Constipation (peds): Difference between revisions
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==Diagnosis== | ==Diagnosis== | ||
== | ==Management== | ||
===Infants=== | ===Infants=== | ||
''Glycerin suppositories or rectal stimulation with a lubricated rectal thermometer can be used if there is very hard stool in rectum, but may cause irritation and develop tolerance.'' | ''Glycerin suppositories or rectal stimulation with a lubricated rectal thermometer can be used if there is very hard stool in rectum, but may cause irritation and develop tolerance.'' | ||
Revision as of 12:09, 7 July 2016
Background
Clinical Features
Differential Diagnosis
Pediatric Constipation
Infants
- Hirschsprung’s disease
- Congenital anorectal malformations
- Neurologic disorders
- Encephalopathy
- Spinal cord abnormalities: myelomeningocele, spina bifida, tethered cord
- Cystic fibrosis
- Metabolic causes
- Hypothyroidism
- Hypercalcemia
- Hypokalemia
- diabetes insipidus
- Heavy-metal poisoning
- Medication side effects
Children (older than 1 year)
- Functional constipation (>95% of cases)
- Organic causes
- Hirschsprung’s disease
- Metabolic causes
- Hypothyroidism
- Hypercalcemia
- Hypokalemia
- Diabetes insipidus
- Diabetes Mellitus
- Cystic fibrosis
- Gluten enteropathy
- Spinal cord trauma or abnormalities
- Neurofibromatosis
- Heavy-metal poisoning
- Medication side effects
- Developmental delays
- Sexual abuse
Pediatric Abdominal Pain
0–3 Months Old
- Emergent
- Nonemergent
3 mo–3 y old
- Emergent
- Nonemergent
3 y old–adolescence
- Emergent
- Nonemergent
Diagnosis
Management
Infants
Glycerin suppositories or rectal stimulation with a lubricated rectal thermometer can be used if there is very hard stool in rectum, but may cause irritation and develop tolerance.
- Not yet begun solid foods
- Sorbitol-containing juices (eg, apple, prune, or pear)
- For infants four months and older, starting dose: 2-4 ounces of 100-percent fruit juice per day
- Karo syrup, add 1 tsp to 4 oz cooled, boiled water; give 1 oz of solution to baby just before feeds twice a day until stool softens
- Who have begun solid foods[1]
- Substitute multigrain or barley cereal for rice cereal
Toddlers and children
- WITHOUT withholding behavior, bleeding, or anal fissure
- Fiber: age + (5 to 10) grams daily
- Adequate fluid intake: 32-64 ounces [960-1920 mL] per day
- WITH withholding behavior, pain while defecating, rectal bleeding or anal fissure
- Polyethylene glycol (PEG) (e.g., Miralax) 0.4 gms/kg/day MAX 6 days
See Also
References
- ↑ Baby Care Advice. http://www.babycareadvice.com/babycare/microsites/infant_constipation/infant_constipation.old.htm.
- Sorbitol-containing fruit purees (e.g. pureed prunes).