An Increased Incidence of Constipation-related ED Visits for Children With Autism

PediatricsOnline 

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Emergency Department visits by children with autism are more likely to be due to constipation than ED visits for those without autism, and these visits are more likely to result in the child with autism to be admitted to the hospital.

The risk of children with autism spectrum disorder developing constipation-related concerns is well known, but the Autism GI Clinic at Nationwide Children’s Hospital was noticing that many of its constipation patients were being referred after an Emergency Department visit – the symptoms were so severe that immediate intervention was needed.

Recent research from the clinic leader and his colleagues shows that the rest of the country is seeing the same issue.

The study, published in The Journal of Pediatrics, found that ED visits across the United States by children with autism were twice as likely to be constipation-related as those by children with no chronic condition, and 3x as likely to be constipation-related as those by children with other chronic conditions.

It also found that children with autism who visited the ED for constipation were significantly more likely to be admitted than children in the other groups, suggesting their symptoms were more severe or more difficult to treat as an outpatient.

“Parents of children with autism may not know their child is experiencing constipation before they end up in the ED,” says Kent Williams, MD, member of the Division of Gastroenterology at Nationwide Children’s, lead physician in the Autism GI Clinic and senior author of the study. “Some children cannot communicate how they are feeling, and parents don’t understand that a child can have bowel movements every day and still be severely constipated.”

The study used the Nationwide Emergency Department Sample database to compare ED visits and hospitalizations among the patient groups. The authors also found increased constipation-related hospital costs for children with autism as a result of the increased visits.

The study highlights both the difficulty of treating constipation at home for these children and the necessity of improving ways of caring for their GI symptoms before the hospital, says Dr. Williams, who is also an assistant professor of Pediatrics at The Ohio State University College of Medicine.

Educating parents to recognize the signs of constipation in their children is important. Providers must also realize the challenges of adhering to constipation treatments for this population, says Dr. Williams. Children with autism often have a restricted diet and display behaviors that make administering medications and other therapies difficult. Fully addressing a child’s constipation may take time and shifting strategies.

“We have to realize that there is no one-size-fits all solution for these children,” Dr. Williams says.

Reference:

Sparks B, Cooper J, Hayes C, Williams K. Constipation in children with autism spectrum disorder associated with increased emergency department visits and inpatient admissions. The Journal of Pediatrics.  2018 Nov; 202:194-19