JPED Journal

Perspective

According to ESPGHAN, polyethylene glycol with electrolytes (PEG) is generally the recommended laxative for bowel cleansing prior to colonoscopy in children owingto cleansing quality and safety [1].Children with variousgastrointestinal disorders such as Inflammatory Bowel Disease (IBD)undergo colonoscopy as thestandard examination of the bowel as a diagnostic and therapeutic tool. A colonoscopy can only be performed if the bowel is clean, however it has been seen that bowel cleansing is the most difficult part of the procedure prior to colonoscopy[2, 3, 4-7]. The whole procedure consists of several elements, for example, diet regime before bowel cleansing, blood tests, laxative intake andanesthesia. However, children and their parents reported that bowel cleansing was the mostwearisome[3,4].Despite the availability of various laxatives, the ideal bowel preparation regimen for pediatric colonoscopy remains elusive because few randomized controlled studies in children have been published[5]. Prescription of PEG in children is based on Millar et al.[6] and mayentail a large volume of PEG, which previous studies have reported is difficult to intake as children perceive it to have a bad taste [3,7].  The intake of PEG can beoral or via a nasopharynx tube, however previous studies showed that children did not accept the tube as a possible solution[3]. They often chose oral laxative intake, which in several cases was experienced as stressfulby children. In most of cases the child cannot drink the prescribed volume and in-patient administration through a nasogastric tube is often required [3]. Earlier studies showed that children need to feel involved in decision-making about their care for better care, thus the possibility to choose may contribute to children feeling that they make their own decisions[8]. However, it may be difficult for children to perceive a tube as apositive option to choose without knowledge of difficulties with the oral intake.The study about children´s experiences prior to colonoscopy shows that they reported difficulties with oral intake of PEG and see tube administration as a bad option[3]. However, the most of children mast accept the tube when orally intake is not successful. It has been shown that oral intake is a difficulty process that has a negative effect on the child and therefore the tube may be preferable primarily.Introducing the tube earlier during the process and in a way which is adapted to children may possibly help to minimize the negative experience of bowel cleansing in children.

To help children properly, we need to listento them and use their perspective to develop the procedure.In study by Vejzovic et al.[3] the children preferred orally intake without knowledge about these difficulties as may be reason to not choose tube as first alternative. 

In this case it is perhaps the right time for us to consider the child’s perspective which is based on children’s own experiences. We do not yet have an ideal bowel cleansing procedure for children entailing a good cleansing quality which is safe, acceptable and tolerable by children. While we are waiting for new study results with other better options for bowel cleansing in children, we need to invest in using current results based on children´s perspective for children.The tube insertion is also one medicine procedure which can experiences negative but with propriety individually introduction can in that case maybe alternative that mean less stress for the child.

1.       ESPGHAN/NSPGHAN, European Society for Paediatric Gastroenterology, Hepatology and Nutrition, and North American Society for Pediatric Gastroenterology, Hepatology and Nutrition(2007) Differentiating Ulcerative Colitis from Crohn’s Disease in Children and Young Adults: Report of a Working Group of the North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition and the Crohn’s and Colitis Foundation of America. Journal of Pediatric Gastroenterology and Nutrition 44: 653-674.

2.       Turner D, Levine A,Weiss B, Hirsh A, Shamir R, et al. (2010) Evidence-based recommendations for bowel cleansing before colonoscopy in children: a report from a national working group. Endoscopy 42:1063-70.

3.       Vejzovic V, Wennick A, Idvall E, Bramhagen A C (2015) A private affair: children’s experiences prior to colonoscopy. Journal of Clinical Nursing 24: 1038-1047.

4.       Vejzovic V, Bramhagen A C, Idvall E,Wennick A (2015) Parents’ experiences when their child is undergoing an elective colonoscopy. Journal for Specialists in Paediatric Nursing 20: 123-130.

5.       Mathus-Vliegen E, Pellisé M, Heresbach D, Fischbach W, Dixon T, et al. (2013) Consensus guidelines for the use of bowel preparation prior to colonic diagnostic procedures: colonoscopy and small bowel video capsule endoscopy. Current Medical Research and Opinion 29: 931-945.

6.       Millar A J W, Rode H, Buchler I, Cywes S (1988) Whole-gut lavage in children using an isoosmolar solution containing polyethelene glycol (golytely). Journal of Pediatric Surgery 23: 822-824.

7.       Vejzovic V, Wennick A, Idvall E, Agardh D, Bramhagen A C (2015) Polyethylene Glycol- or Sodium Picosulphate-Based Laxatives before Colonoscopy in Children. Journal of Pediatric Gastroenterology and Nutrition 62: 414-419.

8.       Coyne I and Gallagher P (2011) Participation in communication and decision-making: children and young people’s experiences in a hospital setting. Journal of Clinical Nursing 20: 2334-2343.