Constipation

Question 1

What features in a Hx indicate constipation in a child <1y/o?

Answer 1

1) <3 complete stools/week
2) Hard large stools/rabbit droppings
3) Bleeding
4) Straining
5) Distress on opening bowels
6) Fissure
7) PMHx

Question 2

What is the definition of constipation in a child >1y/o?

Answer 2

1) <3 complete stools/week
2) Overflow soiling
3) Large infrequent stools that block the toilet/rabbit droppings
4) Poor appetite, that improvements on BM
5) Straining
6) Fissure
7) PMHx

Question 3

What are the two categories of causes for constipation?

Answer 3

GI and non-GI

Question 4

What are the GI causes of constipation?

Answer 4

1) Hirschprung’s
2) Anal disease
3) Partial obstuction
4) Food hypersensitivity
5) Coeliac disease

Question 5

What are the different types of anal disease that can cause constipation?

Answer 5

1) Infection
2) Stenosis
3) Hypertonic
4) Fissue

Question 6

What is an example of a partial obstruction that might cause constipation?

Answer 6

Volvulus

Question 7

What are the non-GI causes of constipation?

Answer 7

1 ) Hypothyroidism

2) Hypercalcaemia
3) Neurological disorders - e.g. spinal disease and learning difficulties
4) Chronic dehydration
5) Drugs - e.g. opiates
6) Low-fibre diet
7) Sexual abuse

Question 8

What is required to make a Dx of Hirschsprung’s?

Answer 8

A rectal biopsy

Question 9

What are the indications to do a rectal biopsy? (i.e. the red flags for Hirschsprung’s)

Answer 9

1) Delayed passage of meconium (>48hrs)
2) Constipation since the first few weeks of life
3) Chronic abdominal distension and vomiting
4) FHx
5) Faltering growth in addition to any of the other features

Question 10

How is constipation managed in a child that is not yet weened?

Answer 10

Depends on how they are fed - bottle or breast-fed?

Question 11

How is a bottle-fed infant with constipation managed?

Answer 11

1) Water between feeds

2) Abdominal massage/bicycling of legs

Question 12

How is a breast-fed infant with constipation managed?

Answer 12

Constipation is unusual in breast-fed infants - an organic cause should be established

Question 13

How is a weened child with constipation managed?

Answer 13

Depends on whether or not they are impacted?

Question 14

How is a non-impacted child managed?

Answer 14

Polyethylene glycol 3350 + electrolytes with dose adjusted for Sx/response
Stimulant laxative added if needed
Continue medication at maintenance dose even after regular bowel habits have been established (this may take months). Then gradually reduce the dose over a period of months

Question 15

What is polyethylene glycol 3350 + electrolytes?

Answer 15

Movicol Paediatric Plan

Question 16

How is an impacted child managed?

Answer 16

Polyethylene glycol 3350 + electrolyes at escalating dose

Stimulant laxative added if dis-impaction has not occured by 2/52