Practice Guidelines

Diagnosis and management of idiopathic childhood constipation: summary of NICE guidance

BMJ 2010; 340 doi: https://doi.org/10.1136/bmj.c2585 (Published 01 June 2010) Cite this as: BMJ 2010;340:c2585
  1. Lauren Bardisa-Ezcurra, research fellow1,
  2. Roz Ullman, senior research fellow1,
  3. Jenny Gordon, programme manager evidence into practice2
  4. on behalf of the Guideline Development Group
  1. 1National Collaborating Centre for Women’s and Children’s Health, London W1T 2QA
  2. 2Royal College of Nursing Institute, Cowley, Oxford OX4 2JY
  1. Correspondence to: L Bardisa-Ezcurra lbardisa-ezcurra{at}ncc-wch.org.uk

    Constipation is described as “the subjective complaint of passage of abnormally delayed or infrequent passage of dry, hardened faeces, often accompanied by straining and/or pain.”1 Constipation is common in childhood, is rarely life threatening, and therefore might be expected to have little effect on healthcare provision. The reality is somewhat different, however. Symptoms become chronic in more than a third of patients, causing great discomfort, and many children need medical treatment and nursing care.2 3 4 5 Lack of understanding about the condition, delayed diagnosis, and suboptimal treatment and support contribute to ongoing symptoms and multiple medical consultations.6 Social costs include children missing school, being excluded from peer group activities, and feeling that they cannot tell their friends about their condition. This article summarises the most recent recommendations from the National Institute for Health and Clinical Excellence (NICE) on the care and management of children and young people with idiopathic constipation.7

    Recommendations

    NICE recommendations are based on systematic reviews of best available evidence and explicit consideration of cost effectiveness. When minimal evidence is available, recommendations are based on the experience and opinion of the Guideline Development Group (GDG) on what constitutes good practice. Evidence levels for the recommendations are given in italic in square brackets.

    Establishing the presence of constipation

    Establish whether constipation is present during history taking. Two or more of the following findings indicate constipation:

    • Children under 1 year: fewer than three complete stools a week (fig 1; this does not apply to exclusively breast fed babies after 6 weeks of age), hard large stools, “rabbit droppings” or “nuts” (type 1, fig 1), distress on defecating, bleeding associated with hard stools, straining, previous episode(s) of constipation, and previous or current anal fissure. [Based on moderate quality observational studies and the experience and opinion of the GDG] …

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