Prevention and treatment of acute constipation in infants and children
- 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 is a common problem throughout childhood and often accepted as a normal variation that will resolve as children get older. The opportunity for early intervention is often missed, and may result in complications, such as anal fissure, stool withholding, and fecal incontinence (also known as encopresis). The prevention of constipation focuses on timely anticipatory guidance regarding diet, toilet training, and toileting behaviors. The treatment of constipation depends upon the age of the child and the duration of symptoms. It may involve education, dietary changes, behavior changes, and pharmacotherapy, alone or in combination [1,2].
The prevention and treatment of acute constipation will be discussed here. The definition, etiology, and diagnosis of constipation are presented separately, as is the treatment of chronic constipation and fecal incontinence. (See "Constipation in infants and children: Evaluation" and "Chronic functional constipation and fecal incontinence in infants and children: Treatment" and "Functional constipation in infants and children: Clinical features and differential diagnosis".)
Constipation is a disorder in which a child passes infrequent bowel movements (two or fewer per week), has painful defecation, or passes large caliber and hard stools that may require excessive straining. Some children may have rectal impaction and overflow fecal incontinence, which typically develops because they have learned to withhold stool, usually to avoid pain during bowel movements.
These symptoms are described as "acute" constipation if they have been present for less than four weeks. Symptoms of longer duration are classified as "chronic" functional constipation if they cannot be fully explained by another condition (table 1) [3,4]. (See "Functional constipation in infants and children: Clinical features and differential diagnosis".)
PREVENTION AND MONITORING
Discussion of dietary and bowel habits should be part of routine health supervision visits for children of all ages. There are certain times during a young child's life when constipation is likely to occur . If parents are given appropriate and timely education, these episodes may be anticipated and prevented, or if not prevented, quickly treated with temporary interventions. Complaints of simple constipation should not be ignored. Painful bowel movements can lead to withholding of stool , worsening constipation, and eventual fecal impaction and fecal incontinence, often without parental awareness of a problem. The pathogenesis of constipation is discussed in detail separately, but mentioned briefly here since it is relevant to the provision of anticipatory guidance. (See "Functional constipation in infants and children: Clinical features and differential diagnosis", section on 'Etiology'.)
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- PREVENTION AND MONITORING
- Transition to solid diet
- Toilet training
- School entry
- Toddlers and children
- - Acute constipation
- - Recurrent constipation
- - Acute constipation
- - Recurrent constipation
- INFORMATION FOR PATIENTS
- SUMMARY AND RECOMMENDATIONS
- Triggers and prevention
- Management in toddlers and children
- Management in Infants