children with cerebral palsy. To deal with this problem, first we attempt to have the family eliminate any sources of irritation at bedtime, trying to make sure there is no source of pain such as ill-fitting night braces, problems with muscle spasms that interfere with sleep or severe constipation. Then aim to have a regular sleep routine, including a regular bedtime, having the room quiet and dark at night, having the room bright in the morning upon awakening and minimizing exciting stimuli shortly before bedtime. Sometimes melatonin supplements are used as a natural sleep aide.
