Dietary changes. Dietary modifications used as a part of the treatment. Increasing water and fiber intake by offering granola bars. dried fruits, whole-grain cereals, and fresh vegetables with low-fat dip d make it easier to pass. Decrea can increase the bulk in stool an sugar and milk intake also helps keep stools soft. It may be advised tosupplement with fat-soluble vitamins when minera oil is being used because the oil can theoretically interfere with vitamin absorption in the small intestine. Changing the Retention Habit. To help reestablish a normal bowel habit, the child should sit on the toilet for 5 to 10 minutes after break- st and dinner. This routine will allow the normal gastrocolic reflex to assist with defecation and will climinate the need to be involved with retraining during school hours. Star charts and small prizes may be helpful in rewarding success. These interventions are continued for at least 3 to 6 month, during which the rectum will resume its normal size and the child will relearn to attend to the defecation reflec If fecal impaction occurs at any time, enemas are again administered and the dosage of mineral oil is adjusted.
Emotional Support. The child and parents are encouraged to express their feelings of success and failure with the ongoing program. To minimize the damage to the child's self esteem, the nurse encourages self-care as much as possible. To decrease embarrassment, school-age children should have a complete change of pants and underwear at school if leakage occurs. Age-appropriate support groups may be avail- able in a center with a large patient population or encopresis dinic Though teaching is a major intervention. encouraging the child and Parents to share feelings of embarrassment and other concerns is equally important. The child is provided developmentally appropriate anatomic information to assist with understanding the cause of the problem. Drawings and books may be effective ways to begin providing information and prompting the child to share feelings. Relieving the child of shame and embarrassment may improve cooperation with the plan of care