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

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If the child or young person has constipation take a history using 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
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
 

'Amber flag': possible idiopathic constipation

Growth and general wellbeing: Faltering growth

Personal/familial/social factors: Disclosure or evidence that raises concerns over possibility of child maltreatment

Reference:

Last reviewed 01/2018

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