Constipation (peds)

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Background

Clinical Features

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

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 (PEG) (e.g., Miralax) 0.4 gms/kg/day MAX 6 days

Disposition

  • Outpatient

See Also

References

  1. Baby Care Advice. http://www.babycareadvice.com/babycare/microsites/infant_constipation/infant_constipation.old.htm.