Materiały źródłowe

• #1 Constipation in Children and Adolescents: Evaluation and Treatment | AAFP

  https://www.aafp.org/pubs/afp/issues/2022/0500/p469.html

  Constipation in children is usually functional constipation without an organic cause. Organic causes of constipation in children, which include Hirschsprung disease, cystic fibrosis, and spinal cord abnormalities, commonly present with red flag signs and symptoms. A history and physical examination can diagnose functional constipation using the Rome IV diagnostic criteria. […] Referral to a pediatric gastroenterologist is recommended when there is a concern for organic causes or constipation persists despite adequate therapy. […] Functional constipation is diagnosed by history and physical examination findings in patients without red flag signs or symptoms. […] Digital rectal examination and abdominal radiography should not be performed routinely in children with suspected functional constipation.

• #2 Paediatric constipation: An approach and evidence-based treatment regimen

  https://www1.racgp.org.au/ajgp/2018/may/paediatric-constipation

  Constipation affects 530% of children and is responsible for 3% of primary care visits. […] The aim of this article is to review the assessment and management of children with constipation to empower GPs to initiate treatment and know when to refer to a paediatrician. […] In the absence of organic aetiology, childhood constipation is almost always functional and often due to painful bowel movements that prompt the child to withhold stool. […] The Rome IV criteria are applied in order to formally define functional constipation. Constipation under these criteria requires two or more of the following: two or fewer defaecations per week, at least one episode of faecal incontinence per week, history of retentive posturing or excessive volitional stool retention, history of painful or hard bowel movements, presence of a large faecal mass in the rectum, history of large diameter stools that may obstruct the toilet, symptoms occurring at least once per month for a minimum of one month, with insufficient criteria to diagnose irritable bowel syndrome.

• #3 Childhood constipation

  https://www.racgp.org.au/afp/2017/december/childhood-constipation

  Constipation is best defined as difficulty passing stools that may be infrequent (2 per week), painful and associated with stool retention. […] Successful diagnosis and management can occur in primary care, and specialist referral is only needed for refractory cases or concerns regarding organic pathology. […] Structured history and examination can screen for organic pathology or red flags that require specialist referral. […] Investigations such as abdominal X-ray are not routine. […] Treatment needs to first disimpact hard stool from the bowel, then maintain ongoing soft stools. […] Successful management of childhood functional constipation in primary care will have a significant positive impact for children and families, and be very rewarding for clinicians. […] Childhood functional constipation is best described using the Rome IV criteria and is defined by the presence of two or more of the following features for at least one month: 2 stools per week, excessive stool retention, painful or hard bowel movements, presence of large faecal mass in rectum, history of large diameter bulky stools, 1 episode per week of faecal incontinence after toilet training completed.

• #4 Pediatric Functional Constipation – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK537037/

  Functional constipation is a term used to describe a condition in which patients have hard, infrequent bowel movements that are often difficult or painful to pass. […] This activity underscores the importance of diagnosing functional constipation as a condition of exclusion, ruling out underlying organic causes, which account for only about 5% of cases. […] Functional constipation is defined as functional constipation if there is no underlying organic cause, which is the case in up to 95% of children. […] Functional constipation is a clinical diagnosis based on history and physical examination. […] History should include information about the frequency and consistency of stools, associated issues, and the duration of symptoms. […] Rome IV defines functional constipation separately for infants and children older than 4 years of age.

• #5 Constipation in Children – Pediatrics – Merck Manual Professional Edition

  https://www.merckmanuals.com/professional/pediatrics/symptoms-in-infants-and-children/constipation-in-children

  Constipation in children is divided into 2 main types: Organic (5%) and Functional (95%). […] Organic causes of constipation involve specific structural, neurologic, toxic/metabolic, or intestinal disorders. […] Functional constipation is difficulty passing stools for reasons other than organic causes. […] Evaluation should focus on differentiating functional constipation from constipation with an organic cause. […] A primary finding that suggests an organic cause in neonates is constipation from birth; those who have had a normal bowel movement are unlikely to have a significant structural disorder. […] In older children, clues to an organic cause include constitutional symptoms (particularly weight loss, fever, or vomiting), poor growth (decreasing percentile on growth charts), an overall ill appearance, and any focal abnormalities detected during examination.

• #6 Constipation in children – Diagnosis & treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/constipation-in-children/diagnosis-treatment/drc-20354248

  Your child’s doctor will: […] Gather a complete medical history. Your child’s doctor will ask you about your child’s past illnesses. He or she will also likely ask you about your child’s diet and physical activity patterns. […] Conduct a physical exam. Your child’s physical exam will likely include placing a gloved finger into your child’s anus to check for abnormalities or the presence of impacted stool. Stool found in the rectum may be tested for blood. […] More-extensive testing is usually reserved for only the most severe cases of constipation. If necessary, these tests may include: […] Abdominal X-ray. This standard X-ray test allows your child’s doctor to see if there are any blockages in your child’s abdomen. […] Anorectal manometry or motility test. In this test, a thin tube called a catheter is placed in the rectum to measure the coordination of the muscles your child uses to pass stool.

• #7 Evaluation and Treatment of Constipation in Children and Adolescents | AAFP

  https://www.aafp.org/pubs/afp/issues/2014/0715/p82.html

  Childhood constipation is common and almost always functional without an organic etiology. Stool retention can lead to fecal incontinence in some patients. Often, a medical history and physical examination are sufficient to diagnose functional constipation. Further evaluation for Hirschsprung disease, a spinal cord abnormality, or a metabolic disorder may be warranted in a child with red flags, such as onset before one month of age, delayed passage of meconium after birth, failure to thrive, explosive stools, and severe abdominal distension. […] A history and physical examination are usually sufficient to distinguish functional constipation from constipation caused by organic conditions. […] The Rome III criteria are the most accepted criteria for diagnosing childhood constipation. However, the time duration does not need to be fulfilled to start therapy because there is evidence that early treatment favorably affects outcome.

• #8 Constipation | Symptoms, Diagnosis & Treatment

  https://www.cincinnatichildrens.org/health/c/constipation

  Constipation is a common problem for children. Children who are constipated will often hold in their poop and try not to go to the bathroom. […] When your child is having trouble with constipation, they may have: A decrease in how often they poop, may skip days between pooping; Hard, dry poop; Trouble pushing poop out of their rectum; Pain with pooping; Abdominal bloating, cramping or pain; Small liquid stools or smears of stool in their underwear. […] During an office visit, a doctor (or advanced practice nurse) will ask you questions about your child’s medical history and complete an exam. The provider might ask questions like: How old was the child when they had their first poop as a newborn baby? How often does your child poop? Does your child complain of pain with pooping? Have you been trying to toilet train your child lately? What is your child’s diet like? Has your child had any increased stress lately? Does your child soil their pants? If so, how often?

• #9 Toddler Constipation: Symptoms, Causes & Treatment

  https://my.clevelandclinic.org/health/diseases/17785-constipation-in-children

  Constipation in toddlers is very common. Toddlers who are constipated poop (have a bowel movement) less frequently than usual. Every toddler is different, but this usually means they poop less than two times a week. When they do go, their poop (stool) is hard, dry and large in size. Their poop may be difficult or painful to pass. […] To diagnose constipation, your childs healthcare provider will ask about your childs symptoms and medical history and perform a physical examination. Theyll ask you about your childs: Bathroom and bowel movement patterns. Diet and eating habits. Toilet training. Health problems (if any). Medications (if any). […] Your child probably wont need any tests to diagnose their condition. Your childs healthcare provider may order tests if their constipation is caused by an underlying health condition. Tests they may order include: Abdominal X-ray: An X-ray can show stool thats still in your childs colon. Blood test: Blood tests, such as a complete blood count, can show signs of certain diseases. Stool test: A stool test can show signs of infection or blood in your childs stool. Urine test: A urine test can show signs of bladder inflammation or infection. Bowel function test: This test can show how well stool moves through your childs colon. Rectal biopsy: A small piece of tissue from your childs rectum will be examined under a microscope. […] Take your child to their healthcare provider if their constipation lasts for more than two weeks and home remedies arent helping. Your child may need additional treatment.

• #10 Evaluation and Treatment of Constipation in Children and Adolescents | AAFP

  https://www.aafp.org/pubs/afp/issues/2014/0715/p82.html

  Physical examination should include a review of growth parameters, an abdominal examination, an external examination of the perineum and perianal area, an evaluation of the thyroid and spine, and a neurologic evaluation for appropriate reflexes. A digital examination of the anorectum is recommended to assess for perianal sensation, anal tone, rectum size, anal wink, and amount and consistency of stool in the rectum. […] Abdominal radiography is of limited value in diagnosing chronic constipation because it lacks interobserver reliability and accuracy. It should be reserved for specific clinical circumstances in which a rectal examination is unreasonable or the diagnosis is uncertain. […] Further evaluation is indicated in older children with red flags or with intractable constipation despite strict adherence to therapy. Laboratory studies may be performed to evaluate for systemic diseases, such as thyroid disease, other metabolic diseases, celiac disease, or lead toxicity. […] Referral to a pediatric gastroenterologist may be needed when a child with constipation has red flags for organic disease or the constipation is unresponsive to adequate therapy.

• #11 Diagnosis of Constipation in Children – NIDDK

  https://www.niddk.nih.gov/health-information/digestive-diseases/constipation-children/diagnosis

  Doctors use your childs medical and family history, a physical exam, or medical tests to diagnose and find the cause of constipation. […] During a physical exam, a doctor may check your childs abdomen for swelling or tenderness. […] Doctors dont normally need medical tests to diagnose constipation in children. However, in some cases, your childs doctor may use medical tests to help find the cause of constipation. […] If your childs constipation doesnt improve with nutrition changes, your childs doctor may use bowel function tests, including colorectal transit studies. […] In some cases, your childs doctor may use imaging tests of your childs abdomen to look for problems that may be causing his or her constipation. […] Your childs doctor may suggest a rectal biopsy. The rectal biopsy is the best test to diagnose or rule out Hirschsprung disease.

• #12 Constipation in Children and Adolescents: Evaluation and Treatment | AAFP

  https://www.aafp.org/pubs/afp/issues/2022/0500/p469.html

  Constipation in children is usually functional constipation without an organic cause. Organic causes of constipation in children, which include Hirschsprung disease, cystic fibrosis, and spinal cord abnormalities, commonly present with red flag signs and symptoms. A history and physical examination can diagnose functional constipation using the Rome IV diagnostic criteria. […] Referral to a pediatric gastroenterologist is recommended when there is a concern for organic causes or constipation persists despite adequate therapy. […] Functional constipation is diagnosed by history and physical examination findings in patients without red flag signs or symptoms. […] Digital rectal examination and abdominal radiography should not be performed routinely in children with suspected functional constipation.

• #13 Constipation in Children and Adolescents: Evaluation and Treatment | AAFP

  https://www.aafp.org/pubs/afp/issues/2022/0500/p469.html

  Functional constipation is a clinical diagnosis based on Rome IV diagnostic criteria. The Rome IV criteria are symptom based, and no additional testing is required in patients without red flag signs and symptoms. […] A comprehensive history and physical examination are usually sufficient to diagnose functional constipation and should exclude red flag signs and symptoms suggesting organic causes. […] There is insufficient evidence to support routine digital rectal examination for the diagnosis of constipation, especially in children older than one year with no red flag signs or symptoms. […] Additional diagnostic testing (i.e., laboratory tests, radiography, colonic transit time, and anorectal manometry) is not required in children with functional constipation and no red flag signs or symptoms.

• #14 Constipation in children — gpraj

  https://gpraj.com/paediatric-medicine/2020/1/14/constipation-in-children

  Abdominal distension with vomiting. […] Abnormal appearance/position/patency of anus: fistulae, bruising, multiple fissures, tight or patulous anus, anteriorly placed anus, absent anal wink. […] Digital rectal examination should be undertaken only by healthcare professionals competent to interpret features of anatomical abnormalities or Hirschsprung’s disease. […] If a child younger than 1 year has a diagnosis of idiopathic constipation that does not respond to optimum treatment within 4 weeks, refer them urgently to a healthcare professional competent to perform a digital rectal examination and interpret features of anatomical abnormalities or Hirschsprung’s disease. […] Do not perform a digital rectal examination in children or young people older than 1 year with a 'red flag’ refer them urgently to a healthcare professional competent to perform a digital rectal examination and interpret features of anatomical abnormalities or Hirschsprung’s disease.

• #15 Paediatric constipation: An approach and evidence-based treatment regimen

  https://www1.racgp.org.au/ajgp/2018/may/paediatric-constipation

  Constipation affects 530% of children and is responsible for 3% of primary care visits. […] The aim of this article is to review the assessment and management of children with constipation to empower GPs to initiate treatment and know when to refer to a paediatrician. […] In the absence of organic aetiology, childhood constipation is almost always functional and often due to painful bowel movements that prompt the child to withhold stool. […] The Rome IV criteria are applied in order to formally define functional constipation. Constipation under these criteria requires two or more of the following: two or fewer defaecations per week, at least one episode of faecal incontinence per week, history of retentive posturing or excessive volitional stool retention, history of painful or hard bowel movements, presence of a large faecal mass in the rectum, history of large diameter stools that may obstruct the toilet, symptoms occurring at least once per month for a minimum of one month, with insufficient criteria to diagnose irritable bowel syndrome.

• #16 Constipation in children and adolescents – Knowledge @ AMBOSS

  https://www.amboss.com/us/knowledge/constipation-in-children-and-adolescents/

  Diagnostics are not routinely required if the Rome IV diagnostic criteria for functional constipation in children are met. […] Refer to pediatric gastroenterology for further evaluation of: red flags in pediatric constipation (i.e., concern for secondary constipation), lack of improvement despite treatment, children with no red flag features who do not meet the diagnostic criteria for functional constipation. […] Functional constipation is a clinical diagnosis that is based on the presence of 2 of the following for 1 month: 2 defecations per week, history of voluntary stool retention; and/or, in children with developmental age 4 years, stool-withholding behaviors, painful or hard bowel movements, large fecal mass in the rectum, toilet-trained toddlers and children: history of large-diameter stools that can obstruct the toilet, toilet-trained children and adolescents: 1 episode of fecal incontinence per week (retentive encopresis).

• #17 Pediatric Constipation

  https://mobile.fpnotebook.com/GI/Peds/PdtrcCnstptn.htm

  Child stiffens body to contract buttocks or anal sphincter […] Child hides in corner while stooling in diaper, crosses legs, rocks back and forth or fidgets with each urge to defecate […] Results in fecal stasis with hardening and enlarging of distal stool, that becomes more difficult to pass […] Ultimately stretches Rectum, decreases Defecation urge Sensation and results in Stool Incontinence […] Rome 4 Criteria for Functional Constipation 4 years old (at least 2 criteria present for 1 month) […] Two or less Bowel Movements per week […] One or more Stool Incontinence episodes per week (after Toilet Training is complete) […] Excessive stool retention history […] Painful or hard Bowel Movement history […] Large rectal fecal mass […] Large diameter stools (may plug the toilet)

• #18 Pediatric Functional Constipation – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK537037/

  After appropriate evaluation, another medical condition cannot fully explain the symptoms. […] Children with a history and exam consistent with functional constipation may not require any specific testing. […] A thorough head-to-toe physical examination is necessary. […] The differential diagnosis of constipation includes anatomic abnormalities like anal atresia and presacral masses, metabolic conditions like hypothyroidism, cystic fibrosis, and lead intoxication, and neurologic conditions like meningomyelocele and Hirsprung disease. […] In most cases, a thorough history and physical examination will rule out most of these conditions. […] The diagnosis needs to be reevaluated, and more testing may be necessary if there is a recurring failure despite sufficient adherence to a maximal laxative regimen. […] Anorectal manometry and/or balloon expulsion tests should be used to assess patients with chronic constipation who continue to experience it despite following the recommended medicinal and behavioral interventions.

• #19 Constipation in Children: Novel Insight Into Epidemiology, Pathophysiology and Management

  https://www.jnmjournal.org/journal/view.html?volume=17&number=1&spage=35

  Constipation has long been considered a symptom, rather than a disease.1 It is often perceived as infrequent motions or passage of hard stools. Some defined constipation as less than 3 bowel motions per week2 or as difficulty in passing stools.3 Approximately 0.5% of school children have defecation frequency less than 3 per week and 0.3% have fecal incontinence.4 Furthermore, 20% of children also have at least 1 clinical feature of constipation.5 Therefore, it is important to use diagnostic criteria based on multiple symptoms to define constipation. […] In 1999, Rome II criteria were developed to diagnose defecation disorders.6 Functional constipation was identified in infants and preschool children and functional fecal retention in older children. Subsequently, Rome II criteria were found to be too restrictive in diagnosing defecation disorders because they did not include cardinal features of constipation (fecal incontinence) as diagnostic criteria and demanded persistence of symptoms for at least 3 months.7,8 Furthermore, division of functional constipation and functional fecal retention has no implications in clinical practice. However, the Rome process established a pathway to formulate universally acceptable diagnostic criteria for childhood defecation disorders through international collaboration.

• #20 Evaluation and Treatment of Constipation in Children and Adolescents | AAFP

  https://www.aafp.org/pubs/afp/issues/2014/0715/p82.html

  Childhood constipation is common and almost always functional without an organic etiology. Stool retention can lead to fecal incontinence in some patients. Often, a medical history and physical examination are sufficient to diagnose functional constipation. Further evaluation for Hirschsprung disease, a spinal cord abnormality, or a metabolic disorder may be warranted in a child with red flags, such as onset before one month of age, delayed passage of meconium after birth, failure to thrive, explosive stools, and severe abdominal distension. […] A history and physical examination are usually sufficient to distinguish functional constipation from constipation caused by organic conditions. […] The Rome III criteria are the most accepted criteria for diagnosing childhood constipation. However, the time duration does not need to be fulfilled to start therapy because there is evidence that early treatment favorably affects outcome.

• #21 Constipation in children and adolescents – Knowledge @ AMBOSS

  https://www.amboss.com/us/knowledge/constipation-in-children-and-adolescents/

  Constipation is characterized by the infrequent and sometimes painful passage of hard stools. Pediatric constipation is common, with a worldwide prevalence of approximately 10%. Functional constipation accounts for the majority of cases in children and adolescents. Secondary constipation, which is the result of an underlying pathological condition (e.g., Hirschsprung disease, spinal cord abnormalities, metabolic disorder) accounts for fewer than 5% of pediatric constipation. Diagnostics are not routinely recommended to confirm functional constipation; a clinical diagnosis can be established if the Rome IV diagnostic criteria for pediatric functional constipation are met. […] Diagnostic studies should be performed if secondary constipation is suspected (e.g., constipation in infants aged <6 months, presence of red flags in pediatric constipation) or if symptoms persist despite treatment.

• #22 Constipation — Risk for Alternative Diagnoses, Differential Diagnosis — Clinical Pathway: Emergency Department and Inpatient | Children’s Hospital of Philadelphia

  https://www.chop.edu/clinical-pathway/constipation-risk-alternative-diagnoses-differential-diagnosis

  The diagnosis of functional constipation is most often made through careful history and physical […] Further Evaluation is Indicated if Concern for Alternative Diagnoses Tests should be targeted to findings by History and Physical Exam. […] Concerns for Alternative Diagnoses include delayed passage meconium after 48 hrs of life, symptom onset 1 mos, persistent abdominal distention, vomiting, bloody diarrhea, bilious emesis, family history Hirschsprungs disease, malnutrition, tight rectum gripping finger; explosive stool and air from rectum upon withdrawal examining finger, poor growth, significant weight loss, concern for abdominal mass, abnormal neurologic exam especially lower extremities, rectal exam, and lower spin abnormalities. […] Differential Diagnosis of Constipation includes functional constipation, cows milk allergy, Crohns disease, celiac disease, malnutrition, starvation, poor fluid intake, motility disorders such as Hirschsprung disease and congenital pseudo-obstruction, neurologic issues like infant botulism and spinal cord abnormality, endocrine disorders such as thyroid disorders, toxins like lead, and medications known to cause constipation including antidepressants, antipsychotics, iron, loperamide, anticholinergics, and antihistamines.

• #23 Constipation in children — gpraj

  https://gpraj.com/paediatric-medicine/2020/1/14/constipation-in-children

  Considering the need for specialist referral if symptoms do not respond to optimal treatment in primary care, or if there is faecal impaction and the child is very distressed. […] Refer children and young people with idiopathic constipation who do not respond to initial treatment within 3 months to a practitioner with expertise in the problem. […] Referral for specialist assessment by a paediatrician is indicated in constipation when: An underlying cause is suspected. […] There are 'red flags’ such as failure to thrive, distended abdomen, blood and/or mucus in the stools. […] Treatment is unsuccessful. […] Management is complex (and requires more than the advice, support, and prescription of laxatives that can be provided in primary care because there are major psychological causes or consequences).

• #24 Constipation in children and adolescents – Knowledge @ AMBOSS

  https://www.amboss.com/us/knowledge/constipation-in-children-and-adolescents/

  Children with functional constipation and no red flag features should not be routinely screened for cow’s milk protein allergy, hypothyroidism, hypercalcemia, or celiac disease. […] Referral to pediatric gastroenterology is recommended for advanced diagnostics if clinically indicated to evaluate for secondary constipation.

• #25 Constipation in Children and Adolescents: Evaluation and Treatment | AAFP

  https://www.aafp.org/pubs/afp/issues/2022/0500/p469.html

  Functional constipation is a clinical diagnosis based on Rome IV diagnostic criteria. The Rome IV criteria are symptom based, and no additional testing is required in patients without red flag signs and symptoms. […] A comprehensive history and physical examination are usually sufficient to diagnose functional constipation and should exclude red flag signs and symptoms suggesting organic causes. […] There is insufficient evidence to support routine digital rectal examination for the diagnosis of constipation, especially in children older than one year with no red flag signs or symptoms. […] Additional diagnostic testing (i.e., laboratory tests, radiography, colonic transit time, and anorectal manometry) is not required in children with functional constipation and no red flag signs or symptoms.

• #26 Childhood constipation

  https://www.racgp.org.au/afp/2017/december/childhood-constipation

  Investigations are not necessary if the history is consistent with functional childhood constipation. […] Full blood count and testing for coeliac disease, hypercalcaemia or hypothyroidism should be considered in cases of intractable constipation. […] Digital rectal examination is not routinely indicated in children, as the history and abdominal examination is sufficient for evaluation of retained stool: refer for specialist assessment if there are specific concerns. […] If there are ongoing symptoms of constipation after six months of appropriate treatment, a referral for specialist care and a second opinion is warranted.

• #27 Evaluation and Treatment of Constipation in Children and Adolescents | AAFP

  https://www.aafp.org/pubs/afp/issues/2014/0715/p82.html

  Physical examination should include a review of growth parameters, an abdominal examination, an external examination of the perineum and perianal area, an evaluation of the thyroid and spine, and a neurologic evaluation for appropriate reflexes. A digital examination of the anorectum is recommended to assess for perianal sensation, anal tone, rectum size, anal wink, and amount and consistency of stool in the rectum. […] Abdominal radiography is of limited value in diagnosing chronic constipation because it lacks interobserver reliability and accuracy. It should be reserved for specific clinical circumstances in which a rectal examination is unreasonable or the diagnosis is uncertain. […] Further evaluation is indicated in older children with red flags or with intractable constipation despite strict adherence to therapy. Laboratory studies may be performed to evaluate for systemic diseases, such as thyroid disease, other metabolic diseases, celiac disease, or lead toxicity. […] Referral to a pediatric gastroenterologist may be needed when a child with constipation has red flags for organic disease or the constipation is unresponsive to adequate therapy.

• #28 Constipation in Children and Adolescents: Evaluation and Treatment | AAFP

  https://www.aafp.org/pubs/afp/issues/2022/0500/p469.html

  Functional constipation is a clinical diagnosis based on Rome IV diagnostic criteria. The Rome IV criteria are symptom based, and no additional testing is required in patients without red flag signs and symptoms. […] A comprehensive history and physical examination are usually sufficient to diagnose functional constipation and should exclude red flag signs and symptoms suggesting organic causes. […] There is insufficient evidence to support routine digital rectal examination for the diagnosis of constipation, especially in children older than one year with no red flag signs or symptoms. […] Additional diagnostic testing (i.e., laboratory tests, radiography, colonic transit time, and anorectal manometry) is not required in children with functional constipation and no red flag signs or symptoms.

• #29 The Diagnostic Accuracy of Abdominal X-ray in Childhood Constipation: A Systematic Review of the Literature

  https://www.mdpi.com/2624-5647/6/1/6

  The objective of this study was to evaluate the diagnostic accuracy of abdominal X-ray for the evaluation of functional constipation in children. […] There is insufficient evidence to support the use of abdominal X-ray as part of the diagnostic workup of functional constipation. More methodologically rigorous studies are needed to determine the utility of abdominal X-ray in the evaluation of functional constipation. The diagnosis of functional constipation should be based on history and clinical findings. […] Clinical practice guidelines discourage the use of AXR for the diagnostic workup of children with constipation due to its limited value, misleading nature, and radiation exposure. AXR is an imperfect test for the assessment of constipation in children due to the absence of comparative radiologic normative data from children without constipation and the fact that symptoms may not correlate with the extent of faecal loading seen on the AXR or if other factors, such as air in the colon rather than the stool, may play a role in symptomatology.

• #30 Abdominal Radiographs: Misleading in the Diagnosis of Pediatric Constipationlogo-32logo-40logo-60NEJM Journal WatchnejmJW_1L_RGB-b

  https://www.jwatch.org/na32709/2013/11/05/abdominal-radiographs-misleading-diagnosis

  Abdominal x-rays were obtained more often in misdiagnosed children evaluated for constipation. […] Abdominal radiographs are not recommended for evaluation of a primary suspected diagnosis of constipation. […] Constipation is diagnosed by at least two of the following criteria: <3 stools/week, ≥1 episode of fecal incontinence, large stool palpated on rectal or abdominal examination, passing large amounts of stool obstructing the toilet, posturing suggesting withholding, and painful defecation. Thus, the diagnosis can be made from history and physical exam. [...] Unless an alternative diagnosis is being considered, abdominal x-rays are not helpful and can delay us from recognizing more serious diagnoses.

• #31 Constipation in children – Diagnosis & treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/constipation-in-children/diagnosis-treatment/drc-20354248

  Barium enema X-ray. In this test, the lining of the bowel is coated with a contrast dye (barium) so that the rectum, colon and sometimes part of the small intestine can be clearly seen on an X-ray. […] Rectal biopsy. In this test, a small sample of tissue is taken from the lining of the rectum to see if nerve cells are normal. […] Transit study or marker study. In this test, your child will swallow a capsule containing markers that show up on X-rays taken over several days. Your child’s doctor will analyze the way the markers move through your child’s digestive tract. […] Blood tests. Occasionally, blood tests are performed, such as a thyroid panel. […] If your child’s constipation lasts longer than two weeks, you’ll likely first seek medical care from your child’s doctor. If necessary, your child may be referred to a specialist in digestive disorders (gastroenterologist).

• #32 Constipation in Children – American College of Gastroenterology

  https://gi.org/topics/constipation-in-children/

  Your doctor may suggest one or more of the following special tests for constipation: Plain x-ray of the abdomen (also known as a KUB) This is a single or set of x-rays that can give your physician a rough idea if there is a lot of stool present. It may also indicate if the colon is dilated. […] Anorectal manometry or motility test This test determines if the nerves and muscles responsible for passing a bowel movement are working together. It is performed by inserting a very small balloon at the end of a catheter into the rectum and blowing up the balloon. The response to inflating the balloon determines if the nerves and muscles are working together properly. Relaxation of the anal muscles, known as the anal sphincter, after inflation of the balloon should occur. […] Barium enema This is an x-ray test where barium or another type of contrast is inserted via a catheter into the rectum and x-rays of the abdomen are taken. The test may or may not require a special bowel preparation to clean out the bowel before the test. This test is used to diagnose a blockage in the intestine or an area that may be narrowed or abnormal. It is also used in the diagnosis of Hirschsprung’s disease.

• #33 Constipation in children – Symptoms, diagnosis and treatment | BMJ Best Practice

  https://bestpractice.bmj.com/topics/en-us/784

  1st investigations to order include no initial test. […] Investigations to consider include abdominal x-ray, radiopaque marker colonic transit study, abdominal ultrasound, contrast enema, rectal suction biopsy, and psychological assessment. […] Emerging tests include anorectal manometry and colonic manometry.

• #34 Chronic Constipation Diagnosis | Stanford Health Care

  https://stanfordhealthcare.org/medical-conditions/digestion-and-metabolic-health/chronic-constipation/diagnosis.html

  Colonic transit study (Sitz marker study): This test assesses how long it takes for food to move from your stomach through a bowel movement with a series of X-rays and a capsule with tiny rings that you swallow. […] Colonoscopy or sigmoidoscopy: Examining the entire length of your colon (screening colonoscopy) or just the lower part of your colon (sigmoidoscopy) with the help of a small flexible tube and tiny camera we insert into your rectum. […] Defecating proctogram: Recording movement in your pelvic floor muscles and rectum while you attempt to empty the contents of your rectum […] Magnetic resonance imaging (MRI) defecography: Examining all structures in your pelvic floor, rectum, and sphincter, with the help of magnetic resonance imaging, which uses radio waves and a strong magnetic field

• #35 Chronic Constipation Diagnosis | Stanford Health Care

  https://stanfordhealthcare.org/medical-conditions/digestion-and-metabolic-health/chronic-constipation/diagnosis.html

  Colonic transit study (Sitz marker study): This test assesses how long it takes for food to move from your stomach through a bowel movement with a series of X-rays and a capsule with tiny rings that you swallow. […] Colonoscopy or sigmoidoscopy: Examining the entire length of your colon (screening colonoscopy) or just the lower part of your colon (sigmoidoscopy) with the help of a small flexible tube and tiny camera we insert into your rectum. […] Defecating proctogram: Recording movement in your pelvic floor muscles and rectum while you attempt to empty the contents of your rectum […] Magnetic resonance imaging (MRI) defecography: Examining all structures in your pelvic floor, rectum, and sphincter, with the help of magnetic resonance imaging, which uses radio waves and a strong magnetic field

• #36 Constipation in children – Diagnosis & treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/constipation-in-children/diagnosis-treatment/drc-20354248

  Your child’s doctor will: […] Gather a complete medical history. Your child’s doctor will ask you about your child’s past illnesses. He or she will also likely ask you about your child’s diet and physical activity patterns. […] Conduct a physical exam. Your child’s physical exam will likely include placing a gloved finger into your child’s anus to check for abnormalities or the presence of impacted stool. Stool found in the rectum may be tested for blood. […] More-extensive testing is usually reserved for only the most severe cases of constipation. If necessary, these tests may include: […] Abdominal X-ray. This standard X-ray test allows your child’s doctor to see if there are any blockages in your child’s abdomen. […] Anorectal manometry or motility test. In this test, a thin tube called a catheter is placed in the rectum to measure the coordination of the muscles your child uses to pass stool.

• #37 Constipation in Children – American College of Gastroenterology

  https://gi.org/topics/constipation-in-children/

  Your doctor may suggest one or more of the following special tests for constipation: Plain x-ray of the abdomen (also known as a KUB) This is a single or set of x-rays that can give your physician a rough idea if there is a lot of stool present. It may also indicate if the colon is dilated. […] Anorectal manometry or motility test This test determines if the nerves and muscles responsible for passing a bowel movement are working together. It is performed by inserting a very small balloon at the end of a catheter into the rectum and blowing up the balloon. The response to inflating the balloon determines if the nerves and muscles are working together properly. Relaxation of the anal muscles, known as the anal sphincter, after inflation of the balloon should occur. […] Barium enema This is an x-ray test where barium or another type of contrast is inserted via a catheter into the rectum and x-rays of the abdomen are taken. The test may or may not require a special bowel preparation to clean out the bowel before the test. This test is used to diagnose a blockage in the intestine or an area that may be narrowed or abnormal. It is also used in the diagnosis of Hirschsprung’s disease.

• #38 Chronic Constipation Diagnosis | Stanford Health Care

  https://stanfordhealthcare.org/medical-conditions/digestion-and-metabolic-health/chronic-constipation/diagnosis.html

  Abdominal X-ray: A standard X-ray of your small intestine to identify abnormalities or blockages […] Anorectal manometry: Measuring muscle strength in your anus with the help of a thin plastic probe we place in your rectum. This test also measures sensation and reflex activity. […] Barium enema/lower GI series: X-ray study of your rectum, large intestine, and the lower part of your small intestine using a special dye containing barium. This chemical helps show the fine details of your intestines. […] Blood tests: Using a sample of your blood, we may run a number of tests including: Complete blood count to look for signs of anemia and infections, Electrolyte and kidney function panel to look for electrolyte abnormalities and liver issues, Albumin tests to assess your nutritional status.

• #39 Constipation in children – Diagnosis & treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/constipation-in-children/diagnosis-treatment/drc-20354248

  Barium enema X-ray. In this test, the lining of the bowel is coated with a contrast dye (barium) so that the rectum, colon and sometimes part of the small intestine can be clearly seen on an X-ray. […] Rectal biopsy. In this test, a small sample of tissue is taken from the lining of the rectum to see if nerve cells are normal. […] Transit study or marker study. In this test, your child will swallow a capsule containing markers that show up on X-rays taken over several days. Your child’s doctor will analyze the way the markers move through your child’s digestive tract. […] Blood tests. Occasionally, blood tests are performed, such as a thyroid panel. […] If your child’s constipation lasts longer than two weeks, you’ll likely first seek medical care from your child’s doctor. If necessary, your child may be referred to a specialist in digestive disorders (gastroenterologist).

• #40 Constipation in Children – American College of Gastroenterology

  https://gi.org/topics/constipation-in-children/

  Rectal biopsy This is a test where a small (pinch) biopsy is performed from the lining of the rectum to determine if normal nerve cells are present in its walls. The sample of tissue that is obtained is examined under the microscope looking for ganglion cells, which are special nerve cells. If they are absent then the diagnosis of Hirschsprung’s disease is made. […] Transit study or marker study This test is performed to determine if the reason for constipation is due to slow movement throughout the colon or just in the last part of the colon known as the rectum. […] Colonoscopy This is an endoscopy of the lower GI tract. This test is usually not indicated for the evaluation of routine constipation in children. […] Colonic manometry This is a specialized test done in children who have continued problems with intractable constipation despite adequate medical therapy. It involves placing a catheter at the time of colonoscopy to determine whether there are normal contractions in all parts of the colon. The test requires a period of prolonged monitoring of the contractions of the colon after placement of the catheter. This test is used to establish the diagnosis of colonic pseudo-obstruction in children, a very rare condition.

• #41 Chronic Constipation Diagnosis | Stanford Health Care

  https://stanfordhealthcare.org/medical-conditions/digestion-and-metabolic-health/chronic-constipation/diagnosis.html

  Colonic transit study (Sitz marker study): This test assesses how long it takes for food to move from your stomach through a bowel movement with a series of X-rays and a capsule with tiny rings that you swallow. […] Colonoscopy or sigmoidoscopy: Examining the entire length of your colon (screening colonoscopy) or just the lower part of your colon (sigmoidoscopy) with the help of a small flexible tube and tiny camera we insert into your rectum. […] Defecating proctogram: Recording movement in your pelvic floor muscles and rectum while you attempt to empty the contents of your rectum […] Magnetic resonance imaging (MRI) defecography: Examining all structures in your pelvic floor, rectum, and sphincter, with the help of magnetic resonance imaging, which uses radio waves and a strong magnetic field

• #42 Constipation in Children – American College of Gastroenterology

  https://gi.org/topics/constipation-in-children/

  Rectal biopsy This is a test where a small (pinch) biopsy is performed from the lining of the rectum to determine if normal nerve cells are present in its walls. The sample of tissue that is obtained is examined under the microscope looking for ganglion cells, which are special nerve cells. If they are absent then the diagnosis of Hirschsprung’s disease is made. […] Transit study or marker study This test is performed to determine if the reason for constipation is due to slow movement throughout the colon or just in the last part of the colon known as the rectum. […] Colonoscopy This is an endoscopy of the lower GI tract. This test is usually not indicated for the evaluation of routine constipation in children. […] Colonic manometry This is a specialized test done in children who have continued problems with intractable constipation despite adequate medical therapy. It involves placing a catheter at the time of colonoscopy to determine whether there are normal contractions in all parts of the colon. The test requires a period of prolonged monitoring of the contractions of the colon after placement of the catheter. This test is used to establish the diagnosis of colonic pseudo-obstruction in children, a very rare condition.

• #43 Pediatric Chronic Constipation – Conditions and Treatments | Children’s National Hospital

  https://www.childrensnational.org/get-care/health-library/chronic-constipation

  Chronic constipation is also known as idiopathic or functional constipation, meaning that there is no identifiable or anatomic cause. […] Doctors may conduct motility studies to pinpoint the cause of constipation. Motility testing may include: Anorectal manometry, Colonic manometry. […] An accurate diagnosis to figure out what could be causing idiopathic constipation is very important to develop the best possible treatment plan. Our gastrointestinal (GI) specialists conduct motility studies and use the latest diagnostic tests and tools to accurately pinpoint the problem. […] While not all children with chronic constipation will need motility testing, it can provide vital information about your child’s condition and guide treatment decisions. […] If you have noticed any of these symptoms in your child, its essential to seek medical attention from a pediatric specialist. Early diagnosis and treatment can prevent complications and help restore normal bowel function.

• #44

  https://link.springer.com/article/10.1007/s40746-020-00193-5

  Constipation Is a common pediatric symptom that can affect children of all ages. […] Diagnosis Is primarily based on fulfilling defined clinical criteria. […] Despite being so prevalent, functional constipation is often misdiagnosed and inappropriately treated. […] The diagnostic role of anorectal and colonic manometry has been clarified and these tests have been standardized in the pediatric population. […] Children with chronic constipation who Are unresponsive to maximal medical treatment benefit from further evaluation with colonic transit studies, anorectal and colonic manometry, imaging studies of the spine, and defecography especially if more invasive interventions such as anal sphincter botulinum toxin injection, appendicostomy, cecostomy, colonic resection, ileostomy, and sacral nerve stimulation are being considered. […] These children Are best evaluated in specialized centers that offer a multi-disciplinary approach to both the physical and psychosocial components of chronic constipation treatment.

• #45 Constipation in Children and Adolescents: Evaluation and Treatment | AAFP

  https://www.aafp.org/pubs/afp/issues/2022/0500/p469.html

  Functional constipation is a clinical diagnosis based on Rome IV diagnostic criteria. The Rome IV criteria are symptom based, and no additional testing is required in patients without red flag signs and symptoms. […] A comprehensive history and physical examination are usually sufficient to diagnose functional constipation and should exclude red flag signs and symptoms suggesting organic causes. […] There is insufficient evidence to support routine digital rectal examination for the diagnosis of constipation, especially in children older than one year with no red flag signs or symptoms. […] Additional diagnostic testing (i.e., laboratory tests, radiography, colonic transit time, and anorectal manometry) is not required in children with functional constipation and no red flag signs or symptoms.

• #46 Constipation in Children: Novel Insight Into Epidemiology, Pathophysiology and Management

  https://www.jnmjournal.org/journal/view.html?doi=10.5056/jnm.2011.17.1.35

  A detail history and thorough physical examination are the cornerstones in assessing a child with chronic constipation. These 2 steps would reveal the possible etiology and associated complications in the majority. Investigations are only needed in those who show clinical features of organic diseases and children do not respond to initial medical management. […] Laboratory investigations are rarely indicated in childhood constipation except in those with evidence of organic diseases from history and examination and in those who do not respond to adequate medical management. Otherwise, investigations are unlikely to reveal any additional information for the management.

• #47 Constipation in children – Diagnosis & treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/constipation-in-children/diagnosis-treatment/drc-20354248

  Barium enema X-ray. In this test, the lining of the bowel is coated with a contrast dye (barium) so that the rectum, colon and sometimes part of the small intestine can be clearly seen on an X-ray. […] Rectal biopsy. In this test, a small sample of tissue is taken from the lining of the rectum to see if nerve cells are normal. […] Transit study or marker study. In this test, your child will swallow a capsule containing markers that show up on X-rays taken over several days. Your child’s doctor will analyze the way the markers move through your child’s digestive tract. […] Blood tests. Occasionally, blood tests are performed, such as a thyroid panel. […] If your child’s constipation lasts longer than two weeks, you’ll likely first seek medical care from your child’s doctor. If necessary, your child may be referred to a specialist in digestive disorders (gastroenterologist).

• #48 Constipation in Children | Diagnosis & Treatment | Freedmans Health

  https://freedmanshealth.org/diseases-conditions/diagnosis-treatment/constipation-in-children/

  To diagnose constipation, your childs healthcare provider will ask about your childs symptoms and medical history and perform a physical examination. […] During the physical exam, your childs healthcare provider will check your childs belly. Theyll want to see if its swollen, tender or has any masses or lumps. They may also examine your childs rectum to look for blood or a blockage. […] Your child probably wont need any tests to diagnose their condition. Your childs healthcare provider may order tests if their constipation is caused by an underlying health condition. Tests they may order include: […] A stool test can show signs of infection or blood in your childs stool. […] A urine test can show signs of bladder inflammation or infection. […] A bowel function test can show how well stool moves through your childs colon. […] A small piece of tissue from your childs rectum will be examined under a microscope.

• #49 Constipation in infants and children: MedlinePlus Medical EncyclopediaLock

  https://medlineplus.gov/ency/article/003125.htm

  Constipation occurs when the stool remains in the colon for too long. Too much water gets absorbed by the colon, leaving hard, dry stools. […] Medical causes of constipation may include: Diseases of the bowel, such as those that affect the bowel muscles or nerves, Other medical conditions that affect the bowel, Use of certain medicines. […] Contact your child’s provider right away if: An infant (except those who are only breastfed) goes 3 days without a stool and is vomiting or irritable. […] Your child’s provider will perform a physical exam. This may include a rectal exam. […] The following tests may help find the cause of constipation: Blood tests such as a complete blood count (CBC), X-rays of the abdomen.

• #50 Paediatric constipation: An approach and evidence-based treatment regimen

  https://www1.racgp.org.au/ajgp/2018/may/paediatric-constipation

  The presence of abdominal pain, distension, behaviour change and anorexia in these children may indicate a need for disimpaction. […] Assessment for coeliac disease, hypothyroidism and hypercalcaemia is not recommended in children without alarm symptoms. […] Allergy testing is not recommended to diagnose suspected cows milk allergy in children with constipation, as it is usually not IgE mediated. […] If needing additional help with toileting, children with a developmental age 4 years may benefit from referral to an occupational therapist or continence physiotherapist. […] Consider if constipation is medication-dependent after six months of adequate treatment, or if medication resistant or organic causes have been considered. […] Up to 50% of patients referred to a paediatrician for constipation will regain normal function and be off laxatives in six to 12 months. […] Early therapeutic intervention is beneficial and easy to commence.

• #51 Constipation in children and adolescents – Knowledge @ AMBOSS

  https://www.amboss.com/us/knowledge/constipation-in-children-and-adolescents/

  Children with functional constipation and no red flag features should not be routinely screened for cow’s milk protein allergy, hypothyroidism, hypercalcemia, or celiac disease. […] Referral to pediatric gastroenterology is recommended for advanced diagnostics if clinically indicated to evaluate for secondary constipation.

• #52 Diagnosis of Constipation in Children – NIDDK

  https://www.niddk.nih.gov/health-information/digestive-diseases/constipation-children/diagnosis

  Doctors use your childs medical and family history, a physical exam, or medical tests to diagnose and find the cause of constipation. […] During a physical exam, a doctor may check your childs abdomen for swelling or tenderness. […] Doctors dont normally need medical tests to diagnose constipation in children. However, in some cases, your childs doctor may use medical tests to help find the cause of constipation. […] If your childs constipation doesnt improve with nutrition changes, your childs doctor may use bowel function tests, including colorectal transit studies. […] In some cases, your childs doctor may use imaging tests of your childs abdomen to look for problems that may be causing his or her constipation. […] Your childs doctor may suggest a rectal biopsy. The rectal biopsy is the best test to diagnose or rule out Hirschsprung disease.

• #53 Constipation in children – Diagnosis & treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/constipation-in-children/diagnosis-treatment/drc-20354248

  Barium enema X-ray. In this test, the lining of the bowel is coated with a contrast dye (barium) so that the rectum, colon and sometimes part of the small intestine can be clearly seen on an X-ray. […] Rectal biopsy. In this test, a small sample of tissue is taken from the lining of the rectum to see if nerve cells are normal. […] Transit study or marker study. In this test, your child will swallow a capsule containing markers that show up on X-rays taken over several days. Your child’s doctor will analyze the way the markers move through your child’s digestive tract. […] Blood tests. Occasionally, blood tests are performed, such as a thyroid panel. […] If your child’s constipation lasts longer than two weeks, you’ll likely first seek medical care from your child’s doctor. If necessary, your child may be referred to a specialist in digestive disorders (gastroenterologist).

• #54 Pediatric Constipation Workup: Approach Considerations, Abdominal Radiography, Contrast Enema

  https://emedicine.medscape.com/article/928185-workup

  Anorectal manometry can be useful in discriminating between functional constipation and Hirschsprung disease. […] Rectal biopsy is the definitive means of establishing or excluding Hirschsprung disease. […] This procedure is usually unnecessary when the clinical picture and the radiologic findings are characteristic of idiopathic constipation. […] A study by Doniger et al sought to determine the performance of point-of-care ultrasound using a sonographic numeric cutoff value for diagnosing constipation.

• #55 Constipation in Children | Phoenix Children’s Hospital

  https://phoenixchildrens.org/specialties-conditions/constipation-children

  Constipation is when a child has very hard stools and has fewer bowel movements than normal. It is a very common gastrointestinal (GI) problem. […] Constipation is often defined as having fewer than 3 bowel movements a week. The number of bowel movements may be different for each child. But a change in what is normal for your child may mean there is a problem. […] The healthcare provider will ask about your child’s symptoms and health history. The provider will give your child a physical exam. […] The symptoms of constipation can be like other health conditions. Make sure your child sees a healthcare provider for a diagnosis. […] Your child’s provider may also want to do some tests to see if there are any problems. […] These tests may include: Digital rectal examination. Your child’s healthcare provider puts a gloved, greased (lubricated) finger into your child’s rectum. The provider will feel for anything abnormal.

• #56 Chronic Constipation Diagnosis | Stanford Health Care

  https://stanfordhealthcare.org/medical-conditions/digestion-and-metabolic-health/chronic-constipation/diagnosis.html

  Colonic transit study (Sitz marker study): This test assesses how long it takes for food to move from your stomach through a bowel movement with a series of X-rays and a capsule with tiny rings that you swallow. […] Colonoscopy or sigmoidoscopy: Examining the entire length of your colon (screening colonoscopy) or just the lower part of your colon (sigmoidoscopy) with the help of a small flexible tube and tiny camera we insert into your rectum. […] Defecating proctogram: Recording movement in your pelvic floor muscles and rectum while you attempt to empty the contents of your rectum […] Magnetic resonance imaging (MRI) defecography: Examining all structures in your pelvic floor, rectum, and sphincter, with the help of magnetic resonance imaging, which uses radio waves and a strong magnetic field

• #57 Constipation in Children – American College of Gastroenterology

  https://gi.org/topics/constipation-in-children/

  Rectal biopsy This is a test where a small (pinch) biopsy is performed from the lining of the rectum to determine if normal nerve cells are present in its walls. The sample of tissue that is obtained is examined under the microscope looking for ganglion cells, which are special nerve cells. If they are absent then the diagnosis of Hirschsprung’s disease is made. […] Transit study or marker study This test is performed to determine if the reason for constipation is due to slow movement throughout the colon or just in the last part of the colon known as the rectum. […] Colonoscopy This is an endoscopy of the lower GI tract. This test is usually not indicated for the evaluation of routine constipation in children. […] Colonic manometry This is a specialized test done in children who have continued problems with intractable constipation despite adequate medical therapy. It involves placing a catheter at the time of colonoscopy to determine whether there are normal contractions in all parts of the colon. The test requires a period of prolonged monitoring of the contractions of the colon after placement of the catheter. This test is used to establish the diagnosis of colonic pseudo-obstruction in children, a very rare condition.

• #58 Pediatric Constipation Differential Diagnoses

  https://emedicine.medscape.com/article/928185-differential

  The differential diagnosis of childhood constipation can be extensive and may include Hirschsprung disease (ie, congenital megacolon), spinal or neuromuscular abnormalities (eg, spinal muscular atrophy, tethered cord, Currarino triad [rectal stenosis, hemi sacrum, presacral mass], cerebral palsy [static encephalopathy]), hypothyroidism, anal stenosis, imperforate anus with fistula, anterior displacement of the anus (this is a controversial diagnosis), allergy or sensitivity to cow’s milk, and celiac disease. Other conditions to consider include mitochondrial disorders, neuronal intestinal dysplasia, and prune-belly syndrome. […] For practical purposes, in an otherwise healthy child, the differential diagnosis of chronic constipation is Hirschsprung disease and functional constipation (not Hirschsprung disease). Although differentiating these two disorders may sometimes be difficult, clues in the history and physical examination are helpful.

• #59 Pediatric Constipation Differential Diagnoses

  https://emedicine.medscape.com/article/928185-differential

  The differential diagnosis of childhood constipation can be extensive and may include Hirschsprung disease (ie, congenital megacolon), spinal or neuromuscular abnormalities (eg, spinal muscular atrophy, tethered cord, Currarino triad [rectal stenosis, hemi sacrum, presacral mass], cerebral palsy [static encephalopathy]), hypothyroidism, anal stenosis, imperforate anus with fistula, anterior displacement of the anus (this is a controversial diagnosis), allergy or sensitivity to cow’s milk, and celiac disease. Other conditions to consider include mitochondrial disorders, neuronal intestinal dysplasia, and prune-belly syndrome. […] For practical purposes, in an otherwise healthy child, the differential diagnosis of chronic constipation is Hirschsprung disease and functional constipation (not Hirschsprung disease). Although differentiating these two disorders may sometimes be difficult, clues in the history and physical examination are helpful.

• #60 Pediatric Functional Constipation – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK537037/

  After appropriate evaluation, another medical condition cannot fully explain the symptoms. […] Children with a history and exam consistent with functional constipation may not require any specific testing. […] A thorough head-to-toe physical examination is necessary. […] The differential diagnosis of constipation includes anatomic abnormalities like anal atresia and presacral masses, metabolic conditions like hypothyroidism, cystic fibrosis, and lead intoxication, and neurologic conditions like meningomyelocele and Hirsprung disease. […] In most cases, a thorough history and physical examination will rule out most of these conditions. […] The diagnosis needs to be reevaluated, and more testing may be necessary if there is a recurring failure despite sufficient adherence to a maximal laxative regimen. […] Anorectal manometry and/or balloon expulsion tests should be used to assess patients with chronic constipation who continue to experience it despite following the recommended medicinal and behavioral interventions.

• #61 Constipation in Children – Pediatrics – Merck Manual Professional Edition

  https://www.merckmanuals.com/professional/pediatrics/symptoms-in-infants-and-children/constipation-in-children

  Constipation in children is divided into 2 main types: Organic (5%) and Functional (95%). […] Organic causes of constipation involve specific structural, neurologic, toxic/metabolic, or intestinal disorders. […] Functional constipation is difficulty passing stools for reasons other than organic causes. […] Evaluation should focus on differentiating functional constipation from constipation with an organic cause. […] A primary finding that suggests an organic cause in neonates is constipation from birth; those who have had a normal bowel movement are unlikely to have a significant structural disorder. […] In older children, clues to an organic cause include constitutional symptoms (particularly weight loss, fever, or vomiting), poor growth (decreasing percentile on growth charts), an overall ill appearance, and any focal abnormalities detected during examination.

• #62 Constipation — Risk for Alternative Diagnoses, Differential Diagnosis — Clinical Pathway: Emergency Department and Inpatient | Children’s Hospital of Philadelphia

  https://www.chop.edu/clinical-pathway/constipation-risk-alternative-diagnoses-differential-diagnosis

  The diagnosis of functional constipation is most often made through careful history and physical […] Further Evaluation is Indicated if Concern for Alternative Diagnoses Tests should be targeted to findings by History and Physical Exam. […] Concerns for Alternative Diagnoses include delayed passage meconium after 48 hrs of life, symptom onset 1 mos, persistent abdominal distention, vomiting, bloody diarrhea, bilious emesis, family history Hirschsprungs disease, malnutrition, tight rectum gripping finger; explosive stool and air from rectum upon withdrawal examining finger, poor growth, significant weight loss, concern for abdominal mass, abnormal neurologic exam especially lower extremities, rectal exam, and lower spin abnormalities. […] Differential Diagnosis of Constipation includes functional constipation, cows milk allergy, Crohns disease, celiac disease, malnutrition, starvation, poor fluid intake, motility disorders such as Hirschsprung disease and congenital pseudo-obstruction, neurologic issues like infant botulism and spinal cord abnormality, endocrine disorders such as thyroid disorders, toxins like lead, and medications known to cause constipation including antidepressants, antipsychotics, iron, loperamide, anticholinergics, and antihistamines.

• #63 Constipation in Children and Adolescents: Evaluation and Treatment | AAFP

  https://www.aafp.org/pubs/afp/issues/2022/0500/p469.html

  Constipation in children is usually functional constipation without an organic cause. Organic causes of constipation in children, which include Hirschsprung disease, cystic fibrosis, and spinal cord abnormalities, commonly present with red flag signs and symptoms. A history and physical examination can diagnose functional constipation using the Rome IV diagnostic criteria. […] Referral to a pediatric gastroenterologist is recommended when there is a concern for organic causes or constipation persists despite adequate therapy. […] Functional constipation is diagnosed by history and physical examination findings in patients without red flag signs or symptoms. […] Digital rectal examination and abdominal radiography should not be performed routinely in children with suspected functional constipation.

• #64 Evaluation and Treatment of Constipation in Children and Adolescents | AAFP

  https://www.aafp.org/pubs/afp/issues/2014/0715/p82.html

  Physical examination should include a review of growth parameters, an abdominal examination, an external examination of the perineum and perianal area, an evaluation of the thyroid and spine, and a neurologic evaluation for appropriate reflexes. A digital examination of the anorectum is recommended to assess for perianal sensation, anal tone, rectum size, anal wink, and amount and consistency of stool in the rectum. […] Abdominal radiography is of limited value in diagnosing chronic constipation because it lacks interobserver reliability and accuracy. It should be reserved for specific clinical circumstances in which a rectal examination is unreasonable or the diagnosis is uncertain. […] Further evaluation is indicated in older children with red flags or with intractable constipation despite strict adherence to therapy. Laboratory studies may be performed to evaluate for systemic diseases, such as thyroid disease, other metabolic diseases, celiac disease, or lead toxicity. […] Referral to a pediatric gastroenterologist may be needed when a child with constipation has red flags for organic disease or the constipation is unresponsive to adequate therapy.

• #65 Constipation in children — gpraj

  https://gpraj.com/paediatric-medicine/2020/1/14/constipation-in-children

  Considering the need for specialist referral if symptoms do not respond to optimal treatment in primary care, or if there is faecal impaction and the child is very distressed. […] Refer children and young people with idiopathic constipation who do not respond to initial treatment within 3 months to a practitioner with expertise in the problem. […] Referral for specialist assessment by a paediatrician is indicated in constipation when: An underlying cause is suspected. […] There are 'red flags’ such as failure to thrive, distended abdomen, blood and/or mucus in the stools. […] Treatment is unsuccessful. […] Management is complex (and requires more than the advice, support, and prescription of laxatives that can be provided in primary care because there are major psychological causes or consequences).

• #66

  https://link.springer.com/article/10.1007/s40746-020-00193-5

  Constipation Is a common pediatric symptom that can affect children of all ages. […] Diagnosis Is primarily based on fulfilling defined clinical criteria. […] Despite being so prevalent, functional constipation is often misdiagnosed and inappropriately treated. […] The diagnostic role of anorectal and colonic manometry has been clarified and these tests have been standardized in the pediatric population. […] Children with chronic constipation who Are unresponsive to maximal medical treatment benefit from further evaluation with colonic transit studies, anorectal and colonic manometry, imaging studies of the spine, and defecography especially if more invasive interventions such as anal sphincter botulinum toxin injection, appendicostomy, cecostomy, colonic resection, ileostomy, and sacral nerve stimulation are being considered. […] These children Are best evaluated in specialized centers that offer a multi-disciplinary approach to both the physical and psychosocial components of chronic constipation treatment.

• #67 How to Take on Chronic Childhood Constipation, from Diagnosis to Treatment | Pediatric Gastroenterologist at Children’s Health

  https://www.childrens.com/research-innovation/research-library/research-details/how-to-take-on-chronic-childhood-constipation

  Motility tests can tease out which treatments will work best for each child. […] Chronic and severe constipation requires different management approaches, depending on motility test results. […] Childhood constipation often requires more than one treatment. In a longitudinal study of 403 children, half had at least one relapse within five years of successful treatment. One-third had symptoms into early adulthood. […] Treating childhood constipation is a marathon, not a sprint, Dr. Sanghavi says. To really help these kids, physicians need to continue to monitor patients and follow-up with their parents. Long-term care will help ensure that any relapse is treated quickly and effectively.

• #68 Pediatric Functional Constipation – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK537037/

  Functional constipation is a term used to describe a condition in which patients have hard, infrequent bowel movements that are often difficult or painful to pass. […] This activity underscores the importance of diagnosing functional constipation as a condition of exclusion, ruling out underlying organic causes, which account for only about 5% of cases. […] Functional constipation is defined as functional constipation if there is no underlying organic cause, which is the case in up to 95% of children. […] Functional constipation is a clinical diagnosis based on history and physical examination. […] History should include information about the frequency and consistency of stools, associated issues, and the duration of symptoms. […] Rome IV defines functional constipation separately for infants and children older than 4 years of age.

• #69 Constipation in children | Italian Journal of Pediatrics | Full Text

  https://ijponline.biomedcentral.com/articles/10.1186/1824-7288-37-28

  Constipation remains a frequent presentation to paediatricians, with significant health resource implications. […] This article aims to be a practical guide for paediatricians and primary care physicians, to outline the current diagnostic criteria and provide an evidence-base for the medical management of idiopathic constipation in children, in the light of recent National Institute of Clinical Excellence (NICE) guidelines on constipation. […] Functional constipation has been defined by the ROME III classification as 2 or more of the following features in a child with a developmental age of at least 4 years and occurring at least once per week for at least 2 months before diagnosis (with insufficient criteria for diagnosis of irritable bowel syndrome). […] Constipation is diagnosed by clinical history and examination. History should include a detailed exploration of symptoms, looking at potential precipitants, and for 'red flags’ to exclude organic pathology.

• #70 Constipation in Children and Adolescents: Evaluation and Treatment | AAFP

  https://www.aafp.org/pubs/afp/issues/2022/0500/p469.html

  Functional constipation is a clinical diagnosis based on Rome IV diagnostic criteria. The Rome IV criteria are symptom based, and no additional testing is required in patients without red flag signs and symptoms. […] A comprehensive history and physical examination are usually sufficient to diagnose functional constipation and should exclude red flag signs and symptoms suggesting organic causes. […] There is insufficient evidence to support routine digital rectal examination for the diagnosis of constipation, especially in children older than one year with no red flag signs or symptoms. […] Additional diagnostic testing (i.e., laboratory tests, radiography, colonic transit time, and anorectal manometry) is not required in children with functional constipation and no red flag signs or symptoms.

• #71 Childhood constipation

  https://www.racgp.org.au/afp/2017/december/childhood-constipation

  Investigations are not necessary if the history is consistent with functional childhood constipation. […] Full blood count and testing for coeliac disease, hypercalcaemia or hypothyroidism should be considered in cases of intractable constipation. […] Digital rectal examination is not routinely indicated in children, as the history and abdominal examination is sufficient for evaluation of retained stool: refer for specialist assessment if there are specific concerns. […] If there are ongoing symptoms of constipation after six months of appropriate treatment, a referral for specialist care and a second opinion is warranted.

• #72 Constipation in children — gpraj

  https://gpraj.com/paediatric-medicine/2020/1/14/constipation-in-children

  Considering the need for specialist referral if symptoms do not respond to optimal treatment in primary care, or if there is faecal impaction and the child is very distressed. […] Refer children and young people with idiopathic constipation who do not respond to initial treatment within 3 months to a practitioner with expertise in the problem. […] Referral for specialist assessment by a paediatrician is indicated in constipation when: An underlying cause is suspected. […] There are 'red flags’ such as failure to thrive, distended abdomen, blood and/or mucus in the stools. […] Treatment is unsuccessful. […] Management is complex (and requires more than the advice, support, and prescription of laxatives that can be provided in primary care because there are major psychological causes or consequences).

• #73 Constipation in Children: Causes, Signs & Treatment | CHOC

  https://choc.org/programs-services/gastroenterology/constipation/

  Blood tests: Blood tests may be ordered for some children to look for signs of infection or other underlying illness. […] It is important to speak with your child’s primary care doctor about their constipation when: Episodes of constipation last longer than three weeks and dietary changes or adding hydration has not helped. […] The child develops abdominal pain or swelling that could be a sign of another medical problem. […] In most cases, your child’s pediatrician can manage constipation. If, with treatment, the child’s constipation does not go away, talk to the child’s doctor about seeing a pediatric gastroenterologist.

• #74 Constipation in Children and Adolescents: Evaluation and Treatment | AAFP

  https://www.aafp.org/pubs/afp/issues/2022/0500/p469.html

  Management of constipation includes dietary modifications, behavior interventions, medications, and disimpaction if needed. […] Maintenance therapy should be started in children without impaction or when disimpaction is achieved. The goals of maintenance therapy are to achieve soft stool daily or every other day and to prevent stool impaction.

• #75 Functional constipation in children: challenges and solutions | PHMT

  https://www.dovepress.com/functional-constipation-in-children-challenges-and-solutions-peer-reviewed-fulltext-article-PHMT

  Colonic transit time can be used to determine the colonic motility. There is no recommendation to use colonic transit time for the diagnosis of FC. […] The recommendation for the management of FC includes a normal intake of fibers and fluids, normal physical activity, and an additional pharmacologic treatment for fecal disimpaction followed by a pharmacologic maintenance therapy. […] Although effective and safe treatment options have been reported in children with FC, a lot of challenges persist. […] The new Rome IV criteria have adjusted some criteria, which should make it easier for the diagnosis of FC in younger children, but new studies are needed to evaluate its usefulness in everyday practice. […] The last but not least important aspect of the treatment is counseling parents and children about FC.

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