constipation in children

Question 1

paediatric constipation - nonmedication management (7)

Answer 1

toileting behaviour

• delay toilet training
• toilet sits - TDS for 5 minutes
• check they can access toilets easily
• keep knees higher than hips when sitting to defecate

other behaviour changes

• keep a stool diary
• increase exercise
• maintain fluid intake

Question 2

paediatric constipation - disimpaction protocol (using movicol adult)

Answer 2

start with 1 sachet, increase by 1 per day until day 7
review on day 4
1-5 yo - start with 1 sachet, max 4 sachets
6-11yo start with 2 sachet, max 6 sachets
12+ - 8 sachets per day

Question 3

neonates - dyschezia - define this

Answer 3

when babies can’t coordinate the abdo pressure with pelvic floor relaxation, they get upset and then have a soft poo 10 minutes later. its normal but can look like they’re constipated

Question 4

neonate - didn’t pass meconium in 48 hours

• what disease are you concerned about
• what management

Answer 4

hirschprung’s disease

urgent paeds assessment via emergency department

Question 5

hirschprung’s disease - define

Answer 5

birth defect, nerve cells are missing at the end of a child’s bowel near rectum, signoid colon

Question 6

neonatal constipation - differentials to consider (8)

Answer 6

functional
- dyschezia

surgical / anatomical issues
 - hirschprung's disease
- meconim ileus
- spinal dysraphism causing autonomic or sphincteric dysfunction
anatomical anus malformations

absorption

• CMPI
• coeliac disease

endocrine/electrolyte

• hypothyroidism
• hypercalcaemia