Gastrostomy tube placement for children with autism spectrum disorders and functional constipation.

Objectives: Children with functional constipation (FC) and autism spectrum disorder (ASD) often face sensory and behavioral conditions that prevent giving oral medical therapy to improve constipation and incontinence. We aimed to assess whether children with ASD and FC who had difficulty in taking oral medications could benefit from gastrostomy tube (GT) placement.

Methods: A single-institution retrospective review was performed in children diagnosed with ASD and FC from 2020 to 2023. Children were considered candidates for GT if they suffered from constipation that adversely affected daily function and refused adequate oral medical therapy. Data were collected on ASD severity and FC symptoms before GT and after GT placement.

Results: There were nine patients who underwent GT placement. Median age was 7.4 years (interquartile range [IQR]: 4.8-9.7). Of the five with available ASD evaluations, four had extremely low intelligence quotient and extremely low adaptive skills; only one child of the nine was verbal. Before GT placement, most patients had Bristol 1 or 2 consistency stool (66.7%); following placement, most had Bristol 5 or 6 consistency stool (66.7%). Seven children strained with bowel movements before GT; only one child strained after GT. There were no tube dislodgements or site infections. Gastrointestinal quality of life scores improved for both constipation (+38.5, IQR: 27.5-54.3) and medication administration (+31.5, IQR: 0.0-75.0).

Conclusions: GT placement may be a viable option in children with FC and ASD with minimal complications, improvement in constipation, and improvement in quality of life. Further prospective study will ensure generalizability of these results.