Examination in child with constipation

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Use table below to establish a positive diagnosis of idiopathic constipation by excluding underlying causes. 

If a child or young person has any 'red flag' symptoms do not treat them for constipation. Instead, refer them urgently to a healthcare professional with experience in the specific aspect of child health that is causing concern

If the history-taking and/or physical examination show evidence of faltering growth treat for constipation and test for coeliac disease and hypothyroidism

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Key components	Findings and diagnostic clues that indicate idiopathic constipation	'Red flag' findings and diagnostic clues that indicate an underlying disorder or condition: not idiopathic constipation
Inspection of perianal area: appearance, position, patency, etc	normal appearance of anus and surrounding area	abnormal appearance/position/patency of anus: fistulae, bruising, multiple fissures, tight or patulous anus, anteriorly placed anus, absent anal wink
Abdominal examination	soft abdomen. Flat or distension that can be explained because of age or excess weight	gross abdominal distension
Spine/lumbosacral region/gluteal examination	normal appearance of the skin and anatomical structures of lumbosacral/gluteal regions	abnormal: asymmetry or flattening of the gluteal muscles, evidence of sacral agenesis, discoloured skin, naevi or sinus, hairy patch, lipoma, central pit (dimple that you can't see the bottom of), scoliosis
Lower limb neuromuscular examination including tone and strength	normal gait. Normal tone and strength in lower limbs	deformity in lower limbs such as talipes abnormal neuromuscular signs unexplained by any existing condition, such as cerebral palsy
Lower limb neuromuscular examination: reflexes (perform only if 'red flags' in history or physical examination suggest new onset neurological impairment)	reflexes present and of normal amplitude	abnormal reflexes

Examination in child with constipation

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