Constipation (peds): Difference between revisions
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==Clinical Features== | ==Clinical Features== | ||
*There is a wide range of normal frequency of stools | |||
*Hard stools or painful defecation | |||
*May be associated with [[abdominal pain (peds)|abdominal pain]], rectal discomfort, withholding behavior, encopresis | |||
*May be complicated by [[rectal bleeding]], [[anal fissures]], [[fecal impaction]] | |||
==Differential Diagnosis== | ==Differential Diagnosis== | ||
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**Fiber: age + (5 to 10) grams daily | **Fiber: age + (5 to 10) grams daily | ||
**Adequate fluid intake: 32-64 ounces [960-1920 mL] per day | **Adequate fluid intake: 32-64 ounces [960-1920 mL] per day | ||
*WITH withholding behavior, pain while defecating, rectal bleeding or [[anal fissure]] | *WITH withholding behavior, pain while defecating, [[rectal bleeding]] or [[anal fissure]] | ||
**[[Polyethylene glycol 3350]](e.g., Miralax) 0.4 gms/kg/day MAX 6 days | **[[Polyethylene glycol 3350]](e.g., Miralax) 0.4 gms/kg/day MAX 6 days | ||
Revision as of 21:23, 5 October 2019
This page is for pediatric patients; for adult patients see constipation.
Background
Clinical Features
- There is a wide range of normal frequency of stools
- Hard stools or painful defecation
- May be associated with abdominal pain, rectal discomfort, withholding behavior, encopresis
- May be complicated by rectal bleeding, anal fissures, fecal impaction
Differential Diagnosis
Infant Constipation
- Constipation
- Hirschsprung's disease
- Congenital anorectal malformations
- Imperforate anus
- Bowel obstruction
- Neurologic disorders
- Encephalopathy
- Spinal cord abnormalities: myelomeningocele, spina bifida, tethered cord
- Meconium ileus
- Metabolic causes
- Heavy-metal poisoning
- Medication side effects
Children (older than 1 year) Constipation
- Functional constipation (>95% of cases)
- Organic causes
- Hirschsprung's disease
- Metabolic causes
- 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
Evaluation
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]
- Sorbitol-containing fruit purees (e.g. pureed prunes).
- 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 3350(e.g., Miralax) 0.4 gms/kg/day MAX 6 days
Disposition
- Outpatient