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Management of chronic constipation in infants and toddlers
1University of Iowa College of Medicine, Iowa City.
Insights
Infant constipation, often functional, requires ruling out serious causes like Hirschsprung's disease. Treatment involves disimpaction, laxatives, habit promotion, and toilet training, needing patience for resolution.
Area of Science:
- Pediatrics
- Gastroenterology
- Child Health
Background:
- Constipation is common in infants and toddlers, presenting as infrequent, hard, painful stools and encopresis.
- While often functional, underlying anatomic, endocrinologic, metabolic, or neurologic causes must be excluded.
Purpose of the Study:
- To outline the diagnostic approach and management of constipation in infants and toddlers.
- To highlight Hirschsprung's disease as a significant congenital cause of severe constipation.
Main Methods:
- Clinical history and physical examination to differentiate functional constipation from organic causes.
- Identification of Hirschsprung's disease (aganglionic megacolon) as a specific congenital etiology.
Main Results:
- Functional constipation is the most frequent diagnosis.
- Hirschsprung's disease occurs in approximately 1 in 5,000 births and presents with severe constipation.
Conclusions:
- Effective management includes fecal disimpaction, laxatives, promoting regular bowel habits, and toilet training.
- Treatment requires a supportive, long-term approach, often spanning months to years, with reassurance for parents.
Abstract:
Infants and toddlers with constipation usually have a history of infrequent, hard and painful bowel movements, often accompanied by screaming and stool-holding maneuvers. Encopresis, the intermittent and involuntary passage of formed-to-liquid feces, is common. Although constipation most often has a functional cause, the history and physical examination should rule out anatomic, endocrinologic, metabolic or neurologic causes. Hirschsprung's disease--aganglionic megacolon--is a congenital cause of severe constipation that occurs in one of every 5,000 births. Treatment consists of fecal disimpaction, laxatives to prevent future impaction, promotion of regular bowel habits and, finally, toilet training. Parents should be reassured that although this disorder is not life-threatening, several months to years of supportive intervention may be required for effective treatment.