Constipation in Children

Clinical Notes : Paediatrics

Diagnosis of idiopathic constipation is reached by :

Typical findings

Red flags

Constipation from birth or first few weeks of life, or failure or delay in passing meconium (> 48hours)
Ribbon stools
Gross abdominal distention or distention with vomiting
Abnormalities on examination of lumbosacral region or found on lower limb musculoskeletal or neurological examinations
Faltering growth (Amber flag)

Management

Do not use dietary or lifestyle advice alone
Assess for and treat faecal impaction
Diagnose on basis of history, overflow soiling and/or palpable faecal mass abdominally
PR is not indicated in primary care
Use escalating regime of macrogol and advise family about initial soiling and pain
- i.e. Escalate normal dose gradually to double normal
A stimulant can be added or substituted if not effective
- e.g. senokot

Maintenance treatment – aiming for regular passage of soft stools

Macrogols first line
- e.g. Movicol pediatric
- 2-6 yrs : 1 sachet daily in ¼ cup water
- 7-11 yrs : 2 sachets daily in ¼ cup water
Stimulant laxative second line (as addition or alternative to macrogol)
- e.g. senokot
- 2-6 yrs : 2,5-5 ml nocte
- 6-12 yrs : 1-2 tabs or 5-10 ml nocte
Use osmotic laxative such as docusate or lactulose if stools are hard
- e.g. lactulose
- 1/12-1yr : 2,5ml BD
- 1-2 yrs : 2,5-5ml BD
- 2-5 yrs : 5ml BD
- 5-10 yrs : 10ml BD
Continue treatment for several weeks after regular bowel habit is established, or if toilet training until this is complete

Timely review

Advise to see own GP
- In 1 week if laxatives clearing a blockage/ impaction
- Within 6 weeks for maintenance treatment

Provide clear information

On how to take medication
What to expect
How bowels work and
How to recognize symptoms of constipation
For a patient information leaflet click here
Use of dietary and behavioural interventions once regular toileting is established