Nutrition: A pediatric dietitian will analyze a child’s medical, feeding, and therapy history, past and current diet, and the child’s growth. This examination will uncover what efforts have worked well or have not worked well. Children who have chronic challenges with their boweland bladder tend to have diets that are not optimal, which contributes to how a child feels, learns, grows, sleeps, and interacts in their world. Diet is most often deemed the culprit of bowel issues, and lack of fiber or fluid is the go-to blame. Although these two areas do contribute to constipation, the dietician will closely examine all contributing factors.
Mental Health: A social worker will meet with the child’s caregiver(s) for a biopsychosocial assessment related to the child’s emotional development and history of bladder and bowel issues. Together we will explore how underlying factors, and possible stressors have impacted a child’s sense of safety to achieve this milestone. The social worker will also provide support to both the child and their caregiver(s) as the family navigates the clinic.
Speech-Language Pathology: is involved within the program to assess communication barriers to toileting independently and confidently. The speech-language pathologist (SLP) is an expert on the laryngeal mechanism that is responsible for building pressure and stability within the body to allow for passing bowel movements, as well as clearing debris from the airway and producing speech. The SLP will closely examine feeding and swallowing history and may make informed recommendations for comprehensive speech-language pathology services including oral-motor feeding, a consultation with an ENT or other providers.
Occupational Therapy: is focused on improving a person’s ability to complete daily activities and complete toileting effectively. The occupational therapist (OT) will consider the physical components of independent or assisted toileting (getting on/off the toilet, hygiene, managing clothing, as well as donning/doffing diapers/pull-ups, tolerating head position changes that occur during diaper changes, or management of adaptive devices such as catheters or ostomy bags). An OT will examine a child’s body awareness to better identify how different sensations from their environment impact them (either positively or negatively) and explore calming strategies to use should they become dysregulated. In this evaluation, the OT will assess how the child is managing these different skills, and if they are too aware or lack awareness of different sensations during toileting.
Physical Therapy: identifies and addresses motor components that may be contributing to bowel, bladder, and toileting difficulties. The physical therapist will examine a child's overall muscle tone (the amount of tension or resistance to force in the muscles), core strength, and the way they breathe to see if it supports or hinders their ability to eliminate. Balance, postural control, and alignment can impact how relaxed and confident a child is sitting on the toilet, which lends itself to easier elimination. Children who would benefit from biofeedback to address specific pelvic floor muscle issues, such as weakness, spasms, or the muscles not working together in the right way, will be referred to a physical therapist specializing in pelvic floor dysfunction.
