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- distrazione durante il gioco;

- mancanza di privacy;

- errori dietetici quali l'eccessivo uso di latte vaccino (alimento ricco di proteine e con scarsi residui) o uno scarso apporto di fibre vegetali;

- errori psicologici da parte della famiglia per eccessiva "drammatizzazione“ del sintomo stipsi con soppressione dello stimolo.

Clinica:massima frequenza verso gli 1-3 anni, frequente storia familiare (60-90 %), accrescimento normale, esclusione di altre patologie (infezioni e infestazioni intestinali, infezioni vie urinarie, intolleranza alle proteine del latte o ai disaccaridi, ecc).

Prognosi:tendenza alla guarigione dopo i 3 anni (circa il 10 % evolve verso un D.A.R.).

Terapia: psicologica (tranquillizzare la famiglia) e dietetica

1) Norme igienico-dietetiche:

a) misure per aumentare la massa fecale: uso di alimenti ricchi di fibre vegetali (legumi, verdure, frutta, pane e pasta integrali) o aggiunta di crusca alla dieta. Le fibre vegetali sono contenute in tutti i vegetali anche se in diversa percentuale: ad es. 10 g di crusca equivalgono a 140 g di carote o a 300 g di mele.

b) "toilet training": l'educazione degli sfinteri va fatta con costanza e fermezza (senza esagerare!) abituando il bambino ad evacuare o a tentare di evacuare tutti i giorni alla stessa ora (preferibilmente dopo i pasti) e in un ambiente con adeguata "privacy".

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