Constipation in Children Flashcards
What is constipation?
Constipation is defined as the subjective complaint of abnormally delayed, infrequent, dry, hardened faeces, often accompanied by straining or pain.
What is the prevalence of constipation in children?
Constipation is common in childhood and can cause significant distress to both patients and families.
What are the common causes of constipation in children?
Common causes include changes in routine, diet, illness, toilet training, emotional upset, and withholding.
What are the organic causes of constipation?
Less common organic causes include Hirschsprung’s disease, spinal cord problems, anorectal malformations, and metabolic conditions such as hypothyroidism, coeliac disease, and cystic fibrosis.
What are the risk factors for constipation in children?
Risk factors include a low-fibre diet, low fluid intake, illness, postoperative bed rest or analgesia, and psychological issues related to toilet training.
What are the typical symptoms of constipation in children?
Symptoms include infrequent hard stools, soiling, pain or bleeding when passing stool, straining, abdominal distension, and nausea or vomiting.
What should be assessed during a physical examination of a child with constipation?
Assess growth, perform an abdominal examination, inspect the perianal area, examine the lumbosacral region, and conduct a lower limb neuromuscular examination.
When are investigations necessary for constipation in children?
Investigations are rarely required; plain X-rays can be used to assess faecal loading. Referral for organic causes is considered if standard therapy fails.
What criteria are used to diagnose constipation in children?
Diagnosis is based on the Rome IV criteria, which differ by age.
What are the non-pharmacological management strategies for constipation in children?
Non-pharmacological strategies include dietary changes (increasing fluid and fibre intake, reducing cow’s milk), behavioural training (establishing regular toileting routines, maintaining bowel diaries), and education.
What pharmacological treatments are used for constipation in children?
Pharmacological treatments may include:
- Disimpaction: Polyethylene glycol (PEG) is commonly used for disimpaction.
- Maintenance therapy: After disimpaction, maintenance therapy with PEG is often continued to prevent recurrence.
- Laxatives: Osmotic laxatives like PEG are preferred over stimulant laxatives
- Stimulant laxatives: These are considered second-line treatments.
- Enemas: May be used in certain cases under medical supervision.
What are the potential complications of untreated constipation in children?
Potential complications include faecal impaction, soiling, abdominal pain, and in severe cases, bowel perforation.
How can constipation in children be prevented?
Prevention strategies include maintaining a high-fibre diet, ensuring adequate fluid intake, establishing regular toileting routines, and addressing any psychological issues related to toilet training.
