Constipation in Children Flashcards
how often (on average) does an infant under 6 months poo per day?
3 times
how often (on average) does a child after 3 years old poo per day?
once
what factors should be considered when reviewing a child with constipation?
- stool pattern
- symptoms associated with defecation
- history
diagnosis of constipation is suggested by 2 or more of these symptoms
what stool pattern suggests a diagnosis of constipation in a child <1 year old?
- <3 stools per week
- hard large stool
- ‘rabbit droppings’
3 complete stools per week does NOT apply to exclusively breastfed babies after 6 weeks of age
what stool pattern suggests a diagnosis of constipation in a child >1 year old?
- <3 complete stools per week
- overflow soiling
- ‘rabbit droppings’
- large, infrequent stools that can block the toilet
what are the characteristics of overflow soiling?
commonly very loose, very smelly, stool passed without sensation
what symptoms associated wtih defecation suggests a diagnosis of constipation in a child <1 year old?
- distress on passing stool
- bleeding associated with hard stool
- straining
what symptoms associated wtih defecation suggests a diagnosis of constipation in a child >1 year old?
- poor appetite that improves with passage of large stool
- waxing and waning of abdo pain with passage of stool
- evidence of retentive posturing
- straining
- anal pain
what is retentive posturing?
typically straight-legged, tiptoed, back arching posture
e.g. trying to hold in a poo
what history suggests a diagnosis of constipation in a child <1 year old?
- previous episodes of constipation
- previous or current anal fissure
what history suggests a diagnosis of constipation in a child >1 year old?
- previous episodes of constipation
- previous or current anal fissure
- painful bowel movements and bleeding associated with hard stools
what is the most common cause of constipation in children?
idiopathic
name some causes of constipation in children?
- idiopathic
- dehydration
- low-fibre diet
- medications (e.g. opiates)
- anal fissure
- over-enthusiastic potty training
- hypothyroidism
- hirschsprung’s disease
- learning difficulties
what timing suggests a diagnosis of idiopathic constipation?
- starts after a few weeks of life
- obvious precipitating factors coinciding with the start of symptoms
what ‘red flag’ timing suggests an underlying disorder?
reported from birth or first few weeks of life
what timing of the passage of meconium suggests a diagnosis of idiopathic constipation?
<48 hours
what ‘red flag’ timing for the passage of meconium suggests an underlying disorder?
> 48 hours
what ‘red flag’ stool pattern suggests an underlying disorder?
‘ribbon’ stools
what ‘amber flag’ for growth suggests an underlying disorder?
faltering growth
what ‘red flag’ for neuro/locomotor suggests an underlying disorder?
- previously unknown or undiagnosed weakness in legs
- locomotor delay
what ‘red flag’ abdominal symptom suggests an underlying disorder?
distension
what diet characteristics suggests a diagnosis of idiopathic constipation?
- changes in infant formula
- weaning
- insufficient fluid intake
- poor diet
what factors suggest faecal impaction?
- symptoms of severe constipation
- overflow soiling
- faecal mass palpable in the abdomen
what is the 1st line management of faecal impaction?
polyethylene glycol 3350 + electrolytes (movicol paediatric plain)
what is the treatment plan for faecal impaction?
- polyethylene glycol 3350 + electrolytes
- stimulant laxative if no disimpaction after 2 weeks
- laxative –> osmotic laxative (lactulose) if electrolytes not tolerated
what are the risks for disimpaction treatment?
can initially increase symptoms of soiling and abdominal pain
what is the 1st line maintenance therapy for constipation?
movicol paediatric plain (e.g. electrolytes)
what is the maintenance regimen for constipation?
- movicol paediatric plain
- stimulant laxative
- laxative –> osmotic laxative if movicol not tolerated
continue medication at maintenance dose for several weeks after regular bowel habit established, then reduce the dose gradully
what lifestyle measures can help in constipation?
- ensuring adequate fluid and fibre intake
- regular toileting and non-punitive behavourial interventions
what is the management in an infant who has not yet weaned who has constipation?
- bottle-fed = extra water between feeds, abdo massage and bicycling legs
- breast-fed = constipation unusual –> organic cause
what is the management in an infant who have been weaned/being weaned who have constipation?
- offer extra water, diluted fruit juice and fruit
- lactulose if not effective
