Constipation in children
| <3 complete stools/week | |
|---|---|
| History | ➥ quality of stool ➥ History of anal fissure, previous constipation ➥ overflow soiling, straining, bleeding ➥ Precipitating factors, i.e. fissures, change of diet, infections, medications ➥ Diet and fluid intake ➥ Any neurological problems in the legs? Red flags for Hirschsprung’s: FHx, or ➥ occurring from birth – first few weeks of life ➥ meconium not passed within 48h of birth in term baby (excluding smears) Other red flags: vomiting associated (bowel obstruction), ribbon stools, abnormal appearance of anus, abnormalities around lumbosacral/gluteal regions |
| Examination | abdo o/e (abdo mass?), PR not routine - Abdominal examination - Perianal exam – appearance, position, patency, fissures - Spine – scoliosis - The skin overlying the spine – discoloured/sinus/hairy patch/central pit - Gluteal muscles – is there asymmetry? - Gait - Tone and strength in lower limbs Bloods: TFTs, coeliac serology |
| Diagnostic investigations | |
| Differentials | |
| Immediate management | |
| Ongoing management | Diet and fluid intake Toileting Movicol + COUNSEL for overflow diarrhoea! Aim normal stools every day or every other day |
functional constiaption = 95% of constipation
- Infant dyschezia – straining with soft stools in a less than 6-month-old
- Functional constipation – in infants and preschool children – pebble-like stools less than twice a week
- Functional faecal retention – holding on, soiling, cramps for at least 12 weeks
- Functional non-retentive faecal soiling – inappropriate soiling without retention, emotional issues