Constipation - children

Questionnaire/history: < 3 complete stools a week (unless exclusively breastfed, when stools may be infrequent)? Hard, large stool (may block the toilet in children older than 1 year of age)? 'Rabbit droppings' stools? Overflow soiling in children older than 1 year of age? Associated symptoms in a child at any age? Distress or pain on passing stool? Bleeding associated with hard stool? Straining? Associated symptoms in a child at any age? Poor appetite that improves with passage of large stool? Waxing and waning of abdominal pain with passage of stool? 'Retentive posturing' Anal pain? Past Questionnaire/history of constipation? Previous or current anal fissure? Dx of constipation if 2 or more of the above? Dx of faecal impaction if Questionnaire/history of severe symptoms of constipation? Presence of overflow soiling? Faecal mass palpable on abdominal examination? Red flags? Constipation from birth or during the first few weeks of life? Delay in passing meconium for more than 48 h after birth, in a full-term baby? Abdominal distention with vomiting? FH of Hirschsprung's disease? Ribbon stool pattern? Leg weakness or motor delay? Abnormal appearance of the anus? Abnormalities in the lumbosacral and gluteal regions? Amber flags? Faltering growth, developmental delay or concerns about wellbeing? Constipation triggered by the introduction of cows' milk? Concern of possible child maltreatment? Suggestive of idiopathic constipation? Dietary factors? - Changes to infant formula or weaning? - Poor diet? - Insufficient fluid intake? Acute illness? Anal fissure? Drugs? Psychosocial factors? Past medical history? Current medication? - Laxatives? Drug allergies? Examination: Generally well with normal development? Height and weight within normal limits? Normal gait, tone and power in lower limbs? Abdomen (eg soft and flat or distended)? Appearance of the anus and surrounding area? Management

Non-pharmacological support

Macrogol: 1-11 months: 1/2-1 paed sachet day

12 months - 5 y: 1 paed sachet od-qds

6-11 y: 1 paed sachet bd-qds > 12 y: 1 adult sachet od-tds, or 1 paed sachet bd to 6 x a day

Impaction:

1-11 months: 1/2-1 paed sachet od 12 months to 4 y: 2 paed sachets on the first day, then 4 sachets a day for 2 days, then 6 sachets a day for 2 days, then 8 sachets a day

5-11 y: 4 paed sachets on the first day, then increase by 2 sachet a day to a mx of 12 sachets a day, taken in divided doses > 12 y: 4 adult sachets on the first day, increasing by 2 a day up to 8 sachets a day (double if paeds sachets)

Lengtht of tx: at least 6 weeks, usually months, sometimes years Taper tx slowly in response to stools

Reference(s): NICE CKS: Constipation in children

Information for patient/carer(s): NHS Health A to Z: Constipation Patient: Constipation in Children