Constipation in infants and children: Evaluation
- Manu R Sood, FRCPCH, MD
Manu R Sood, FRCPCH, MD
- Professor and Chief
- Division of Pediatric Gastroenterology, Hepatology and Nutrition Medical College of Wisconsin
Constipation affects up to 30 percent of children and accounting for an estimated 3 to 5 percent of all visits to pediatricians . The peak prevalence is during the preschool years in most reports. There is no consistent effect of gender on the prevalence of childhood constipation.
Complaints range from infrequent bowel evacuation, hard small feces, difficult or painful evacuation of large-diameter stools, and fecal incontinence (voluntary or involuntary evacuation of feces into the underwear, also known as encopresis) [2,3]. Most but not all children with fecal incontinence have underlying constipation.
Functional constipation is responsible for more than 95 percent of cases of constipation in healthy children one year and older, and is particularly common among preschool aged children . Although it is common, it is important to evaluate affected children to identify the few that have organic causes of constipation. Moreover, children with functional constipation will benefit from prompt and thorough treatment interventions. Delayed or inadequate intervention may result in stool withholding behavior with worsening constipation and psychosocial consequences.
The evaluation of an infant or child with constipation will be reviewed here. Related information is available in the following topic reviews:
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- - Alarm signs
- - Psychosocial and environmental factors
- - Constipation and bladder dysfunction
- Physical examination
- - External examination
- - Digital anorectal examination
- DIAGNOSIS OF FUNCTIONAL CONSTIPATION
- Diagnostic criteria
- Exclusion of organic causes
- FURTHER TESTING
- Laboratory tests
- Motility testing
- - Colon transit studies
- - Anorectal manometry
- INFORMATION FOR PATIENTS
- SUMMARY AND RECOMMENDATIONS