Contipation Flashcards
What is constipation in a child < 1 year old?
Fewer than 3 complete stools per week
Hard large stool
Rabbit droppings
What is constipation in a child > 1 year?
Fewer than 3 complete stools per week
Overflow soiling
Rabbit droppings
Large, infrequent stools that can block the toilet
What are symptoms associated with defection in constipation in child < 1 year old?
Distress on passing stool
Bleeding associated with hard stool
Straining
What are symptoms associated with defaecation in constiaption in child > 1 year old?
Poor appetite that improves with passage of large stool
Waxing and waning of abdominal pain with passage of stool
Retentive posturin straight legged, tiptoed
Straining
Anal pain
Wha are causes of constipation in children?
Dehydration Low fibre diet Medications - opiates Anal fissure Hypothyroidism Hirschsprung's disease Hypercalcaemia Learning disabilities Over-Enthusiastic potty training
What are red flags suggesting underlying disorder?
Reported from birth or first few weeks of life
Passage of meconium > 48 hours after birth
Ribbon stools
Faltering growth is amber flag
Previously unknown or undiagnosed weakness in legs
Abdominal distension
What features indicate idiopathic constipation?
Starts after few weeks of life Obvious precipitating factor - fissure, change of diet, potty training, acute events Meconium passage < 48h after birth Growth is generally good Active No neurological problems in legs Changes in infant formula Insufficient fluid intake
What are factors suggesting faecal impaction?
Symptoms of severe constipation
Overflow soiling
Faecal mass palpable in abdomen
What is manamgen if faecal impaction is present?
Polyethelene glycol 3350 + electrolytes (Movicol Paediatric Plan)
Excalating dose regimen
If no disimpaction after 2 weeks:
Add stimulant laxative - sodium picosulphate or senna
Substitue stimulant laxative singly or in combination with an osmotic laxative such as lactulose if Movicol Paediatric Plan is not tolerated
What is maintenance therapy for constipation?
Movicol Paediatric Plan - polyethylene glycol + electrolytes
Add a stimulant laxative if no response
Substitute a stimulant laxative if Movicol Paediatric Plan is not tolerated
Add lactulose if stools are hard
Continue medication at maintenance dose for several weeks after regular bowel habit is established then reduce dose gradually
What is management of infants not yet weaned <6m
Bottle fed infants: give extra water between feeds
Gentle abdominal massage and bicycling infants legs
Breast fed infant: constiaption is unusual - organic causes considered
What is the concern in failure to pass meconium within 24h?
Hirschsprung disease
What is the concern with faltering growth?
Hypothyroidism
Coeliac disease
What is the concern with perianal fistulae, abscesses or fissures?
Perianal Crohn’s disease
What conservative management for constipation?
Ensure adequate oral fluid intake
Encourage good toileting habits
What is Hirschsprug disease?
Absence of ganglion cells from the myenteric and submucosal plexuses of part of the large bowel resulting in narrow, contracted segment.
Mostly confined to rectosigmoid
How does Hirschsprung present?
Intestinal obstruction with failure to pass meconium in first 24h of life
Rectal examination may reveal a narrowed segment and withdrawal of the examining finger often releases a gush of liquid stool and flatus
How is Hirschsprung diagnosed?
Suction renal biopsy demonstrating absence of ganglion cells
Management of Hirschsprung?
Surgical excision + colostomy
