Childhood constipation
BMJ 2021; 375 doi: https://doi.org/10.1136/bmj-2021-065046 (Published 02 December 2021) Cite this as: BMJ 2021;375:e065046- Olivia Bradshaw, paediatric junior clinical fellow1,
- Robbie Foy, professor of primary care2,
- Arnab K Seal, consultant paediatrician, honorary senior lecturer34,
- Jonathan C Darling, clinical associate professor in paediatrics and child health and medical education and honorary consultant paediatrician5
- 1Leeds Teaching Hospitals NHS Trust, Leeds, UK
- 2Leeds Institute of Health Sciences, University of Leeds, Leeds
- 3Leeds Community Healthcare NHS Trust, Leeds
- 4University of Leeds, Leeds
- 5Division of Women’s and Children’s Health, School of Medicine, University of Leeds, Leeds
- Correspondence to O Bradshaw o.bradshaw{at}nhs.net
What you need to know
Prompt initiation and titration of laxatives, active support, and adequate duration of maintenance treatment are cornerstones of management
Disimpaction is complete once the child starts to have watery stools
Maintenance treatment may be required for at least as long as the child has suffered from constipation, to allow for return of regular bowel habit
The parents of a 2 year old boy are concerned that he is struggling to open his bowels and appears to be straining. They tried macrogol for two weeks but stopped because it caused soiling and distress.
Constipation, the passage of fewer than three complete stools per week,1 affects approximately one in 10 children worldwide.2 It occurs most commonly in toddlers,3 often presenting at the time of weaning, toilet training, or starting school.4 Laxatives are safe and effective.5 Early intervention and support for parents with dosing and duration can prevent problems such as chronicity, withholding behaviours, overstretched bowels with decreased motility, and overflow soiling. This article offers an approach to childhood constipation in primary care, especially where initial treatment has been unsuccessful.
What you should cover
Take or revisit the history and examination to differentiate idiopathic constipation from other underlying conditions. Box 1 lists red flags.
Red flag features6
Symptoms
Onset from birth or first few weeks of life
>48 hour delay in passing meconium
Undiagnosed weakness in legs, locomotor delay
Abdominal distension with vomiting
Persistent blood in stool
Ribbon (thin, stringy) stools
Signs
Faltering growth
Gross abdominal distention
Abnormalities of spine, lumbosacral region, or gluteal muscles
Abnormal position, patency, or appearance of the anus (eg, laxity)
Lower limb deformities
Abnormal neuromuscular signs unexplained by any existing condition
Persistent anal issues such as fissures or skin tags
History
Identify the stool patterns and timing of onset. Hard large stool, “rabbit dropping” stool, and overflow soiling are all common. A paediatric Bristol …
Log in
Log in using your username and password
Log in through your institution
Subscribe from £173 *
Subscribe and get access to all BMJ articles, and much more.
* For online subscription
Access this article for 1 day for:
£38 / $45 / €42 (excludes VAT)
You can download a PDF version for your personal record.