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Running head: Pseudo-obstruction Motility Disorder

Pseudo-obstruction Motility Disorder


Lauren Ham
University of North Texas

Pseudo-Obstruction Motility Disorder (CIP) is a gastrointestinal disorder that affects the


muscle that contracts your GI tract to allow food to pass through (Chronic Intestinal PseudoObstruction, 2012). This process is called peristalsis and it propels food through you digestive
system. Your hormones, pacemakers, and nerves control this. Children who have pseudoobstruction motility disorder are not able to digest food because the nervous system is not able to
communicate with the digestive system. So these children are not able to digest their food
properly. This chronic illness does not have any cure, and children have to live with this for the
rest of their lives. Children who have this chronic illness have many hospital visits, and child life
specialists are there to help them through this stay. Throughout this paper we will find out more
about pseudo-obstruction motility disorder and how the child life specialist can intervene and
help these children and their families.

Pseudo-obstruction Motility Disorder

Many children who have CIP show signs of mechanical obstruction, which is a blockage
from a tumor, scar tissue, etc. that is blocking the passage of food through the GI tract. When
these children come to the hospital the Dr. want to have surgery right away to relieve this
blockage from their digestive system. When the Dr. goes in to remove the blockage they end up
finding nothing wrong with the digestive system. (Intestinal Pseudo-Obstruction, 2014)
There are two different types of CIP that children can have and that is either visceral
myopathy or visceral neuropathic. In the visceral myopathy is when the contractions of the
digestive system are weak or absent and arising from the muscles. The visceral neuropathy is
when the contractions are unsynchronized and is arising from the nerves. (Intestinal PseudoObstruction, 2014). Around half of the cases of CIP are from neurologic, autoimmune, Para
neoplastic, metabolic, or from infectious diseases. (Camilleri, 2013). CIP is usually congenital
and present at birth, but other times it can be acquired from an illness or injury to the smooth
muscle (Intestinal Pseudoobstruction, n.d.).
Symptoms of CIP vary among children and their severity of the illness but the most
common are nausea, vomiting, abdominal pain, and constipation. Some other symptoms that
children have are diarrhea, food aversion, weight loss, and they become very full early on in their
eating (Chronic Intestinal Pseudo-obstruction, n.d.). Most children have severe weight loss,
because their nutritional needs cannot be met which leads to malnourishment.
There is not a single lab test that will diagnose CIP, so there are many tests that have to be
run to find out the exact diagnoses. Pseudo-obstruction motility disorder is diagnosed when the
symptoms match the illness, the tests shows a mechanical obstruction, and there are clinical
findings of the illness. Before the doctors diagnose the patient they will run x-rays, look at the
medical history, and do a physical exam to see if there is any blockage in their digestive system.
Other tests that are run are the manometry, which is used to measure the pressure and patterns of
the digestive system (Intestinal Pseudo-Obstruction, 2014). This is used to help confirm the

Pseudo-obstruction Motility Disorder

diagnoses and measure how severe the chronic illness is. This test will also help determine what
kind of treatment the child should have to go through.
Children who have pseudo-obstruction motility disorder are not able to digest food so this
makes it hard for them to get the nutrients that they need to survive. So the most important
treatment for this illness is to make sure that children are getting the proper nutrients that they
need to survive. Children are also on antibiotics to prevent them from getting bacterial infections
so they have to watch how the antibiotics will affect the child. Some children are able to eat
small meals very frequently throughout the day, but others are not able to eat at all due to the
pain from eating. For the children who are not able to eat, there is nutritional support that can be
provided to help the children with a liquid diet that is placed in the intestines or stomach. Using a
NG-tube can be one way for the child to receive the liquid diet. This is placed into the nose and
down to the stomach (Intestinal Pseudo-Obstruction, 2014). Another way is using a
gastrostomy (G-tube) in which the liquid diet if fed and through a tube that is placed directly into
the stomach. If neither of these work than a parenteral nutrition will be used for the child to get
the nutrients that they need. Placing a catheter in a vein and slowly placing the nutrients through
veins will help the child get the nutrients that they are not able to receive. (Intestinal PseudoObstruction, 2014).
Pseudo-obstruction motility disorder has many psychological aspects. Children with this
disorder have severe pain and sometimes are not able to get out of bed. So with them being in
bed or not able to leave their room they become very depressed. They also get very angry
because they dont understand why they have this illness and are not like the other children who
can run around and eat whatever they want. They also have very low self-esteem and body image
issues. This is because their stomach is distended from being malnourished. They also are
worried about what others think of them and having a feeding tube connected and a distended

Pseudo-obstruction Motility Disorder

stomach makes it hard for them to fit in. They are also very scared, because sometimes they have
to stay in the hospital for long periods of time and do not understand what is going on or what is
wrong with them. The physiological aspects of pseudo-obstruction motility disorder are they
have a short stature, distended stomach, are very thin, and could have possible brain damage
from being malnourished.
In the book Miracles From Heaven Annabel Beam was diagnosed with pseudoobstruction motility disorder, and found out it was a severe form of it to where she could not eat
or drink (Beam, 2015). Her CIP was so bad that she had to receive her nutrients through a PICC
line where it went straight through the blood stream. A hospital in Dallas sent her to a leading
expert who works specifically with children who have CIP, and he was able to give her a drug
called cisapride, which is a drug that increases the motility in the GI tract (Beam, 2015). This
drug would give her a somewhat normal life to where she could have some food and drink. This
is another kind of treatment that children can receive to give them a somewhat normal life.
Children who have this chronic illness are in and out of the hospital all the time due to
complications or infections. This is very hard on the child and family, and a child life specialist
can help reduce their anxiety. Pseudo-obstruction motility disorder also affects the child and
family emotionally and physically, so the child life specialist needs to know how she can
intervene and help these children through the different stages of their development.
Pesudo-obstruction motility disorder affects children emotionally. It affects every child
in a different way and every age will react to this chronic illness differently. It also affects the
family and siblings who are apart of the childs life. It is important to explain to parents and
siblings what is going on with the child in a developmentally appropriate way. Erik Erikson came
up with 5 stages of how children will react to their environment. These different stages can help
determine how each child would react to being in the hospital and how it will affect them

Pseudo-obstruction Motility Disorder

emotionally. (Thompson, 2009) It will also help the child life specialist figure out how he/she
can intervene and help this child through their chronic illness.
The first stage is trust vs. mistrust and this is children aged birth to one year old.
(Thompson, 2009) In this stage the baby was most likely born with this illness and has been
placed in the NICU for long term. In this stage Erikson says that they are separated from their
caregiver, the environment is unfamiliar and they are out of their routines. They also have so
many new people coming in and out of their lives such as different doctors, nurses, social
workers, etc. This makes it emotionally hard on the child, because they are not able to be with
their parents and form that attachment, and they also have anxiety from the different people
coming in and out of their lives. The child life specialist can help by making a routine for the
baby. They need to also make sure that the baby is able to form an attachment with the parents.
The child life specialist can help with this by talking with the parents and making sure they know
how important it is that they are here with their baby as much as possible and have that skin-toskin contact. This will help the parents feel that they are involved in this process and are able to
help the child as much as they can. When the parents are involved with the child, than this will
help reduce the anxiety and stress that the baby is feeling from being in the hospital.
The next stage is autonomy vs. doubt, which is from ages one to three years old. In this
stage children want to feel that they are in control and have autonomy. (Thompson, 2009) They
want to have self-control, and they are attached to their parents and do not want to be away from
them. A child at this age who has pseudo-obstruction motility disorder will have less autonomy,
no self-control, and will have separation anxiety, because some parents may have to work or be
away from the child for a little while. They will also be having severe abdomen pain and some
will not be able to eat. A child at this age will not understand why their stomach is hurting and
why they are not able to eat. It is important for the child life specialist to make sure that the child

Pseudo-obstruction Motility Disorder

has some control over their stay in the hospital and has that self-control. They will not have selfcontrol on how much they eat, so the child life specialist will have to teach them to take small
bites and control what they are eating. It is also important to include the parents in their stay and
to talk with them about how important it is for them to be at the hospital as much as possible to
reduce the separation anxiety that they may have. It is also important to explain to the parents
and siblings that the child cannot eat food most of the time so they need to make sure that the
siblings and parents are not bringing food and drink in that the child cannot eat. The child life
specialist also needs to provide normalization for this child, because they may not be used to
being in the hospital for long term. Some of these children will want to lay in bed and not play
because their stomachs hurt, but the child life specialist needs to get them up and playing to take
their mind of off their stomach hurting. The child life specialist can also have bedside care in
which they provide games, toys, and movies to help distract the child from their pain. It is also
important to include the siblings and parents in their play because that is what they are used to.
The next stage of development is initiative vs. guilt and the age range for this stage is
four to five years of age (Thompson, 2009). In this stage the child is egocentric and has magical
thinking. They also want to have control and independence. A child who has not had their illness
explained to them will start to have magical thinking and scare itself, because they will think it is
their fault and worse than it really is. This is when the child life specialist will intervene and
explain the illness in a developmentally appropriate way. They will also explain the different
procedures that they will have to go through. If they are getting an IV or a feeding tube the child
life specialist will explain it on a medical doll and let the child hold the doll and put the IV and
feeding tube on the doll. This will help reduce the anxiety that they feel and let them feel a sense
of control. The child life specialist can bring the siblings in with the child to play with the
medical dolls and feel like they are included in the stay and it will also help explain what is

Pseudo-obstruction Motility Disorder

going on with their sibling. In this stage it is also important for the parents to be involved as
much as possible. The child life specialist needs to explain how important it is for them to be
here at the hospital, and if they are not able to be here then they need to set up times to face time
or call the parents. In this stage the child might understand what their illness is if a child life
specialist explains it to them in a simple way like telling them their stomach is sick and that it
wont let food through so they have to have a tube that will place the food where it needs to go. At
this age the child will be frustrated that they cannot have food, so the child life specialist can
provide activities and play time for the child to distract him/her from thinking about food. It is
important for the child life specialist to talk with the child and explain why they cannot eat, and
to make sure that other children and families are not bringing food around the child. Some
children may be able to have small frequent meals, and so the child life specialist can intervene
and teach the child how to portion their food and to take small bites so that their stomach does
not hurt.
The stage industry vs. inferiority is from ages six to twelve years, and in this stage the
child is separated from their friends, family and school. (Thompson, 2009) They have concrete
literal thought which can lead to misunderstanding of their diagnoses. Having this diagnosis will
also make the child very depressed, because they will have to lie in their bed all day and not be
able to hang out with their friends and family. The child will have a better understanding of what
is going on with their body when a child life specialist explains it, and they will be better off to
follow the treatment so that they can get better and go home to their friends. The child life
specialist can intervene by explaining what their diagnosis is and all the procedures that they are
going to have to go through. They will not have to use baby talk with this age, but will still need
to explain their diagnoses appropriately. At this age friends and family are very important to this
child so it is important for the child life specialist to include the family and friends at the hospital

Pseudo-obstruction Motility Disorder

as much as they can. It is important for the child life specialist to explain what the illness is to the
siblings and friends so they can understand what is going on with their friend/sibling. This can
help the friends and family support the child more and not bring food or drinks when they come
to the hospital. It is important to teach the child why he/she cannot have food. Some children
may be able to have small portions, so at this stage it is important to teach them to eat in
moderation so that their stomach will not hurt.
The last stage of Eriksons stages of development is identity vs. role confusion and this is
for the ages thirteen to seventeen years old. (Thompson, 2009) At this stage the teen wants to
have privacy, they see peer relationships as important, they want to be independent, and they are
concerned with how others see them and are very insecure about their body image. A teen that
has CIP will be very insecure about their body, because a person who has CIP has an extended
stomach due to digestion issues. They will also become very depressed because they will not be
able to get out of bed most days and will not be able to hangout with their friends or family. This
will leave them not wanting to follow their treatment, because they will feel worthless. They will
also become very angry, because they want to be like their other friends who are healthy. The
child life specialist can help by providing opportunities for peer building. They can explain to the
family and friends how important it is for them to be involved with their teen so that she does not
sit in bed all day and become worse. Providing time for the teen to spend time with family and
friends is important for them to get their mind off being in the hospital. It is also important for
them to be able to have time out of their room for activities or walking around to get their mind
off being in the hospital. It is also important for the child life specialist to allow time for privacy
and for peer interaction. At this stage the teen is well aware of what their illness is and how it
affects them so it is important for the child life specialist to respect and support them through

Pseudo-obstruction Motility Disorder

their illness. The child life specialist can provide coping strategies for the teen for when she is
having abdomen pain and how they can distract themselves from the pain.
Pseudo-obstruction motility disorder is a very hard chronic illness for children to live
with. It affects their day-to-day lives, and they have to live with it until there is a cure. Each child
is affected differently, and will have all kinds of emotions from dealing with this illness. Child
life specialists can help relieve this stress and anxiety, and help them learn coping mechanisms to
deal with the emotions they are going through. These children can learn these coping strategies
and live their day-to-day lives as normal as they can till there is a cure found.

References
Beam, C. W. (2015). Miracles from heaven. New York City: Hachette Books.
ChronicIntestinalPseudoobstruction.(n.d.).RetrievedMay03,2016,from
http://www.webmd.com/digestivedisorders/intestinalpseudoobstruction
Chronicintestinalpseudoobstruction.(n.d.).RetrievedMay03,2016,from
http://www.uptodate.com/contents/chronicintestinalpseudoobstruction
ChronicIntestinalPseudoobstructionNORD(NationalOrganizationforRareDisorders).
(n.d.).RetrievedMay03,2016,fromhttp://rarediseases.org/rarediseases/chronic
intestinalpseudoobstruction/
Intestinalpseudoobstruction.(n.d.).RetrievedMay03,2016,from
https://en.wikipedia.org/wiki/Intestinal_pseudoobstruction
Thompson, R. (2009). The handbook of child life: A guide for pediatric psychosocial care.
Charles C. Thomas. Springfield, IL.

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