Constipation%20in%20children Management

• Since relapses are common and bowel movement difficulty may persist into adolescence, follow-up plan of children and their parents should be individualized, tailored based on the child’s treatment response measured by consistency, frequency, and 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 and recovery rate is not related to age of onset, frequency of bowel movement, positive family history, and 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 and infants ≥6 months with functional constipation without fecal impaction after 2 weeks for re-evaluation and evaluation of treatment efficacy

• 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, and 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, and intestinal diversion