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:
- van den Berg MM, Benninga MA, Di Lorenzo C. Epidemiology of childhood constipation: a systematic review. Am J Gastroenterol 2006; 101:2401.
- Rubin GP. Childhood constipation. Am Fam Physician 2003; 67:1041.
- Loening-Baucke V. Chronic constipation in children. Gastroenterology 1993; 105:1557.
- Loening-Baucke V. Prevalence, symptoms and outcome of constipation in infants and toddlers. J Pediatr 2005; 146:359.
- Procter E, Loader P. A 6-year follow-up study of chronic constipation and soiling in a specialist paediatric service. Child Care Health Dev 2003; 29:103.
- Leung AK, Chan PY, Cho HY. Constipation in children. Am Fam Physician 1996; 54:611.
- Tabbers MM, DiLorenzo C, Berger MY, et al. Evaluation and treatment of functional constipation in infants and children: evidence-based recommendations from ESPGHAN and NASPGHAN. J Pediatr Gastroenterol Nutr 2014; 58:258.
- Arce DA, Ermocilla CA, Costa H. Evaluation of constipation. Am Fam Physician 2002; 65:2283.
- Burgers RE, Mugie SM, Chase J, et al. Management of functional constipation in children with lower urinary tract symptoms: report from the Standardization Committee of the International Children's Continence Society. J Urol 2013; 190:29.
- Feng WC, Churchill BM. Dysfunctional elimination syndrome in children without obvious spinal cord diseases. Pediatr Clin North Am 2001; 48:1489.
- Hendren WH. Pediatric rectal and perineal problems. Pediatr Clin North Am 1998; 45:1353.
- Benninga MA, Faure C, Hyman PE, et al. Childhood Functional Gastrointestinal Disorders: Neonate/Toddler. Gastroenterology 2016.
- Hyams JS, Di Lorenzo C, Saps M, et al. Functional Disorders: Children and Adolescents. Gastroenterology 2016.
- Di Lorenzo C. Pediatric anorectal disorders. Gastroenterol Clin North Am 2001; 30:269.
- Thiessen PN. Recurrent abdominal pain. Pediatr Rev 2002; 23:39.
- Pensabene L, Buonomo C, Fishman L, et al. Lack of utility of abdominal x-rays in the evaluation of children with constipation: comparison of different scoring methods. J Pediatr Gastroenterol Nutr 2010; 51:155.
- Berger MY, Tabbers MM, Kurver MJ, et al. Value of abdominal radiography, colonic transit time, and rectal ultrasound scanning in the diagnosis of idiopathic constipation in children: a systematic review. J Pediatr 2012; 161:44.
- Rosen R, Buonomo C, Andrade R, Nurko S. Incidence of spinal cord lesions in patients with intractable constipation. J Pediatr 2004; 145:409.
- Siddiqui A, Rosen R, Nurko S. Anorectal manometry may identify children with spinal cord lesions. J Pediatr Gastroenterol Nutr 2011; 53:507.
- Abi-Hanna A, Lake AM. Constipation and encopresis in childhood. Pediatr Rev 1998; 19:23.
- Hellerstein S, Linebarger JS. Voiding dysfunction in pediatric patients. Clin Pediatr (Phila) 2003; 42:43.
- Loening-Baucke V. Urinary incontinence and urinary tract infection and their resolution with treatment of chronic constipation of childhood. Pediatrics 1997; 100:228.
- Tipnis NA, El-Chammas KI, Rudolph CD, et al. Do oro-anal transit markers predict which children would benefit from colonic manometry studies? J Pediatr Gastroenterol Nutr 2012; 54:258.
- Loening-Baucke, V. Constipation and encopresis. In: Pediatric Gastroenterology and Nutrition in Clinical Practice. Lifschitz CH (Ed), Marcel Dekker, New York 2001. p.551.
- Zaslavsky C, da Silveira TR, Maguilnik I. Total and segmental colonic transit time with radio-opaque markers in adolescents with functional constipation. J Pediatr Gastroenterol Nutr 1998; 27:138.
- Benninga MA, Büller HA, Tytgat GN, et al. Colonic transit time in constipated children: does pediatric slow-transit constipation exist? J Pediatr Gastroenterol Nutr 1996; 23:241.
- Hutson JM, McNamara J, Gibb S, Shin YM. Slow transit constipation in children. J Paediatr Child Health 2001; 37:426.
- de Lorijn F, van Wijk MP, Reitsma JB, et al. Prognosis of constipation: clinical factors and colonic transit time. Arch Dis Child 2004; 89:723.
- Hussain SZ, Di Lorenzo C. Motility disorders. Diagnosis and treatment for the pediatric patient. Pediatr Clin North Am 2002; 49:27.
- Osatakul S, Patrapinyokul S, Osatakul N. The diagnostic value of anorectal manometry as a screening test for Hirschsprung's disease. J Med Assoc Thai 1999; 82:1100.
- Pensabene L, Youssef NN, Griffiths JM, Di Lorenzo C. Colonic manometry in children with defecatory disorders. role in diagnosis and management. Am J Gastroenterol 2003; 98:1052.
- - 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