Paediatric constipation for general paediatricians: Review using a case‐based and evidence‐based approach

Abstract

Constipation is a common problem in childhood. The most common type of constipation is functional, accounting for 90–95% of all cases. The aim of this review is to provide clinical scenarios with treatment using evidence‐based information, and management strategies and a clinical algorithm to guide the management of constipation in children. Recent guidelines and online information sites are detailed. Clinical red flags and organic causes of constipation are included. Four clinical scenarios are presented: case (1) 4‐month‐old child with constipation since birth and likely Hirschsprung disease; case (2) 6‐month‐old infant with infant dyschezia; case (3) 4‐year old with functional constipation; and; case (4) 9‐year old with treatment resistant constipation. Children with functional constipation need a thorough history and physical exam to rule out the presence of any ‘red flags’ but do not require laboratory investigations. Management includes education and demystification, disimpaction followed by maintenance therapy with oral laxatives, dietary counselling and toilet training. Treatment options differ between infants and children. Disimpaction and maintenance regimens for common laxatives are presented. On treatment failure or on suspicion of organic disease the patient should be referred for further evaluation. The radionuclide intestinal transit study (scintigraphy) is a useful modality for evaluation and planning of management in treatment‐resistant children. Treatment options for treatment‐resistant patients are presented. High‐level evidence (meta‐analyses) for pharmalogical and non‐pharmalogical treatment modalities are reviewed and an algorithm for assessment and treatment are presented.

What is needed by parents of constipated infants and toddlers: A cross-sectional study in China

“…A previous study showed that large and hard stool was the most frequent symptom among children with functional constipation, hard stool consistency was found in about 93.7% of cases ( 41 ). In the diagnosis of FC and identification of early warning symptoms ( 42 ), parental perception of constipation depends primarily on stool traits and frequency of defecation, which is also the most common reason for seeking medical attention. This suggested that parents were more likely to ignore other symptoms, leading to delays in seeking medical treatment.…”

Visualization of Nutrient-Related Clinical Practice Guidelines in Childhood

“…The use of CPGs in algorithmic form is very common for the appropriate assessment and care for many pathological conditions, both in adulthood and in childhood. Especially in childhood, many CPGs are presented in the format of an algorithm, either for the diagnosis of a variety of disorders, such as inborn anomalies of metabolism 61 , or the management of several conditions, such as constipation 62 . However, to the best of our knowledge, although CPGs for nutrient intake and nutrient-related chronic metabolic conditions are well established in the literature, this work is the first one that summarizes and presents them in algorithmic form, in order to further increase their adoption in everyday clinical practice.…”

The Overall Prevalence of Hypothyroidism in Children Suffering Chronic Constipation in Shahrekord in 2019

“…4 In addition, approximately 40% of children with functional constipation develop symptoms of constipation in the early years of life. 5 Regarding the close link between childhood constipation and thyroid disorders, practical-clinical guidelines released by the North American Society of Gastroenterology, Liver, and Nutrition recommend that thyroid hormone testing should be performed in children with severe and refractory constipation and that most patients should be screened before referring to a pediatric gastroenterologist. The diagnosis of hypothyroidism should be also considered in the differential diagnosis of constipation.…”