Pediatric Constipation From Emergency Medicine Cases And The J Pediatr Gastroenterol Nutr

The following is from Episode 19 Part 2: Pediatric Gastroenteritis, Constipation and Bowel Obstruction from Emergency Medicine Cases:


Definition as per Rome III criteria

  • [See Alarm Signs and Symptoms In Constipation below]
  • ≤2 stools per week for a duration of 2mo if patient >2yo and for duration of 4mo if patient <2yo, or with evidence of overflow incontinence (no stool, then diarrhea, then no stool, etc), or stools that clog toilet
  • Functional constipation is the most common cause of abdominal pain in children, but consider it a diagnosis of exclusion as severe underlying disease may be present

Differential diagnoses of Pediatric Constipation

  • Cystic fibrosis and hypothyroidism: assess family history, and whether screening was performed
  • Others: Down syndrome, myelomeningocele or neuromuscular problems (slow to walk, walking “funny”), celiac disease (family history), child abuse


  • Oral medications work better when combined with enemas in the ER, but explain to the parents that it takes time to re‐train the bowel (sometimes years)

  • Enemas: if child <2yo, use saline enema 20cc/kg, and if child >20‐25kg, use adult fleet enema

  • At home: our experts prefer PEG 3350 (OTC Laxaday©) at dose of 1.5g/kg/d (rounded to the nearest ½cup of 17g) dissolved in 8ounces of juice, then titrate dose up or down for 1 soft stool per day, and with goal to slowly taper down


What follows is from the: Evaluation and Treatment of Functional Constipation in
Infants and Children: Evidence-Based Recommendations From ESPGHAN and NASPGHAN [PubMed Abstract] [Full Text PDF] J Pediatr Gastroenterol Nutr. 2014 Feb;58(2):258-74.







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