placing the child on the toilet at set times helps in
establishing bowel control or whether it creates emo-
tional conflict between parents and child. Opinion is
divided about the effectiveness of placing the child on
the toilet at fixed times during the day; some doctors
think that taking the child to the toilet after a meal
helps to teach good bowel habits, while others think it
is not a good idea if the child does not feel an urge to
defecate.
There is no evidence that long-term use of laxa-
tives creates dependency on them or causes colon
cancer.
Resources
BOOKS
American Psychiatric Association.Diagnostic and Statistical
Manual of Mental Disorders, Fourth edition. Washing-
ton, DC: American Psychiatric Association, 2000.
Schaefer, Charles E.Childhood Encopresis and Enuresis:
Causes and Therapy. Northvale, NJ: Jason Aronson,
1993.
‘‘Toileting Problems.’’ Chapter 298, Section 19.Merck
Manual of Diagnosis and Treatment, 18th ed. Edited by
Mark H. Beers and Robert Berkow. Whitehouse Sta-
tion, NJ: Merck, 2007.
PERIODICALS
Biggs, Wendy S., and William H. Dery. ‘‘Evaluation and
Treatment of Constipation in Infants and Children.’’
American Family Physician73 (February 1, 2006):
469-482.
Borowitz, Stephen. ‘‘Encopresis.’’eMedicine, July 21, 2006.
[cited May 6, 2007].http://www.emedicine.com/ped/
topic670.htm.
Fishman, Laurie, Leonard Rappaport, Alison Schonwald,
and Samuel Nurko. ‘‘Trends in Referral to a Single
Encopresis Clinic over 20 Years.’’Pediatrics111 (May
2003): 604–607.
Fleisher, David R. ‘‘Understanding Toilet Training Diffi-
culties.’’Pediatrics113 (June 2004): 1809–1810.
Kuhn, Brett R., Bethany A. Marcus, and Sheryl L. Pitner.
‘‘Treatment Guidelines for Primary Nonretentive
Encopresis and Stool Toileting Refusal.’’American
Family Physician59 (April 15, 1999): 2171–2186.
Loening-Baucke, V., E. Miele, and A. Staiano. ‘‘Fiber
(Glucomannan) Is Beneficial in the Treatment of
Childhood Constipation.’’Pediatrics113 (March 2004):
259–264.
McGrath, M. L., M. W. Mellon, and L. Murphy. ‘‘Empiri-
cally Supported Treatments in Pediatric Psychology:
Constipation and Encopresis.’’Journal of Pediatric
Psychology25 (June 2000): 225–254.
Pashankar, Dinesh S., and Vera Loenig-Baucke. ‘‘Increased
Prevalence of Obesity in Children with Functional
Constipation Evaluated in an Academic Medical Cen-
ter.’’Pediatrics116 (September 2005): 377–380.
OTHER
Gurian, Anita. ‘‘About Encopresis (Soiling).’’ New York
AboutOurKids.org. University Child Study Center.
August 2, 2002. [cited May 6, 2007].<http://www.about
ourkids.org/aboutour/articles/about_encopresis.html>.
North American Society for Pediatric Gastroenterology,
Hepatology and Nutrition (NASPGHAN).Treatment
of Encopresis/Soiling. Flourtown, PA: NASPGHAN,- [cited May 6, 2007].http://www.naspghan.org/
user-assets/Documents/pdf/diseaseInfo/Encopresis-
Soiling%20E.pdf.
ORGANIZATIONS
American Academy of Child and Adolescent Psychiatry
(AACAP). 3615 Wisconsin Avenue NW, Washington,
DC 20016-3007. Telephone: (202) 966-7300. Website:
http://www.aacap.org/.
American Academy of Pediatrics (AAP). 141 Northwest
Point Boulevard, Elk Grove Village, IL 60007-1098.
Telephone: (847) 434-4000. Website:http://
[http://www.aap.org.](http://www.aap.org>.)
American College of Gastroenterology (ACG). 6400
Goldsboro Road, Suite 450, Bethesda, MD 20817.
Telephone: (301) 263-9000. Website:http://
[http://www.acg.gi.org.](http://www.acg.gi.org>.)
North American Society for Pediatric Gastroenterology,
Hepatology and Nutrition (NASPGHAN). P.O. Box 6,
Flourtown, PA 19031. Telephone: (215) 233-0808.
Website:http://www.naspghan.org.
Rebecca J. Frey, PhDEnglish dietseeNorthern European diet
Ephedra
Definition
Ephedra is a genus of plants found worldwide.
One species,Ephedra sinicaor Chinese ephedra, has
a long history of use in complementary and alternative
medicine (CAM). In the late twentieth century, ephe-
dra gained popularity as a weight-loss supplement.
The herb can cause life-threatening side effects, and
since April 2004, sale of products containing ephedra
have been banned in the United States. In Traditional
Chinese Medicine (TCM) ephedra is called ma huang.Purpose
Ephedra (ma huang) has been used in TCM for
about 5,000 years primarily to treat sneezing, runny
nose, coughing and other symptoms of a cold,Ephedra