Parental knowledge of fecal incontinence in children.

OBJECTIVES: Fecal incontinence (FI) is a common and stressful symptom of constipation in children. Recurrent FI causes psychological and physiological changes, complicating treatment as symptom duration progresses; however, parental misconceptions about the causes of FI may delay seeking medical care. The aim of the present study was to assess parental knowledge about FI and determine how this relates to the care and treatment of FI. METHODS: A questionnaire was developed from qualitative interviews and clinician input. The questionnaire was administered to 251 parents and tested for reliability and validity. Subscales were compared between parents who did and did not consult a clinician. In addition, 30 parents completed the questionnaire before and after consultation with a pediatric gastroenterologist and after 2 months of treatment. RESULTS: Two subscales were identified with good psychometric properties: "Blame and Punish" and "Worry and Help." Families who consulted a physician for their child's FI acknowledged the role of constipation and scored higher on Worry and Help (mean 36.4 vs mean 46.9; P < 0.0001). Trends were found for Blame and Punish to decrease after consultation with a pediatric gastroenterologist (mean 1.7 vs 1.5; P = 0.08) and after 2 months of treatment (mean 1.5; P = 0.08). CONCLUSIONS: Parental knowledge about FI changes with physician consultation. These findings can help in developing educational materials for parents to encourage early diagnosis and treatment and prevent chronic problems that are difficult to manage.

Audio-recorded guided imagery treatment reduces functional abdominal pain in children: a pilot study.

OBJECTIVE: This study was designed to develop and to test a home-based, guided imagery treatment protocol, using audio and video recordings, that is easy for health care professionals and patients to use, is inexpensive, and is applicable to a wide range of health care settings. METHODS: Thirty-four children, 6 to 15 years of age, with a physician diagnosis of functional abdominal pain were assigned randomly to receive 2 months of standard medical care with or without home-based, guided imagery treatment. Children who received only standard medical care initially received guided imagery treatment after 2 months. Children were monitored for 6 months after completion of guided imagery treatment. RESULTS: All treatment materials were reported to be self-explanatory, enjoyable, and easy to understand and to use. The compliance rate was 98.5%. In an intention-to-treat analysis, 63.1% of children in the guided imagery treatment group were treatment responders, compared with 26.7% in the standard medical care-only group (P = .03; number needed to treat: 3). Per-protocol analysis showed similar results (73.3% vs 28.6% responders). When the children in the standard medical care group also received guided imagery treatment, 61.5% became treatment responders. Treatment effects were maintained for 6 months (62.5% responders). CONCLUSION: Guided imagery treatment plus medical care was superior to standard medical care only for the treatment of abdominal pain, and treatment effects were sustained over a long period.