Changing to Carnation Good Start formula may be helpful with constipation. Limit milk if excessive by history. Avoid hypotonic and phosphate enemas, which can cause electrolyte abnormalities and seizures. Usually starts as a functional voluntary withholding but progresses to decreased urge to defecate because of rectal enlargement and loss of sensation of full rectum. Counseling of patient and parents on cause of soiling.
Outline plan to help patient resolve problem.
Clear rectum of impaction before starting treatment. Continue treatment for 2 to 6 months while rectal size and sensation return to normal. When decreasing dose of laxative start toilet-sitting regimen, that is, sitting for 15 minutes after each meal. Consider reward system appropriate to age. Implement dietary changes as above.