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Evaluation and treatment of constipation in children and adolescents
Samuel Nurko1, Lori A Zimmerman1
1Boston Children's Hospital, Boston, MA, USA.
Insights
Childhood constipation is usually functional and diagnosed via medical history and physical exam. Treatment focuses on resolving impaction and using laxatives, with behavioral interventions and family education crucial for long-term success.
Area of Science:
- Pediatrics
- Gastroenterology
Background:
- Childhood constipation is a prevalent condition, frequently functional rather than organic.
- Stool retention can precipitate fecal incontinence in affected children.
Purpose of the Study:
- To outline the diagnostic approach to childhood constipation.
- To detail effective therapeutic strategies and the importance of patient education.
Main Methods:
- Diagnosis relies on medical history and physical examination.
- Red flag symptoms (e.g., early onset, failure to thrive) warrant further investigation for organic causes like Hirschsprung disease or metabolic disorders.
- Therapeutic strategies include resolving fecal impaction with laxatives (polyethylene glycol-based solutions are primary) and rectal therapies.
Main Results:
- Functional constipation is common and often manageable with conservative measures.
- Polyethylene glycol solutions are a primary treatment, supplemented by dietary fiber.
- Behavioral interventions and family education are vital for managing withholding behaviors and ensuring adherence to long-term therapy.
Conclusions:
- Most childhood constipation is functional and diagnosed clinically.
- Effective management combines pharmacological treatment, dietary adjustments, and comprehensive behavioral and educational support for families.
- Referral to specialists is reserved for cases with suspected organic disease or refractory symptoms.
Abstract:
Childhood constipation is common and almost always functional without an organic etiology. Stool retention can lead to fecal incontinence in some patients. Often, a medical history and physical examination are sufficient to diagnose functional constipation. Further evaluation for Hirschsprung disease, a spinal cord abnormality, or a metabolic disorder may be warranted in a child with red flags, such as onset before one month of age, delayed passage of meconium after birth, failure to thrive, explosive stools, and severe abdominal distension. Successful therapy requires prevention and treatment of fecal impaction, with oral laxatives or rectal therapies. Polyethylene glycol-based solutions have become the mainstay of therapy, although other options, such as other osmotic or stimulant laxatives, are available. An increase in dietary fiber may improve the likelihood that laxatives can be discontinued in the future. Education is equally important as medical therapy and should include counseling families to recognize withholding behaviors; to use behavior interventions, such as regular toileting and reward systems; and to expect a chronic course with prolonged therapy, frequent relapses, and a need for close follow-up. Referral to a subspecialist is recommended only when there is concern for organic disease or when the constipation persists despite adequate therapy.
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