Constipation_Flashcards
What should be done before treating a child for constipation in primary care?
Exclude red flag symptoms (suggesting a serious underlying cause or condition) and make a working diagnosis of idiopathic constipation.
What is the first step in managing constipation if faecal impaction is present?
Recommend a disimpaction regimen.
What laxative is recommended first for faecal impaction in children?
Movicol (polyethylene glycol with electrolytes) with an escalating dose over 2 weeks.
What dietary or lifestyle modification is recommended alongside laxative treatment for faecal impaction?
Dietary and lifestyle modifications.
What should be done if an osmotic laxative is unresponsive in treating faecal impaction?
Add a stimulant laxative (e.g., senna) either on its own or in combination with lactulose or another stool softener laxative, such as docusate.
What is the maintenance laxative treatment if faecal impaction is not present or has been treated?
Osmotic laxative (Movicol: polyethylene glycol with electrolytes) along with dietary and lifestyle modifications.
What advice should be given regarding the duration of maintenance laxative treatment?
Continue the effective dose of laxative for at least several weeks after regular bowel movements are established, aiming for a soft regular formed stool. Gradually reduce the dose over months.
What should be considered if a child does not respond to maintenance laxative treatment in primary care for 3 months?
Consider arranging a specialist referral.
What behavioural interventions can help manage constipation in children?
Bowel habit diary, scheduled toileting, reward systems/star charts, addressing anxieties, and ensuring proper posture during toileting.
What diet and lifestyle advice should be given to a child with constipation?
Ensure adequate fluid and fibre intake: more water, fruits, and vegetables.
What types of laxatives are available for treating constipation?
Bulk-forming (e.g., fybogel, methylcellulose), osmotic (e.g., lactulose, Movicol), stimulant (e.g., bisacodyl, senna, sodium picosulphate), and stool-softener (e.g., arachis oil, docusate sodium).
What should parents understand about Movicol’s time to work and its use?
Movicol takes time to work. Use an escalating dose for disimpaction over 2 weeks and continue for maintenance until bowel habits are re-established. There are no dangers in long-term use.
What is the purpose of scheduled toileting after meals and before bedtime for children with constipation?
To take advantage of the gastrocolic reflex which helps stimulate bowel movements.
How can behavioural intervention aid in treating constipation in children?
Using reward systems like star charts can aid motivation and help establish regular bowel habits.
