Outpatient Specialty Care Clinical Pathway for Evaluation/Management
of Neurogenic Bowel Dysfunction in Children with Spina Bifida
- Related Pathway
- Myelomeningocele/Myeloschisis, Neonatal Clinical Pathway — ICU
- Front-Line Ordering Clinician (FLOC)/
RN Team Assessment - History and Physical Exam
- Bowel Consistency, Bristol Stool Scale (BSS)
- Diet: Fiber and Fluids
- Toileting
- Review current bowel program and assess adherence
- Differential Diagnosis
- Indications for Imaging Studies
- Goals of Bowel Management Plan
- Infants > 6 months/Toddlers BSS 3 - 6
- Children/Adolescents < 1 accident/month
- Considerations for Promoting Independence
Symptoms Consistent with Ineffective Bowel Management
Bowel Management Program and Escalation Plan
Assure
- Optimal fiber and fluids before escalation of treatment
- Avoidance of Trigger Foods
- Adherence to current program, Tips
Medication Escalation Plan | Comments/Considerations | |
---|---|---|
Infants > 6 Months/ Toddlers |
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Children/Adolescents |
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Surgical Alternatives | Comments/Considerations | |
Children/Adolescents |
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Patient Education and Follow-Up Recommendations
- Discharge Education, AVS
- 0-1 year of age Every 3 months
- 1-5 years of age Every 6 months
- 5 years of age/older Every Year
- Encourage patients to call with any changes in bowel function
Posted: December 2019
Revised: February 2021
Authors: J. Kerr DNP; M. Magnusson MD; D. D'Amico, RN; J. Melchionni RN; S. Zderic MD; M. Allukian MD; J. Webster DO; S. Borowicz RD
Revised: February 2021
Authors: J. Kerr DNP; M. Magnusson MD; D. D'Amico, RN; J. Melchionni RN; S. Zderic MD; M. Allukian MD; J. Webster DO; S. Borowicz RD
Evidence
- Spina Bifida Causes, Symptoms and Treatment
- Fetal Surgery for Spina Bifida (Myelomeningocele)
- Guidelines for Care of People with Spina Bifida
- Using a Decision Tree to Guide Bowel Management in Spina Bifida
- Outcomes and Satisfaction in Pediatric Patients with Chait Cecostomy Tubes
CHOP Programs