constipation%20in%20children
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.

Patient Education

  • Family education includes providing information on the mechanism of constipation
  • Encourage parents to have a consistent, positive & supportive attitude during treatment
  • Knowing the precipitating factors of constipation helps remove anxiety of parents & caregivers & encourages them to be involved in its management
  • Treatment may be long & irregular & characterized by improvement alternating with relapses

Lifestyle Modification

Behavioral Therapy

  • Aims to regularize toilet habits, discourage stool withholding & improve understanding of defecation dynamics
  • To establish a regular bowel habit, recommend scheduled toileting appropriate for the child’s developmental stage, with adequate time for bowel movement
    • Encourage the child to sit on the toilet for 5-10 minutes after meals; when in school, it is alright for the child not to go to the toilet
    • Advise parent to give child enough time to spend in the toilet when child shows signs of withholding stool
  • Straining techniques such as relaxation of legs & feet, taking a deep breath then pausing while pushing while holding one’s breath, should be taught to the child
  •  Maintain a bowel diary of stool frequency & consistency which can be discussed during clinic visits
    •  For positive reinforcement, encourage & reward the child’s efforts & not the results
  •  It may be of benefit to refer to a mental health provider for intervention if behavioral problems interfere with treatment, but it is discouraged to do it routinely

Biofeedback Therapy

  • Uses devices (electrical or mechanical) in order to increase awareness of physiological functions of anal sphincter by providing the patient with visual, verbal &/or auditory information & enhances self-control on body functions
  • W/ the rise of the rectal pressure, patients are taught external anal sphincter relaxation
  • Demonstrated efficacy in correcting abnormal defecation dynamics in previous studies but failed to show additional benefit in the treatment of chronic childhood constipation
  • Currently used only for children with pelvic floor dyssynergia & short-term treatment of intractable constipation
  • Not to be used for ongoing treatment of children with functional constipation

Diet

  • Although commonly recommended for treatment of functional constipation, it is discouraged to use dietary modification alone as first-line treatment
  • For infants, the following are recommended:
    • Continue breastfeeding
    • For formula-fed infants, partially or extensively hydrolyzed infant formulas with prebiotics w/o palm oil offer a good alternative for managing functional constipation
    • Helpful for infants are complex carbohydrates & sorbitol present in some juices, eg apple, prune, pear, which increase stool frequency & fecal water content
    • Barley malt extract or corn syrup can be used as stool softeners
  • A high-fiber diet is encouraged to help form soft bulky stool in children
    •  A 0.5 g/kg body weight intake of fiber is recommended in children >2 years
    •  A balanced diet with fruits, vegetables, & whole grains is appropriate for treatment
  •  A double-blind crossover study demonstrated intolerance to cow’s milk results in constipation; however, withholding milk from the diet should be done only on the advice of a specialist
  •  Increased intake of fluids is also recommended; however, studies have shown that doing so only increased urine output & had no effect in output or consistency of stool & did not improve stool frequency
    •  Increase intake of absorbable & non-absorbable carbohydrates esepecially sorbitol, found in some juices like prune, pear & apple juice
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