Outpatient Specialty Care Clinical Pathway for Evaluation/Management
of Neurogenic Bowel Dysfunction in Children with Spina Bifida
- Related Pathway
- Myelomeningocele/Myeloschisis, Neonatal, ICU
- Frontline 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
Age | 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 parent/child to call with any changes in bowel function
Posted: December 2019
Revised: October 2022
Authors: J. Kerr, DNP; M. Magnusson, MD; D. D'Amico, RN; S. Zderic, MD; M. Allukian, MD; D. Nicholson, MD; J. Webster DO
Revised: October 2022
Authors: J. Kerr, DNP; M. Magnusson, MD; D. D'Amico, RN; S. Zderic, MD; M. Allukian, MD; D. Nicholson, MD; J. Webster DO