Constipation

Question 1

What are some causes of constipation in children?

Answer 1

Most common
- Functional

Medical

• Cow’s milk allergy
• Hypercalcaemia, hypothyroidism
• Coeliacs

Surgical

• Hirshsprung
• Meconium ileus
• Anatomical malformation of the anus
• Spinal cord abnormality

Question 2

How is constipation managed non-pharmacologically?

Answer 2

- Behavioural
		○ Position - knees higher than hips
		○ Timed toileting 
		○ Praise child
		○ Dairy
		○ Delay training until child passes painless stools
	- Diet
		○ High fibre may help
		○ Hydrate
                - Avoid too much cows milk

Question 3

What is the first line pharmacology therapy for constipation?

Answer 3

○ Children: Stool softener (paraffin oil) or iso-osmotic laxative (Movicol™ or Osmolax™)
○ Infants 6-12mo: Coloxyl™ drops or Lactulose
○ Infants

Question 4

What do you examine for in constipation?

Answer 4

• Height and weight
  
  • Abdo exam
    ○ Palpable faeces
  • Lower limb neurological
  • Spine - tufts of hair, deep sacral cleft
  • Anal area - fissures