Dietary fibre intake and constipation in children with severe developmental disabilities.

Objective: Constipation is a common problem in children with severe developmental disabilities (DD). This study aimed to evaluate fibre intake of severe DD children living in a residential institution, and the possibility of reducing the use of laxatives by increasing their fibre intake.
Methodology: A baseline study was performed to evaluate the fibre and macronutrient intake in a group of severe DD children. Nutrients including fibre for a standard serving in each meal were calculated and daily macronutrients and fibre intake were estimated. An intervention study was then carried out to evaluate whether increasing fibre intake could relieve constipation. A total of 20 children aged between 3 and 17 years were assessed over a 4-month period. In a residential unit for severe DD children, laxatives were routinely prescribed if there was no spontaneous bowel motion for two consecutive days. Fibre intake was increased in stages by adding All-Bran(R) (Kellogg Company, Battle Creek, MI, USA) and desserts. The mean number of laxative usage per week per child in the different stages were then compared.
Results: The baseline fibre intake was found to be approximately 2 g/day. The mean number of laxatives required per week per child decreased significantly from a baseline value of 1.22 (about 5 laxatives/month) (standard deviation (SD) = 0.36)) to 0.90 (about 3. 5 laxatives/month) (SD = 0.75) in the first stage, and 0.71 (about 3 laxatives/month) (SD = 0.40) in the second stage. Using paired t-test, the difference was statistically significant when compared with the baseline: P < 0.05 for the first, and P < 0.01 for the second stage of fibre supplementation.
Conclusion: Very low daily intake of fibre of 2 g/day was documented. Relief of constipation and a significant reduction in the usage of laxatives was demonstrated by increasing fibre intake to 17 g/day (stage 1). Increasing fibre intake further to 21 g/day (stage 2), showed a further reduction in the use of laxatives. There was, however, no statistical significance between stage 1 and stage 2 of fibre supplementation. Alternative ways to further relieve constipation in severe DD children require further studies.