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Evaluation and treatment of constipation in infants and children
Wendy S Biggs1, William H Dery
1Michigan State University College of Human Medicine, East Lansing, Michigan, USA. wendy.biggs@midmichigan.org
Insights
Functional constipation in children often requires disimpaction and long-term maintenance therapy. While treatments exist, family education and dietary changes are key, with only 50-70% achieving lasting improvement.
Area of Science:
- Pediatrics
- Gastroenterology
- Family Medicine
Background:
- Childhood constipation is typically functional, stemming from stool retention.
- Physicians must identify red flags for rare organic causes like Hirschsprung's disease or cystic fibrosis.
Purpose of the Study:
- To outline the diagnosis and management of functional constipation in children.
- To emphasize the importance of recognizing organic causes and effective treatment strategies.
Main Methods:
- Review of common and uncommon causes of pediatric constipation.
- Discussion of disimpaction and maintenance therapies, including medications and behavioral interventions.
- Consideration of dietary factors such as cow's milk and fiber intake.
Main Results:
- Functional constipation management involves disimpaction (e.g., polyethylene glycol) followed by maintenance therapy (e.g., mineral oil, lactulose).
- Family and child education significantly aids treatment response; biofeedback is not effective.
- Dietary modifications, like reducing cow's milk or increasing fiber, may help.
- Long-term improvement is achieved in only 50-70% of cases despite treatment.
Conclusions:
- Effective management of functional constipation requires a multi-faceted approach including medication, education, and dietary adjustments.
- Persistent vigilance for organic causes is crucial for pediatric constipation.
- Relapse is common, necessitating long-term management strategies.
Abstract:
Constipation in children usually is functional and the result of stool retention. However, family physicians must be alert for red flags that may indicate the presence of an uncommon but serious organic cause of constipation, such as Hirschsprung's disease (congenital aganglionic megacolon), pseudo-obstruction, spinal cord abnormality, hypothyroidism, diabetes insipidus, cystic fibrosis, gluten enteropathy, or congenital anorectal malformation. Treatment of functional constipation involves disimpaction using oral or rectal medication. Polyethylene glycol is effective and well tolerated, but a number of alternatives are available. After disimpaction, a maintenance program may be required for months to years because relapse of functional constipation is common. Maintenance medications include mineral oil, lactulose, milk of magnesia, polyethylene glycol powder, and sorbitol. Education of the family and, when possible, the child is instrumental in improving functional constipation. Behavioral education improves response to treatment; biofeedback training does not. Because cow's milk may promote constipation in some children, a trial of withholding milk may be considered. Adding fiber to the diet may improve constipation. Despite treatment, only 50 to 70 percent of children with functional constipation demonstrate long-term improvement.
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