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CONSTIPATION IN CHILDREN

Constipation is a delay or difficulty in bowel movement persisting for ≥2 weeks.
It is a common digestive problem, not a disease, and usually not serious caused by changes in diet and early toilet training.
Constipation in children generally first happens in the toddler stage, between ages 2 and 4 years, with studies showing variation in gender-specific prevalence.
Functional constipation is  the one that cannot be explained by any anatomical, physiological, radiological or histological abnormalities.
Organic constipation is with identifiable physiological or organic cause.
Chronic constipation is the constipation that lasts for >8 weeks.

Follow Up

  • Since relapses are common & bowel movement difficulty may persist into adolescence, follow-up plan of children & their parents should be individualized, tailored based on the child’s treatment response measured by consistency, frequency, & amount of stool
  • Discuss preventive measures for relapse of constipation

Prognosis

  • In a recent systematic review, majority of children with constipation recover within 6-12 months of starting treatment & recovery rate is not related to age of onset, frequency of bowel movement, positive family history, & presence of fecal incontinence
  • Another study noted that less than half of affected children continued to be symptomatic beyond puberty with associated several complications
  • Relapse rate is high as functional constipation is difficult to treat
  • Underlying organic disorders exacerbate constipation resulting in difficult long-term management

Timing

  • Advise parents/guardians of infants <6 months with functional constipation to bring patient for follow-up after 2-4 weeks & infants ≥6 months with functional constipation without fecal impaction after 2 weeks for re-evaluation & evaluation of treatment efficacy

Specialist Referral

  • Consultation with a pediatric gastroenterologist is indicated if the child’s history or exam findings suggest an organic cause, when the child fails therapy, or for complex management
  • Symptoms not improving after 6 months of good compliance to therapy warrants a pediatric gastroenterology consult
    • The pediatric gastroenterologist further evaluates the child for underlying organic problems, does specialized tests, & gives counseling; review of previous treatment regimen may lead to adjustment of medications
  • Referral to pediatric surgeon may be considered for patients unresponsive to extensive medical management
    • Surgical management of refractory functional constipation may include anal procedures (eg botulinum toxininjection, sphincter myectomy), antegrade continence enema, colorectal resection, & intestinal diversion
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