To the Editor:

The pediatric spine population presents a challenge to compliance with a bowel regimen to prevent constipation, a common occurrence to the hospital course as discussed in "Comparison of Two Postoperative Bowel Regimens in Children with Scoliosis Repair" (Orthopaedic Nursing, 35(1), Jan/Feb 2016).

Each hospital tends to have its own bowel regimen based on positive outcomes. At Hospital for Special Surgery, preoperative regimens are reserved for those with baseline constipation issues.

As a postoperative bowel regimen, the study used polyethylene glycol 3350 (Miralax), 17 g in 8 oz of fluid. We find that reconstituting it in 4 oz of juice (as the powder can sometimes absorb a plastic-like flavor from the single-dose packet) increases compliance. Ducosate sodium (Colace) capsules as an adjunctive medication is also administered. However, we avoid ducosate suspension due to its unpleasant flavor, which sometimes elicits vomiting.

If the regimen is not effective, we administer a double or triple dose of polyethylene glycol (based on the child's weight). As a final resort, a bisacodyl suppository, which increases peristalsis, is given after persuasion, which reliably produces a bowel movement. We find that a glycerin suppository, a lubricant, has little benefit.

Sincerely,

Richard J. Slote, RN, MS, ONC, RNC

Hospital for Special Surgery, New York,

N.Y.

535 East 70th Street

New York, N.Y. 10021

e-mail: [email protected]