Successfully reported this slideshow.
We use your LinkedIn profile and activity data to personalize ads and to show you more relevant ads. You can change your ad preferences anytime.

Constipation in children

4,511 views

Published on

  • Hello! I can recommend a site that has helped me. It's called ⇒ www.HelpWriting.net ⇐ They helped me for writing my quality research paper.
       Reply 
    Are you sure you want to  Yes  No
    Your message goes here
  • Essay writing was never my forte as English isn’t my first language but because I was good at math so they put me into Honors English. I really couldn’t be assed with reading King Lear and then writing a 5,000 word paper on it so I looked up essay services and HelpWriting.net was the first link to come up. I was kind of shocked with the quality of the paper they gave me. I received a very articulate and well-written piece of writing for like $20. Recommended it to a bunch of my foreign friends and now they use it too.
       Reply 
    Are you sure you want to  Yes  No
    Your message goes here
  • Free Shed Plans, 12000 SHED PLANS. FREE SHED PLANS CLICK HERE ➣➣➣ https://t.cn/A62YdZJg
       Reply 
    Are you sure you want to  Yes  No
    Your message goes here
  • Leptitox Upto 70% Off | Order Now To Save Up To 70%? ●●● https://url.cn/5yLnA6L
       Reply 
    Are you sure you want to  Yes  No
    Your message goes here
  • Don't Buy Leptitox Unless You've Seen This Massive Discount & Exclusive Bonuses. 15% off EXTRA Discount. ▲▲▲ https://url.cn/5yLnA6L
       Reply 
    Are you sure you want to  Yes  No
    Your message goes here

Constipation in children

  1. 1. Constipation in children By Phil Byass, 4th Year, HYMS
  2. 2. Definition • “Infrequent passage of stool associated with pain and difficulty, or delay in defecation” • Normal: Frequency of defecation reduces from >4 times per day in early childhood to about once per day by age 4.
  3. 3. Epidemiology • Approx. 5% of schoolchildren suffer from constipation • 90-95% of constipation is functional • Often psychosocial factors involved. Painful defecation causes fear of defecation • Most children with constipation are developmentally normal. It is seen commonly in: a) Infants at weaning. b) Toddlers acquiring toilet skills. c) School age.
  4. 4. History • The frequency of defecation. Infrequent but normal stools are not indicators of constipation • Consistency of stools - this may include use of the Bristol Stool Chart. • Episodes of faecal incontinence (overflow) – typically spotting of faeces on underwear. Not diarrhoea! • Pain on defecation. • Blood on stool or toilet paper • History of anal fissure in PMH • Whether stools block the toilet. • Any associated behaviour. • Onset in infancy may signify Hirschprung’s disease – ask about meconium! • Diet – ask as a basis for giving advice!
  5. 5. Examination • Review growth as Hirschprung’s can cause FTT • Abdominal exam – hard indentable faeces often felt in LLQ • Anorectal examination – anal exam may reveal hard faeces. Look for anal fissure.
  6. 6. Functional Constipation • Low fibre diet • Lack of exercise • Poor colonic history (55% +ve FH) • Stems from painful passage of a hard stool, causing anal fissure • Child withholds to avoid further pain • Water reabsorbed making stool harder and more painful to pass • Cycle perpetuates • Colon becomes stretched and less efficient at moving stool (cannot ‘grasp’ during peristalsis)
  7. 7. Organic Causes of Constipation • Only 5% of causes are organic • GI organic causes: 1) Hirschprung’s disease (delay in passing meconium) 2) Anal disease (stenosis, ectopic, fissure) 3) Partial intestinal obstruction 4) Food hypersensitivity esp cow’s milk 5) Celiac disease
  8. 8. • Non-GI organic causes: 1) Hypothyroidism 2) Hypercalcemia 3) Neurological (spinal disease) 4) Cystic fibrosis 5) Sexual abuse 6) Chronic dehydration – check diabetes insipidus 7) Drugs e.g. opiates, anticholinergics
  9. 9. Management of functional constipation • Aims of treatment to soften stool and promote gut motility and address psychosocial factors: 1) Treat anal fissure with topical anaesthetic (2% lignocaine ointment) to reduce pain 2) Diet: increase oral fluid and fibre e.g. fruit juice 3) Behavioural measures: encourage parents not to show concern, star charts, regular 5 min toilet time after meals 4) Softeners: lactulose (also osmotic laxative) or sodium docusate 5) Stimulant laxatives: senna, sodium picosulphate 6) Macrogels: e.g. Movicol – osmotic laxative. 7) Enemas if no response to treatment. Often use air to inflate colon 8) Hospital admission for manual evacuation under sedation/GA if appropriate
  10. 10. Complications • Faecal impaction. • Chronic constipation. • Mega-colon (may predispose to, or result from, constipation). • Rectal prolapse. • Anal fissure. • Faecal soiling. • Psychological effects.

×