Constipation resident survival guide (pediatrics)

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief:

Constipation resident survival guide (pediatrics) Microchapters
Overview
Causes
FIRE
Diagnosis
Treatment
Do's
Don'ts

Overview

Constipation occurs when waste or stool moves too slowly through the digestive tract, causing the stool to become hard and dry.

Causes

Life Threatening Causes

Life-threatening causes include conditions that may result in death or permanent disability within 24 hours if left untreated.

• Atropine poisoning
• Hypokalemia
• Lead poisoning
• Opium poisoning
• Severe dehydration
• Spinal cord injury
• Superior mesenteric artery occlusion

Common Causes

the most factors can contribute to constipation in children, including:

• Ignoring .

A child may ignore the urge to have a bowel movement or uncomfortable using public toilets.

• Painful bowel movements caused by large, hard stools also may lead to avoid a repeat of the distressing experience.

• Toilet training issues .

• Diet.

Not enough fiber-rich fruits and vegetables or fluid in a child's diet may cause constipation.

• Changes in routine.

Any changes in routine — such as travel, hot weather, stress or start school — can affect bowel function.

• Medications.

Certain antidepressants and various other drugs can contribute to constipation.

• Cow's milk allergy.

• Family history

• Medical conditions.

irritable bowel syndrome

Hirschsprung’s disease

hypothyroidism

cystic fibrosis

FIRE: Focused Initial Rapid Evaluation

The most common kind is functional Constipation and not life-threatening. Diagnosed with history one of these symptoms:-

• Hard stools •

• Pain or trouble passing stool •

• Less than three stools per week

Many children with impaction have a loss of appetite and are less interested in physical activity. After passing the stool, the child feels better and symptoms improve.

Complete Diagnostic Approach

Shown below is an algorithm summarizing the diagnosis of [[constipation]] according the the [Rome III Diagnostic Criteria] guidelines.

Diagnosing Functional Constipation in Children

At least two of the following in a child with a developmental age younger than four years* Two or fewer bowel movements per week At least one episode of incontinence per week after the acquisition of toileting skills History of excessive stool retention History of painful or hard bowel movements Presence of a large fecal mass in the rectum History of large diameter stools that may obstruct the toilet At least two of the following in a child with a developmental age of four years or older with insufficient criteria for irritable bowel syndrome† Two or fewer bowel movements in the toilet per week At least one episode of fecal incontinence per week History of retentive posturing or excessive voluntary stool retention History of painful or hard bowel movements Presence of a large fecal mass in the rectum History of large diameter stools that may obstruct the toilet —Criteria must be fulfilled for at least one month. Accompanying symptoms may include irritability, decreased appetite, and/or early satiety, and they may disappear immediately following passage of a large stool. —Criteria must be fulfilled at least once a week for at least two months. Adapted with permission from Rasquin A, Di Lorenzo C, Forbes D, et al. Childhood functional gastrointestinal disorders: child/adolescent. Gastroenterology . 2006; 130(5):1533, and Hyman PE, Milla PJ, Benninga MA, Davidson GP, Fleisher DF, Taminiau J. Childhood functional gastrointestinal disorders: neonate/toddler. Gastroenterology . 2006;130(5):1524. }

Diagnosing Functional Constipation in Children older than four years

For a child with a developmental age 4 years 1. <2 defecations in the toilet per week 2. At least ONE episode of fecal incontinence per week 3. History of retentive posturing or excessive volitional stool retention 4. History of painful or hard bowel movements 5. Presence of a large fecal mass in the rectum 6. History of large-diameter stools that may obstruct the toilet

Treatment

Shown below is an algorithm summarizing the treatment of [ [Constipation in Infants Younger than Six Months]] according the the [Singapore Medical Association and North American Society For Pediatric Gastroenterology, Hepatology & Nutrition ...] guidelines.

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Constipation in Infants Younger than Six Months

Do's

• The content in this section is in bullet points.

Don'ts

• The content in this section is in bullet points.

References

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