History taking in children (to discriminate features suggestive of idiopathic constipation or other causes)

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

Timing of onset of constipation and potential precipitating factors

• in a child younger than 1 year:
  • starts after a few weeks of life
  • obvious precipitating factors coinciding with the start of symptoms: fissure, change of diet, infections
• in a child/young person older than 1 year:
  • starts after a few weeks of life
  • obvious precipitating factors coinciding with the start of symptoms: fissure, change of diet, timing of potty/toilet training or acute events such as infections, moving house, starting nursery/school, fears and phobias, major change in family, taking medicines

• reported from birth or first few weeks of life

Passage of meconium

• normal (within 48 hours after birth [in term baby])

• failure to pass meconium/delay (more than 48 hours after birth [in term baby)

Stool patterns

• 'ribbon stools' (more likely in a child younger than 1 year)

Growth and well-being

• in a child younger than 1 year:
  • generally well, weight and height within normal limits
• in a child/young person older than 1 year:
  • generally well, weight and height within normal limits, fit and active

• No 'red flag', but see 'amber flag' below

Symptoms in legs /locomotor development

• no neurological problems in legs (such as falling over in a child/young person older than 1 year), normal locomotor development

• previously unknown or undiagnosed weakness in legs, locomotor delay

Abdomen

• abdominal distension with vomiting

Diet and fluid intake

• in a child younger than 1 year:
  • changes in infant formula, weaning, insufficient fluid intake
• in a child/young person older than 1 year:
  • History of poor diet and/or insufficient fluid intake