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[Constipation in childhood; evaluation of a diagnostic-therapeutic protocol]
H S Heymans1, M A Benninga, I de Groot
1Academisch Ziekenhuis Beatrix Kinderkliniek, afd. Kindergeneeskunde, Groningen.
Insights
A three-phase treatment protocol effectively manages functional constipation in children over three years old. This approach prioritizes diet and laxatives, with further investigation only if initial treatments fail, improving care for pediatric constipation.
Area of Science:
- Pediatric Gastroenterology
- Clinical Therapeutics
- Diagnostic Protocols
Context:
- Constipation is a common pediatric issue requiring effective management strategies.
- Differentiating functional constipation from organic causes like Hirschsprung's disease is crucial.
- Age-specific diagnostic and treatment approaches are necessary for pediatric patients.
Purpose:
- To assess the causes and treatment efficacy of constipation in 87 children.
- To evaluate a three-phase diagnostic-therapeutic protocol for pediatric constipation.
- To compare treatment outcomes based on patient age (<3 vs. >=3 years) and referral status.
Summary:
- A three-phase protocol involving history, physical exam, diet, laxatives, and toilet training was applied to 59 children.
- Functional constipation was diagnosed in 69% of children under 3 and 98% over 3 years.
- The protocol succeeded in 86% of functional constipation cases in children aged 3 years and older, with a mean treatment duration of 9.5 months.
- Hirschsprung's disease was diagnosed in 14% of younger children and 2% of older children.
- For children under 3, limited initial lab tests are advised, with further investigation for Hirschsprung's disease if initial treatment fails.
Impact:
- The study validates a phased, conservative approach for functional constipation in older children, reducing unnecessary investigations.
- It highlights the need for early supplementary examination in younger children (<3 years).
- The findings support tailored diagnostic and therapeutic strategies for pediatric constipation based on age and clinical presentation.
Abstract:
In 87 children with constipation an assessment was made of the causes, and of the effect of treatment. Two subdivisions were made, one by age (< 3 years and > or = 3 years) and the second into 'own' or 'referred' patients. For the 59 own children a diagnostic-therapeutic protocol was used, the three-phase protocol. For children over 3 years (n = 29) this policy consists in the first phase of anamnesis, physical examination, diet and oral and/or rectal laxatives. In the second phase, toilet training is administered in combination with diet and oral laxatives. The third phase comprises continuation of the diet and tapering off of the laxatives. If no improvement is seen, supplementary examination is carried out. In the group of own patients younger than 3 years, supplementary examination is already carried out during the first phase. Functional constipation was diagnosed in 69% and 98%, respectively, of the 36 patients under 3 years and the 51 over 3 years. Hirschsprung's disease was diagnosed in 14% and 2%, respectively. In the children > or = 3 years with functional constipation the three-phase policy was successful in 86% with a mean duration of the treatment of 9.5 months. The efficiency of diagnostic examination of children over 3 years appears to be low, justifying the proposed three-phase policy. In children under 3 years, on the other hand, limited laboratory examination is necessary during the first phase. Examination for the presence of Hirschsprung's disease, by means of rectal biopsy or anorectal manometry is indicated if the treatment during the first phase is unsuccessful.