Constipation (peds)

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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
  • Should have a benign "soft" abdominal exam (vs. more concerning abdominal pathologies)

Differential Diagnosis

Infant Constipation

Children (older than 1 year) Constipation

Pediatric Abdominal Pain

0–3 Months Old

3 mo–3 y old

3 y old–adolescence

Evaluation

Workup

Stool burden that may be consistent with constipation on KUB. Use of a KUB to diagnose constipation in pediatric patients is generally NOT indicated, as other serious pathology may also result in the imaging findings.
  • Consider basic labs
  • Consider abdominal ultrasound and/or CT
  • Consider UA
Use of a KUB to diagnose constipation in pediatric patients is generally NOT indicated, as acute appendicitis and other serious pathology may also result in increased stool burden. If the abdominal exam is concerning, proceed to ultrasound/CT.

Diagnosis

  • Consider and, if necessary, rule out other more concerning diagnoses first
  • Pediatric constipation is typically a clinical 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]
    • Sorbitol-containing fruit purees (e.g. pureed prunes).
    • Substitute multigrain or barley cereal for rice cereal

Toddlers and children

Disposition

  • Outpatient

See Also

  • Constipation
  • Tables on neonatal constipation differential and normal stool/urine output[2].

References

  1. Baby Care Advice. http://www.babycareadvice.com/babycare/microsites/infant_constipation/infant_constipation.old.htm.
  2. Helman, A. Morgenstern, J. Ivankovic, M. Long, B. Reid, S. Swaminathan, A. EM Quick Hits 25 – Cerebral Venous Thrombosis, Diphenhydramine Alternatives, Abdominal Compartment Syndrome, Neonatal Constipation, Intubating Metabolic Acidosis. Emergency Medicine Cases. January, 2021. https://emergencymedicinecases.com/em-quick-hits-jan2021/ Accessed 1/26/2021