----------- PARENTS GUIDE TO COLON HEALTH FOR CHILDREN
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PARENTS GUIDE TO COLON HEALTH FOR CHILDREN

Contemporary Bowel Health Among Children and Teens

By Catherine Cavanaugh, R.N.

From my observations, the bowel habits of children today appear to be worse than at any time in the 20 years of my nursing career. Discussions with nurses whose experience predates my own reinforce this conclusion, and several recent pediatriac health care books mention this very same fact. In one excellent text Dr. Jack Schiller mentions that he frequently encounters children whose parents assure him that the child has regular daily bowel movements, but nevertheless he finds the child to be constipated.1 He attributes this to the fact that even though a movement may be taking place every day, only part of the days accumulation of waste is being passed, and the remainder gradually builds up and clogs the colon. This is known as cumulative constipation and is not just confined to youngsters. Many adults suffer from cumulative constipation. It's far more common than most people realize.

I have reviewed my records for the past 13 years and found that I have been called upon to remove nearly twice as many fecal impactions in children and teens in the last 5 years than in the previous 10 years combined. The reasons for this appear to be worsening dietary habits, lack of sufficient exercise, and inadequate parental supervision of bowel function, (often a result of poor advice from uninformed pediatricians and family medical doctors). I am also amazed at how many of the younger families today don't even own an enema bag!

Specifically, in my opinion the following are major contributors to the problem:

Regarding this last item, recent research, both published and ongoing along with my own personal observations and experiences over the years has convinced me of the importance of a bowel movement every day. Not 4 or 5 times a week, but at least one movement every single day. Recently the Presidential Commission on Physical Fitness published a report that emphasized the fact that the fitness trend of recent years has not yet reached our children. One observation made was that "...many parents are in better shape than their kids." It is impossible for the body to be in a fit condition when the colon is clogged with waste, and in far too many children today this is the sad condition in which they find themselves.

Importance of an Early Colon Health Program

For these reasons it is important that children are taught proper bowel habits at an early age. If the children will be home alone after school or during the summer, try not to have junk food around the house. Instead, keep plenty of fresh fruit and natural (unsugared) juices available.

What is clear from experience is that the younger the child is when a colon hygiene program is begun, the more readily it is accepted, and the more likely it will be continued when the child leaves home. One of my current areas of interest is in expanding the role of colon hydrotherapy in pediatric health care. As I mention in my paper, Keep Your Colon Healthy my experience has convinced me that the colon health of our children has steadily deteriorated during the last two decades. Apparently I am not the only health care professional who has noticed this trend.

A recent book on child health care mentions that constipation in children has become a more serious problem during the past decade, but it is apparent from the conclusion drawn that the author only got it half right. She concludes that poor nutritional habits by todays youth are responsible for the increased number of constipated children "...despite the evident relaxation of mothers about the timing and pace of toilet training..." I agree that poor nutritional habits account for part of the decline in bowel health that has been widely observed in children today, however it is precisely the relaxation of parental discipline regarding the importance of their childs bowels moving daily that is also a major contributing factor. Perhaps not exactly during the toilet training phase, but afterwards during the childhood years when mothers have been told by their pediatricians not to worry about their children not having daily movements.

In commenting on the importance of the parents role in insuring that their that their children develop regular bowel habits, and the impact of the health of the colon on the rest of the body's organs, Dr. Norman Walker, on page 26 of his book Colon Health states that "Beginning in childhood, and through adolescence, discipline, (or lack of it) is greatly responsible for it's condition". My experience over the last decade has convinced me that this lack of emphasis on the part of the parents in insuring that their children develop regular bowel habits is a major contributor to the overall poor physical condition of kids today.

When I was growing up, an enema bag was practically a standard fixture, hanging on the back of the bathroom door in most families homes. My mother was no different from other mothers of that day, and she gave all of us enemas more frequently than we cared for, and there were many occasions when I questioned why I had to have one. Today as a registered nurse I realize that mom was right. I became convinced of the benefits of enemas during my training as a student nurse. Our instructors emphasized the many advantages that enemas provided and mentioned that we would often be instructed to administer enemas to patients who were not constipated. They explained that for many reasons enemas seemed to stimulate and accelerate the body's natural healing mechanisms. With my own children, since infancy, I have followed the practice my mother established with our family: a routine cleansing enema every week or two whether it appeared they needed it or not. I can't count the number of times they would grumble that they didn't need an enema because they had gone every day, only to find large amounts of stool evacuated in the return.

Parents should carefully monitor the childs bowel movements and be prepared to intercede whenever necessary. If you are unsure whether the childs bowels are moving regularly and adequately, you will be able to get some indication by observing the return from periodic cleansing enemas. Also, by gently pressing your fingers around the childs abdominal area you can usually feel if the bowel is distended with stool. It may take some practice to accurately estimate the degree of bowel fullness, but performing this check just before and after the childs enema, and observing the amount of stool evacuated, will help you to more accurately estimate in the future.

In my opinion, parents who know their child needs help in moving their bowels but avoid giving them an enema because they complain or refuse to cooperate, are doing a disservice to the child. No child likes an enema, and children always have an excuse why they don't need one. The movement will always be coming "tomorrow". Parents often take the easy way out and give the child a laxative, a suppository, or a Fleets enema, even though laxatives have been proven to cause long range harm and become habit forming, suppositories are frequently ineffective and cause rectal irritation, and Fleets enemas seldom produce adequate results, and often cause severe cramping, discomfort, irritation of the bowel, and rapid excessive fluid loss.

Often, when I am called upon to help relieve a childs blocked bowels, the parents explain that they were going to give the child an enema several days ago, but he or she put up such a fuss that they felt that it wasn't worth it. When you know you are right, and that what you are going to do will be of direct and lasting benefit to the child, you should be gentle, but decisive and firm, and make it clear to the child that no matter how much they fuss "we are just going to do it".

Colon Hydrotherapy for Children

Children whose parents start them out with regular bowel cleansing at an early age are more likely to stay with the program throughout life than those who are introduced to the program in teen years or later. The age at which children are accepted for colonics varies. Some clinics specialize in pediatric colonics and take children as early as three years old. More often, five to eight is the preferred starting age. Regardless of the age at which professional colonics are begun, the parents can begin the routine of regular bowel cleansing using enemas at home for the young child. This way the youngster grows up accepting occasional bowel cleansing as part of the normal routine.

My children each received their first colonic at about 8 years of age. My oldest was extremely reluctant to go in the first time, but after that readily cooperated. My youngest, who is now 12, had her first one 4 years ago and accepted it without the slightest hesitation or complaint. She had accompanied me on many occasions since she was 3 years old when I went in for a colonic, and I believe her familiarity with the procedure was responsible for her easy acceptance. With what I know today, I would have even started them at a much younger age. Using special pediatriac attachments I have given colonics to 4 year olds who have responded beautifully to them.

In recent years my idea of the desirable frequency of colonics has also changed such that whereas I used to try and get my children in 3 or 4 times a year, now that I am giving colonics myself, I try to make that as close to once a month as possible. With the oldest two being away at college this is difficult, but I make sure that whenever they come home for holidays and semester breaks that by the time they are ready to go back to school they are well cleaned out. Also, whenever anybody appears lethargic, or seem to be coming down with some bug, or their bowels seem to be sluggish, I encourage them to let me give them a colonic and it usually helps.

I firmly believe that colon hydrotherapy can play a role in the following areas of children's health care:

Giving an Enema to a Child

It is important that the parents be especially gentle when administering enemas to the child as to not make it an unduly unpleasant experience. You will get far better results if you can gain the childs cooperation first. Take the time to explain exactly what you are going to do and why you have to do it.

Explain to the child that they will probably feel that they have to get up and go to the toilet almost immediately, but they have to wait until the enema does it's work. Be honest in admitting that there may be some discomfort and their tummy might hurt a little during the enema, but it will only be for a few minutes, and they will feel a lot better afterwards.

I have had a great deal of experience dealing with bowel problems in children, patients as well as my own four girls. When I am called upon to give an enema to a child I usually try to put him or her at ease by describing to them how I will be giving them a gentle internal bath. I tell them I will stop the flow whenever they tell me to. This way the children feel they have some sort of control over the procedure. When they experience discomfort I stop the flow, and after a bit, when the immediate discomfort has subsided, resume after giving them a few moments warning ahead of time. I have found this to be an proven technique that allows a sufficient volume of solution to be comfortably introduced and produces excellent results.

The recommended amounts of solution for a childs enema are much less than for an adult. The size and weight of a person influences how much they can take without experiencing excessive discomfort. Unless otherwise specified, a safe general rule of thumb used in the hospital is approximately one ounce of solution for every two to three pounds of body weight. Using this guideline the following amounts would be indicated:

Approximate weight (lbs)   Enema Volume
       25                 8 to 12 ounces
       50                 1 to 1 1/2 pints
       75                 1 1/2 to 2 pints
      100                 1 to 1 1/2 quarts

For weights in between those values in the table, use an amount of solution that falls in between the weight range values.

If the child will cooperate, the enema is administered in the same manner as with an adult. (Detailed instructions for adults are included in my paper Keep Your Colon Healthy. Send me a note or postcard for a free copy). With an uncooperative child it is often a very difficult task, and may require the assistance of a spouse, other family member, or a friend to help hold the child in place. If the uncooperative youngster is small enough to control, but old enough to use the toilet, and you must proceed alone, then I have found the following procedure effective:

  1. Prepare the enema solution and suspend the bag on a strong cord from the shower curtain rod in the bathroom. The bottom of the bag should be about 18 inches above the level of the childs rectum when lying on your lap.

  2. Lubricate the first 3 inches of the rectal tube with Vaseline, K-Y Jelly or cold cream, and keep the container close by to use again shortly.

  3. Allow a little solution to flow to remove air from the tubing, and then loop the tubing over the bag to hold it there in order to free your hands.

  4. Sit on the side of the bathtub, or the closed toilet seat if it is close enough to the tub. Spread your legs and lay the child over your left knee. (assuming you are right handed; if not, reverse right and left as presented here) Clamp your right knee against the back of the childs legs holding them secure.

  5. Using your left hand spread the buttocks, and with your right forefinger lubricate the childs anus and rectal area thoroughly. This will make insertion easier and more comfortable. Now, with your left hand still spreading the buttocks, use your right hand and gently insert the rectal tube 2 to 3 inches into the rectum.

  6. Open the shutoff and allow the solution to flow.

  7. Use your left hand to help control the child if he or she squirms, the right hand to keep the rectal tube from slipping out, and your legs and knees to keep the child in place.

  8. Tell the child you will temporarily stop the flow if he or she experiences cramping. Encourage the child to let you know when this occurs and clamp the shutoff for a minute or so to allow the peristalitic reflex to naturally help distribute the solution to the upper areas of the colon. The sharp pangs of discomfort that sometimes accompany an enema shouldn't be confused with the natural feeling of fullness that occurs as the enema proceeds toward completion. The only way to reduce discomfort from this inevitable consequence is to proceed slowly and and not be impatient to "hurry up and get it over with".

  9. When the bag is empty, carefully withdraw the tubing, press a towel against the the anus and squeeze the buttocks together to encourage retention of the solution. If possible, try and encourage the child to retain the enema for 3 to 5 minutes or so, but if the child appears to be suffering excessive discomfort, allow him or her to expell the enema before that.

Administering an Enema to a Small Infant

For an infant the best type of enema unit is the old fashioned bulb syringe. Typically an infant syringe holds 4 ounces.

  1. Prepare the solution by stirring a bar of Ivory soap in a bowl of warm water (103 degrees F measured with a baby bath thermometer), and fill the syringe by squeezing the bulb, putting the tip in the water, and then releasing the pressure on the bulb, allowing it to fill.

  2. Lubricate the rectal tip generously.

  3. Have the baby lay on his or her back on the bed with a diaper underneath, or across your knee, whichever seems easier.

  4. Using your forefinger, lubricate the babys anal area to make insertion easier.

  5. Hold the bulb with the rectal nozzle pointed straight up and slowly squeeze it until a few drops of water come out. Don't release the pressure on the bulb. This purges any remaining air in the bulb.

  6. Slowly insert the rectal tip into the rectum. Rotating the tip back and forth makes it slip in easier.

  7. Gently, but firmly, squeeze the bulb, causing the solution to be introduced into the rectum.

  8. When all the solution has been introduced, slowly remove the rectal tip, taking care not to release pressure on the bulb.

  9. Depending on the size of the infant you may want to try and give another 4 ounces of solution.

  10. Clamp the buttocks together for a few minutes to encourage retention of the solution.

  11. Allow the baby to expel the enema onto the diaper.

  12. Occasionally, especially if the baby is severly constipated, no solution will be expelled. This is no cause for alarm. It means that the dried, hardened stool has absorbed all the solution. Simply wait a while and repeat the enema.

Follow-up Program

Finally, parents should prepare the child for the time when they will be leaving home so they can continue the program of preventive colon care on their own. Instruction should be provided in the technique of giving an enema to oneself and the child should be given a personal enema bag. Before my oldest daughter left home for college a few years ago I made sure she knew how to confidently give herself an enema. I packed several disposable enema bags like we use in the hospital when she left for school, but I also had our family physician arrange with the University Health Center to allow her to walk in and be given a cleansing enema if that would be more convenient.

At that time I had not yet begun giving colonics myself, and during term breaks, when she came home to visit, I had made appointments in advance for her to receive colonics, which as it turned out, were definitely needed. The fast pace at college with new eating habits, long study hours, and weekend parties, caused enough of a change in normal elimination to make bowel cleansing more important than ever. I know she appreciated my concern, and although she insisted that I was making an unnecessary fuss about her, I was confident that each time she returned to school she was well prepared physically to again face the rigors of college life. Today, with the experience I have gained over the past several years, I could not be more convinced that colon hydrotherapy is one of the best tools available to rejuvenate the body as well as the mind. Colonics make you feel good all over, and when you feel good physically it is amazing how much better your mind works at just about any mental activity.

You really just have to commit yourself to it and be determined to stick with colon health maintenance on a regular basis. It is so easy to become complacent and put things off like the enema you know you or a family member needs because it is so inconvenient, or because the child insists they don't need it, or the colonic appointment that is surely guaranteed to conflict with some other important event unforseen at the time you made it. Nevertheless, I can speak with experience when I say that the slight inconvenience often experienced when you follow through with them is more than made up by the benefits that colon cleansing provides. You owe it to yourself and your children to insure that they have every benefit that modern health care can provide, and a regular program of home cleansing enemas, combined with professionally administered colonics, can provide them with the base for a solid foundation of personal health care that will benefit them for a lifetime.

From my personal experience over the years, and what I have learned through my education and from others, the old fashioned enema bag and bulb syringe are the most valuable natural health care accessories a family can have in the home.

1. Childhood Illness, page 123 by Jack G. Schiller M.D., Day Books, 1982.