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Paediatric constipation for general paediatricians: Review using a case-based and evidence-based approach.

Rishi Bolia1, Mark Safe2, Bridget R Southwell3,4,5

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|November 16, 2020
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Childhood constipation, primarily functional, requires evidence-based management. This review offers clinical scenarios, treatment strategies, and an algorithm for effective pediatric constipation care.

Keywords:
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Area of Science:

  • Pediatrics
  • Gastroenterology
  • Clinical Management

Background:

  • Constipation is a prevalent pediatric issue, with functional constipation comprising 90-95% of cases.
  • Effective management requires distinguishing functional from organic causes and addressing 'red flags'.

Purpose of the Study:

  • To provide evidence-based clinical scenarios and a management algorithm for pediatric constipation.
  • To guide healthcare providers in diagnosing and treating constipation in children, including resistant cases.

Main Methods:

  • Review of recent guidelines and online information resources.
  • Presentation of four distinct clinical scenarios illustrating different constipation types and ages.
  • Inclusion of diagnostic red flags and organic causes.

Main Results:

  • Functional constipation management involves education, disimpaction, maintenance therapy with laxatives, dietary counseling, and toilet training.
  • Treatment varies for infants versus older children; radionuclide intestinal transit study (scintigraphy) aids in resistant cases.
  • High-level evidence for pharmacological and non-pharmacological treatments is reviewed.

Conclusions:

  • A structured approach, including a clinical algorithm, is essential for managing pediatric constipation.
  • Early identification of red flags and appropriate treatment strategies improve outcomes.
  • Referral is indicated for treatment failure or suspected organic disease.