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Constipation in children
Insights
Childhood constipation, often functional, can signal organic disorders. Diagnosis relies on history and physical exam, guiding treatment for this common pediatric issue.
Area of Science:
- Pediatrics
- Gastroenterology
Background:
- Constipation affects 5-10% of children, frequently functional.
- Organic causes, though less common, require prompt identification.
Purpose of the Study:
- To differentiate functional from organic constipation in children.
- To outline diagnostic approaches and treatment strategies.
Main Methods:
- Review of clinical presentation, history, and physical examination findings.
- Emphasis on differentiating congenital, acute, and chronic constipation.
- Guidance on when laboratory investigations are indicated.
Main Results:
- Functional constipation is the most common cause.
- Congenital causes are suspected in neonatal-onset constipation.
- Hirschsprung's disease suggested by failure to thrive and abdominal distention.
- Rectal exam differentiates stool-filled (functional) from empty/tight (Hirschsprung's) rectum.
Conclusions:
- Diagnosis of childhood constipation primarily relies on thorough history and physical exam.
- Treatment is cause-directed, with functional constipation managed via diet, habits, and pharmacologic therapy/biofeedback.
- Organic causes necessitate specific interventions based on the underlying disorder.
Abstract:
Constipation is a common childhood condition, estimated to occur in 5 to 10 percent of children. In most cases, the cause is functional. However, constipation may occasionally indicate a significant organic disorder, which can usually be determined by a thorough history and physical examination. Constipation that is present from birth or that begins in the neonatal period is most likely to be congenital in origin. Acute constipation usually has an organic cause, while chronic constipation usually has a functional cause. Failure to thrive and gross distention of the abdomen suggest the diagnosis of Hirschsprung's disease. Rectal examination of a child with constipation usually reveals a distended rectum that is full of stool. In patients with Hirschsprung's disease, the rectum is usually empty and tight. Laboratory investigations are usually not necessary in patients with mild constipation. Treatment should be directed at the underlying cause. Functional constipation can be managed by changes in diet, regular bowel habits and, if necessary, pharmacologic therapy and biofeedback training.