last authored: Oct 2009, Dave LaPierre
Constipation is a very common concern, the most frequent GI complaint in children. It is defined by less frequent stool, hardness, associated with symptoms.
The vast majority (over 95%) of pediatric constipation is functional, caused by psychological or dietary issues.
Constipation should be considered to be clinically relevant if:
When did it start?
shape of stool
Height and weight
lowe back for occult neural tube defect
If treatment of functional constipation does not work, investigations should be done for
Blood tests - CBCD, electrolytes, Ca, Mg, urea, creatinine, glucose, TSH
An abdominal X-ray can show obstruction etc. On flat X-ray, divide abdomen into 4 quadrants, and rate the amount of stool in each from 0-3. Constipation is suggested if score is >6/12.
For functional constipation, education of patients and families is first. Disimpaction is the next step: PEG is the first line, and should be kept up for a few weeks or months. It is not addictive and can be stopped abruptly with no concerns.
Diet is key in preventing constipation. Wheat bran, high-bran cereals, psylium 2-3tsp/d can all provide insoluble fibre. Exercise and adequate hydration are also very important. Dried prunes are also helpful (Attaturi et al, 2011).
Behaviour modification: setting reasonable expectations, routine (5 min after breakfast and supper), rewards.
Laxatives, in order of increasing potency, include:
Manual disimpaction can be used in people for whom stool has hardened to such a degree it can not be expelled.
Medications that cause constipation should be reduced or held as soon as is possible.
Children can become quite afraid of defecation for a number of reasons, including parental pressure, painful bowel movements, or fear of toilets. Accordingly, fecal withholding is quite common as a cause of defecation.
created: DLP, Aug 09
authors: DLP, Aug 09