Childhood constipation

Constipation is common in childhood

• prevalent in around 5-30% of the child population, depending on the criteria used for diagnosis
• symptoms become chronic in more than one third of patients and constipation is a common reason for referral to secondary care

Constipation in children can be divided into causes in infants and causes in older children. There are also a variety of causes that must be considered in the neonate who has never passed meconium.

Constipation is referred to as 'idiopathic' if it cannot be explained by anatomical or physiological abnormalities

• exact cause of 'idiopathic' constipation is not fully understood but factors that may contribute include pain, fever, dehydration, dietary and fluid intake, psychological issues, toilet training, medicines and familial history of constipation

Many people don't recognise the signs and symptoms of constipation and few relate the presence of soiling to constipation

• signs and symptoms of childhood idiopathic constipation include:
  • infrequent bowel activity, foul smelling wind and stools, excessive flatulence, irregular stool texture, passing occasional enormous stools or frequent small pellets, withholding or straining to stop passage of stools, soiling or overflow, abdominal pain, distension or discomfort, poor appetite, lack of energy, an unhappy, angry or irritable mood and general malaise.

Note that there is a high degree of normal variation in the frequency of bowel habit. It is essential to enquire of the parents as to how regular they are.

Reference:

1) NICE (May 2010). Constipation in children and young people: diagnosis and management