Materiały źródłowe

• #1 Management of Functional Constipation in Children: Therapy in Practice

  https://pmc.ncbi.nlm.nih.gov/articles/PMC4768242/

  Functional constipation is a common healthcare problem among children worldwide and accounts for high healthcare usage and costs. Treatment consists of non-pharmacological and pharmacological interventions. Non-pharmacological interventions involve education and demystification, toilet training (with a reward system), and a defecation diary. Pharmacological treatment comprises three steps: disimpaction, maintenance treatment, and weaning. The treatment of first choice is oral laxatives, preferably polyethylene glycol. When this is insufficient, other therapeutic agents are available. […] In the treatment of functional constipation, the medication of first choice for both disimpaction and maintenance treatment is polyethylene glycol. Other therapeutic agents (e.g., stimulant laxatives or lubricants) may be useful as additional or second-line therapy if adequate treatment with oral laxatives is insufficient.

• #1 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. […] Successful therapy requires prevention and treatment of fecal impaction, with oral laxatives or rectal therapies. Polyethylene glycol-based solutions have become the mainstay of therapy, although other options, such as other osmotic or stimulant laxatives, are available. […] Education is equally important as medical therapy and should include counseling families to recognize withholding behaviors; to use behavior interventions, such as regular toileting and reward systems; and to expect a chronic course with prolonged therapy, frequent relapses, and a need for close follow-up. […] The treatment of functional constipation requires parental education, behavior interventions, measures to ensure that bowel movements occur at normal intervals with good evacuation, close follow-up, and adjustment of medication and evaluation as necessary.

• #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. […] The first goal of managing constipation is to treat fecal impaction, and then maintenance therapy is used to prevent a recurrence. Polyethylene glycol is the first-line treatment for constipation. […] Increasing dietary fiber and fluid intake above usual daily recommendations and adding probiotics provide no additional benefits for treating constipation. […] Frequent follow-up visits and referrals to a psychologist can assist in reaching some treatment goals. […] Referral to a pediatric gastroenterologist is recommended when there is a concern for organic causes or constipation persists despite adequate therapy. […] Management of constipation includes dietary modifications, behavior interventions, medications, and disimpaction if needed.

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

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

  Education is the first step in treatment. […] Behavior modification with regular toileting (for five to 10 minutes) after meals combined with a reward system is often helpful. […] Dietary changes are often advised in children with constipation. […] When fecal impaction is present, disimpaction with oral or rectal medication is required before initiation of maintenance therapy. […] The goal of maintenance therapy is to avoid reaccumulation of stool by maintaining soft bowel movements, preferably occurring once a day. […] Most children with functional constipation require prolonged treatment and have frequent relapses. […] 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.

• #1

  https://www.healthychildren.org/English/health-issues/conditions/abdominal/Pages/constipation.aspx

  Constipation is a common problem in children. […] Many treatments and strategies exist to help children manage their constipation. While some of these medicines are over the counter, we recommend that you discuss any treatments with your child’s doctor before starting. Let’s look at some of these options: […] There is no specific „constipation diet” that has been shown to be effective in preventing or treating constipation. However, increasing water intake and the use of natural fibers from fruits and vegetables are a healthy option that can be recommended to children. […] Making sure that children drink enough water every day is crucial to many bodily functions. […] There are many sources of fiber including from foods and supplements. Food-based, natural fibers are recommended over supplements.

• #1 Constipation in children – Symptoms & causes – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/constipation-in-children/symptoms-causes/syc-20354242

  Constipation in children is a common problem. A constipated child has infrequent bowel movements or hard, dry stools. […] Encouraging your child to make simple dietary changes such as eating more fiber-rich fruits and vegetables and drinking more water can go a long way toward alleviating constipation. If your child’s doctor approves, it may be possible to treat a child’s constipation with laxatives. […] To help prevent constipation in children: Offer your child high-fiber foods. A diet rich in fiber can help your child’s body form soft, bulky stool. Serve your child more high-fiber foods, such as fruits, vegetables, beans, and whole-grain cereals and breads. […] Encourage your child to drink plenty of fluids. Water is often the best. […] Promote physical activity. Regular physical activity helps stimulate normal bowel function. […] Create a toilet routine. Regularly set aside time after meals for your child to use the toilet. […] Review medications. If your child is taking a medication that causes constipation, ask his or her doctor about other options.

• #1 Constipation in Kids: Symptoms, Remedies, and Medical Treatment

  https://www.healthline.com/health/constipation-in-kids

  Constipation is infrequent bowel movements, typically fewer than three in 1 week. In many cases, child constipation is short term and resolves with treatment. […] To treat it, though, you must learn how to recognize the signs of constipation in your child. […] Several home remedies can help soften stools and relieve constipation. […] Drinking water can soften stools, making them easier to pass. […] Fruit juice is also effective for relieving constipation because some contain the sweetener sorbitol, which can function as a laxative. […] If your baby has started eating solid foods, incorporate more high fiber baby foods into their diet. […] Rice cereal can also trigger constipation because its low in fiber. Reduce the amount of rice cereal you feed your baby to relieve constipation.

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

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

  Infants respond well to juices containing sorbitol (e.g., apple, prune, pear), which can increase stool frequency and water content in stools. […] Although low fluid and fiber intake may contribute to the development of constipation, increasing fluid (water, milk, other beverages) or fiber intake above usual daily recommendations does not improve constipation in children. […] Quality of life scores are lower in children with chronic constipation than those without constipation. […] Current evidence does not support intensive behavior therapy or biofeedback in the treatment of functional constipation. […] However, minor behavior modifications such as structured toilet training with a reward system, in which the child is instructed to defecate after each meal, may prevent recurrence of fecal impaction.

• #1 Home Remedies for Constipation in Kids

  https://www.unitypoint.org/news-and-articles/home-remedies-for-constipation-in-kids

  Constipation in kids is extremely common, affecting roughly 30-35% of children. […] If you think your child is constipated, Dr. Granger lists safe and easy options for quick relief at home: […] Try abdominal massage. For infants and small children, massaging the abdomen and bicycling the legs are great measures to help pass stools. […] Use natural laxatives. Foods that help with constipation in kids include prunes, apples and pears. […] Increase water. Water intake (for children older than one) keeps the body hydrated, which also makes passing stools easier. […] Increase fiber. Feed your child a diet rich in fiber by aiming for five servings of fruits and vegetables each day. […] Decrease dairy. Excess dairy intake, especially milk, can cause constipation. […] Provide stress free potty breaks. Constipated children may take a much longer time in the bathroom to have a bowel movement.

• #1 Constipation and children | Better Health Channel

  https://www.betterhealth.vic.gov.au/health/conditionsandtreatments/constipation-and-children

  Constipation is the passing of a hard bowel motion (poo) with pain and discomfort. […] Treatment for infant constipation requires expert medical advice. […] A healthy diet, having enough to drink, exercise, correct toilet training and regular toilet habits are important to prevent and help treat constipation in children. […] Suggestions for treating constipation in children include: Encourage your child to exercise more. Establish a regular toilet routine. Bowel training requires motivation and encouragement. Use a star chart system of rewards to help your child to go and sit on the toilet. This will help your child get used to doing a bowel movement at a similar time each day. […] Limit the use of laxatives. They should not be used more than once or twice. They dont solve the underlying problem and may change the way your childs bowels work.

• #1

  https://www.healthychildren.org/English/health-issues/conditions/abdominal/Pages/constipation.aspx

  A simple way to make sure your child is getting enough fiber is by making healthful food choices. […] If you find it helpful to keep track of total grams of fiber that your child is eating, add 5 to your child’s age. […] It is important to note that fiber supplements taken without enough water can worsen your child’s constipation! […] One tool to improve toilet posture is the defecation posture modification device, a potty stool. […] There are many laxative medicines available to treat children with functional constipation including stool softeners, osmotic laxatives, stimulant laxatives, secretagogue laxatives and rectal therapies. […] Examples include docusate sodium. […] Examples include polyethylene glycol 3350 (PEG), PEG 4000, Milk of Magnesia (magnesium hydroxide), and Magnesium Citrate.

• #1 Patient education: Constipation in infants and children (Beyond the Basics) – UpToDate

  https://www.uptodate.com/contents/constipation-in-infants-and-children-beyond-the-basics/print

  If your child has been constipated for a short time, changing what they eat may be the only treatment needed. You can make these changes as often as needed so that the child has soft and painless bowel movements. […] If your child develops constipation while learning to use the toilet, stop toilet training temporarily. It is reasonable to wait two to three months before restarting toilet training. […] If your infant or child has repeated episodes of constipation (called recurrent constipation), work with your child’s doctor or nurse to figure out why this is happening. […] Your child may also need a „clean out” treatment to help empty the bowels. This treatment may include a medicine (eg, polyethylene glycol [PEG]; such as Miralax] or magnesium hydroxide [Milk of Magnesia]), an enema or rectal suppository (a pill that you insert in the child’s rectum), or a combination of treatments.

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

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

  For children presenting with fecal impaction, removing the hard stool from the colon is the first step in treating constipation. […] Polyethylene glycol is the first-line treatment because it is more effective than other agents for disimpaction and maintenance therapy, is well-tolerated, and has a low risk of adverse effects. […] Maintenance therapy should be started in children without impaction or when disimpaction is achieved. […] Polyethylene glycol is superior to other oral laxatives and is recommended as a first-line maintenance treatment for constipation. […] Relapses are common and should be treated with maintenance therapy or disimpaction therapy when appropriate. […] Rarely, surgical intervention is required to treat refractory constipation.

• #1 Management of Functional Constipation in Children: Therapy in Practice

  https://pmc.ncbi.nlm.nih.gov/articles/PMC4768242/

  Non-pharmacological management involves education, demystification, a toilet program with a reward system, and a daily bowel diary. Pharmacological treatment with laxatives consists of disimpaction, maintenance treatment, and eventually weaning off medication. PEG is the laxative of first choice for both disimpaction (high-dose: 11.5 g/kg/day) and maintenance treatment (0.20.8 g/kg/day). If PEG is not available or is poorly tolerated, lactulose is recommended. Stimulant laxatives (bisacodyl, senna, sodium picosulfate), magnesium hydroxide, and/or mineral oil may be considered as second-line or additional treatment if treatment with osmotic laxatives is insufficient. Maintenance treatment should be continued for at least 2 months, and FC symptoms should be resolved for at least 1 month before a gradually reduction of the medication.

• #1 Pediatric Constipation Treatment & Management: Approach Considerations, Colon Evacuation, Removal of Pain-Associated Defecation

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

  Aggressive use of oral cathartics such as polyethylene glycol, sodium phosphate, magnesium citrate, or a balanced electrolyte solution with polyethylene glycol or a series of enemas can accomplish disimpaction. […] Once the colon has been evacuated, chronic laxative therapy is generally required. Virtually any laxative can be used as long as it is used in sufficient quantity to produce 1-2 soft stools daily. In young children, eliminating any pain associated with the passage of bowel movements is extremely important. […] In many cases, long-term success in the management of constipation depends on the child establishing regular and routine toilet times. […] Dietary changes, such as increasing the child’s intake of fluids and carbohydrates, are commonly recommended as part of the treatment of constipation.

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

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

  Depending on the circumstances, your child’s doctor may recommend: […] Over-the-counter fiber supplements or stool softeners. If your child doesn’t get a lot of fiber in his or her diet, adding an over-the-counter fiber supplement, such as Metamucil or Citrucel, might help. However, your child needs to drink at least 32 ounces (about 1 liter) of water daily for these products to work well. Check with your child’s doctor to find out the right dose for your child’s age and weight. […] Glycerin suppositories can be used to soften the stool in children who can’t swallow pills. Talk with your child’s doctor about the right way to use these products. […] A laxative or enema. If an accumulation of fecal material creates a blockage, your child’s doctor may suggest a laxative or enema to help remove the blockage. Examples include polyethylene glycol (GlycoLax, MiraLax, others) and mineral oil.

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

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

  Never give your child a laxative or enema without the doctor’s OK and instructions on the proper dose. […] Hospital enema. Sometimes a child may be so severely constipated that he or she needs to be hospitalized for a short time to be given a stronger enema that will clear the bowel (disimpaction).

• #1 Pediatric Constipation Medication: Osmotic Laxatives, Lubricants, Stimulant Laxatives, Stool Softeners, Stool Softeners in Combination With Stimulants, Gastrointestinals, Guanylate Cyclase-C Agonists

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

  In several randomized trials, laxatives have been shown to be beneficial in the treatment of chronic childhood constipation. Studies have also shown that polyethylene glycol, mineral oil, magnesium hydroxide, and lactulose are effective and can be used for prolonged time periods without risk. […] The key to pharmacotherapy is to use a sufficient amount of laxative to produce the desired effect. The intermittent use of stimulant laxatives may be necessary in some children; however, routine usage of these agents in young children is not generally recommended. Continuous laxative therapy may be required for a number of months until the association between pain and the passage of bowel movements has been extinguished. […] Docusate sodium is used to avoid straining during defecation. This agent allows incorporation of water and fat into the stool, causing it to soften. […] Selective GC-2C agonist. It is indicated for functional constipation in children aged 6-17 years.

• #1

  https://www.healthychildren.org/English/health-issues/conditions/abdominal/Pages/constipation.aspx

  Examples include: senna (and other sennokot plant derivates), bisacodyl and sodium picosulfate (not sold in United States). […] These are highly specialized medications that should be used by pediatric gastroenterologists. […] Rectal therapies include suppositories (which give medicine directly to the rectum) and enemas (which given medicine higher into the colon to provide additional hydration, lubrication or stimulation to evacuate poop). […] There is research showing that children and parents benefit from receiving a Constipation Action Plan at the time of diagnosis. […] Some children may need a medical disimpaction (or cleanout) before starting maintenance therapy. […] Constipation should be treated with maintenance medications for at least 2 months. […] If this happens, your child should CONTINUE toilet training and take their medicines until toilet training is completed and they have been free of symptoms for one additional month.

• #1 Pediatric Constipation Treatment & Management: Approach Considerations, Colon Evacuation, Removal of Pain-Associated Defecation

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

  In infants and young children, it is appropriate to consider removing cow-milk protein from the diet for a period is appropriate, because chronic constipation may be precipitated by ingestion of cow-milk proteins. […] Consultation with a pediatric gastroenterologist or pediatric surgeon is appropriate if the child’s history or examination findings suggest an underlying organic cause (eg, Hirschsprung disease). […] Assessment of constipation after disimpaction assures that the prescribed therapy was effective. […] In June 2023, the US Food and Drug Administration (FDA) approved linaclotide (Linzess) as the first treatment for pediatric functional constipation. […] A study by Sharifi-Rad et al that included 90 children reported treatment success with interferential electrical stimulation as an adjuvant therapy for functional constipation.

• #1 Constipation Treatment | KidsHealth New Zealand’s Trusted Voice On Children’s Health

  https://www.kidshealth.org.nz/constipation/constipation-treatment

  Laxatives are medicines that help the body to get rid of poo. They are an essential part of the treatment of long-lasting constipation and soiling. […] Laxatives can be used for as long as it takes. Tamariki (children) often need laxatives for months to years rather than weeks. […] A bowel washout is always just one part of your child’s overall treatment – the first part. It is never a standalone treatment. […] Enemas and suppositories are medicines given into the bottom to help to empty the lower bowel. This can be an unpleasant experience for tamariki, causing pain and embarrassment.

• #1 NHS England » National clinical constipation pathway for primary care for children

  https://www.england.nhs.uk/long-read/national-clinical-constipation-pathway-for-primary-care-for-children/

  This guidance supports clinicians in the prevention and management of constipation in children and young people with the following actions: providing a clear and standardised approach based on guidelines from the National Institute for Health and Care Excellence (NICE), the British National Formulary for Children (BNFc) and clinical expert groups […] Laxatives are always first line management of acute or chronic constipation in children. The aim is to titrate doses to ensure the passage of soft, pain free stools and to overcome any withholding behaviours. […] Do not use diet and fluids alone as treatment. Diet and fluid adjustments do not break down hard faeces and there is evidence that constipation is unrelated to diet and fluid intake in about 59% of affected children. […] When constipation has persisted for more than four weeks it is considered chronic. Resolution can take six months or more if the child has developed mega-rectum or mega-colon. Maintenance doses of laxatives for chronic constipation should be continued for at least three to six months after symptoms resolve and toilet training is established unless loose stools develop. They should then be slowly and cautiously titrated down as the child tolerates. The aim is to prevent relapse.

• #1

  https://link.springer.com/article/10.1007/s40272-015-0142-4

  Pharmacological treatment for FC consists of treatment with laxatives and involves three steps: disimpaction, maintenance treatment, and, eventually, weaning. The pharmacological treatment options will be discussed below and are summarized in Table 2, including recommended dosages. […] Fecal impaction, defined as the presence of a large fecal mass in the rectum or abdomen, occurs in approximately 50 % of children with FC. Removal of this fecal mass (disimpaction) is recommended prior to initiation of maintenance treatment in order to increase treatment success. […] After successful disimpaction, maintenance therapy should be initiated to prevent re-accumulation of feces. The aim of maintenance treatment is to soften the stools, which facilitates easy and frequent defecation. Several laxatives (oral and rectal), as well as stool softeners, are available for maintenance treatment. Again, PEG is the oral laxative of first choice, in a dosage of 0.20.8 g/kg/day. […] Approximately 50 % of children with FC on maintenance treatment can stop using their medication within 612 months after initiation of treatment. Maintenance medication should be gradually reduced, rather than abruptly discontinued, in order to prevent a relapse.

• #1 NHS England » National clinical constipation pathway for primary care for children

  https://www.england.nhs.uk/long-read/national-clinical-constipation-pathway-for-primary-care-for-children/

  Children with disabilities are more prone to constipation than their typically developing peers. It must be treated proactively to prevent long-term morbidities and potential mortality in the young person or young adult with a learning disability. […] Continued provision of prescriptions for laxatives is essential to allow the bowel to recover and prevent withholding due to fear of painful bowel actions. […] Laxatives should not be stopped abruptly. […] If stools are too loose with macrogol alone, or if macrogol alone is insufficiently effective, add a stimulant laxative (sodium picosulfate or senna). Start with a lower dose and titrate upwards until desired effect achieved. […] Regular follow up improves outcomes. Family should be contacted one week after commencing disimpaction, two weeks after commencing maintenance, then within a further four weeks and then within eight weeks. Further follow up should continue as appropriate to the child and family.

• #1 Constipation and children | Better Health Channel

  https://www.betterhealth.vic.gov.au/health/conditionsandtreatments/constipation-and-children

  See a doctor if constipation is a long-term problem. […] A healthy diet is very important. Suggestions for improving your childs diet include: Offer more wholegrain or wholemeal breads, rice, cereals and biscuits with high fibre. […] Offer more fruits, dried fruits and vegetables. […] Encourage your child to drink lots of water. […] Suggestions to treat constipation in babies include: If your baby is bottle-fed, check the formula tin to make sure the formula is being made correctly. Always measure the water first and then add formula powder. […] Offer extra drinks of water. […] Gentle tummy massage can help. […] A warm bath may help the babys muscles to relax (be prepared for them to poo in the bath). […] Give only medication prescribed by your doctor.

• #1 Constipation in Children – Pediatrics – MSD Manual Professional Edition

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

  Specific organic causes of constipation should be treated. […] Functional constipation is ideally initially treated with dietary changes. […] Dietary changes differ depending on the age of the child. Infants can be given prune juice after 3 to 6 months of age. Older infants and children should increase water intake, increase consumption of fruits, vegetables, and other sources of fiber, and decrease consumption of constipating foods (eg, milk, cheese). […] Behavior modification for older children involves encouraging regular stool passage after meals if they are toilet trained and providing a reinforcement chart and encouragement to them. […] Unresponsive constipation is treated by disimpacting the bowel and maintaining a regular diet and stool routine. Disimpaction can occur through oral or rectal agents. […] For maintenance of healthy bowels, some children may require over-the-counter dietary fiber supplements.

• #1 Surgical Treatment for Children With Functional Constipation | Children’s National Hospital

  https://www.childrensnational.org/get-care/departments/colorectal/provider-resources/surgical-treatment-constipation

  When a typical bowel management program is not effective, surgery may need to be performed depending on your child’s condition and individual case. For most children with colorectal disorders, surgical intervention can be life-changing. […] Pediatric surgeons are often consulted by pediatricians, emergency physicians or pediatric gastroenterologists to assist treating children with severe cases of constipation, fecal impaction and fecal incontinence. Pediatric surgeons perform the following procedures that help improve these conditions: Antegrade continence enema (ACE) procedure, also called a Malone appendicostomy; Cecostomy; Neo-appendicostomy; Colon resection. […] An antegrade continence enema (ACE) procedure, also known as a Malone procedure, is a surgical procedure that involves constructing a tube from the appendix through the belly button through which an enema can be given. This provides an alternative route for the enema, and can more easily be performed by the patient, promoting their independence.

• #1 Comparing Treatments for Intractable Functional Constipation – Pediatrics Nationwide

  https://pediatricsnationwide.org/2020/06/04/comparing-treatments-for-intractable-functional-constipation/

  Constipation is a common problem in children. While a majority of kids respond to traditional treatments, including behavioral interventions and laxatives, a sizable number continue to have problems with intractable constipation that can lead to fecal incontinence. […] For these children, treatment options include minimally invasive surgical procedures such as antegrade continence enemas (ACE) and sacral nerve stimulation (SNS). However, there is little data comparing these procedures and guidelines for their use are lacking, leading to variation in treatment practices between centers. […] The research team, led by Peter Lu, MD, MS, an attending pediatric gastroenterologist at Nationwide Children’s, found that both ACE and SNS led to durable improvement of functional constipation in children, although the two treatments had different effects on specific symptoms.

• #1 Chronic Constipation: Causes, Symptoms, Diagnosis and Treatment | Nationwide Children’s Hospital

  https://www.nationwidechildrens.org/conditions/chronic-constipation

  Chronic constipation is a slightly different, yet much more challenging condition to treat. […] Nationwide Childrens has a team of experts and specialized outpatient clinics dedicated to providing children with the right combination of behavioral, medical and nutritional therapies they need to successfully overcome chronic constipation. […] Nationwide Children’s Hospital offers a team of experts focused on the treatment of children with chronic constipation. […] Nationwide Childrens Bowel Management Clinics offer a streamlined, comprehensive treatment approach using both behavioral and medical interventions. […] The team will determine if the child could benefit from over-the-counter or prescription therapies that change the consistency of stool or relax the rectal muscles. […] If medical therapy is not effective, then motility studies may be indicated to assess how the child’s anus and colon are functioning.

• #1 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

  Most pediatric constipation can be treated with diet and over-the-counter treatments. But when medical management fails, it can be a sign of a larger problem that needs specialty care. […] Chronic and severe constipation requires different management approaches, depending on motility test results. Childrens Health offers a number of options, including: […] Biofeedback therapy uses a rectal balloon and a computer program to teach children how to contract and relax their pelvic floor muscles. […] Antegrade continence enemas (ACE): This surgical procedure can help children with nerve or muscular issues and/or anorectal malformations overcome chronic constipation while avoiding daily rectal enemas. […] 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.

• #1 Surgical Treatment for Children With Functional Constipation | Children’s National Hospital

  https://www.childrensnational.org/get-care/departments/colorectal/provider-resources/surgical-treatment-constipation

  In a cecostomy, the healthcare provider puts a tube (catheter) into the large intestines (cecum) located in the lower right abdomen, also for access to place an enema used to empty the colon. […] In cases in which a child requires long-term bowel management and the colon is difficult to empty, a segmental colon resection may be performed to reduce either their daily laxative intake or the needed daily enema volume. It is recommended to perform a colon resection in children only after they have had a thorough motility assessment. The procedure does not cure the constipation, but rather will assist in subsequent bowel management, making it easier to empty the colon, either by laxatives or flushes. […] Bowel management is considered successful when a child can wear normal underwear and stay totally clean for 24 hours. This is achievable in the majority of children with anorectal malformations, Hirschsprung’s disease or severe functional constipation.

• #1 A new treatment option for pediatric constipation | Parkview Health

  https://www.parkview.com/blog/a-new-treatment-option-for-pediatric-constipation

  Pediatric anal Botox involves the injection of a neurotoxin called Botulinum Toxin Type A (Botox) into the anal sphincter muscles of children suffering from chronic constipation. Botox is a muscle relaxant that temporarily paralyzes the muscles and reduces their spasticity, which can help relieve the symptoms of constipation. […] If a child has not responded to other treatments (laxatives, behavioral interventions, dietary changes, etc.), pediatric anal Botox injections can be an effective treatment option for chronic constipation. […] The injections are performed under sedation or general anesthesia in a hospital setting and typically take around 15-20 minutes to complete. […] It’s important to note that anal Botox injections are not a permanent solution for constipation. Additional treatments, such as daily osmotic and stimulant laxative treatment, diet changes, scheduled toileting practices, behavioral therapy, etc., will be necessary for several months.

• #1 NHS England » National clinical constipation pathway for primary care for children

  https://www.england.nhs.uk/long-read/national-clinical-constipation-pathway-for-primary-care-for-children/

  If no improvement within four weeks in children under one year, refer urgently to a paediatrician. […] If no or limited improvement after three months, in children over one year old, or additional concerns refer to specialist service. […] First line treatment of all idiopathic constipation in children is with laxatives, usually macrogols. Prompt treatment may prevent constipation becoming chronic. […] Chronic constipation requires long-term treatment to overcome fear of painful defecation and subsequent withholding and establishment of toilet training in younger children. […] Many children require laxatives for months. […] Adjust laxative dose according to response. Consider adding stimulants if macrogols insufficiently effective, not tolerated or refused by the child. Children who are on a stimulant laxative only may benefit from the addition of an osmotic laxative such as lactulose or docusate. […] Reassess as appropriate to the child and family. If no improvement after three months refer to specialist service (local childrens bladder and bowel service if there is one or to a paediatrician).

• #2

  https://link.springer.com/article/10.1007/s40272-015-0142-4

  Functional constipation is a common healthcare problem among children worldwide and accounts for high healthcare usage and costs. Treatment consists of non-pharmacological and pharmacological interventions. Non-pharmacological interventions involve education and demystification, toilet training (with a reward system), and a defecation diary. Pharmacological treatment comprises three steps: disimpaction, maintenance treatment, and weaning. The treatment of first choice is oral laxatives, preferably polyethylene glycol. When this is insufficient, other therapeutic agents are available. […] In the treatment of functional constipation, the medication of first choice for both disimpaction and maintenance treatment is polyethylene glycol. Other therapeutic agents (e.g., stimulant laxatives or lubricants) may be useful as additional or second-line therapy if adequate treatment with oral laxatives is insufficient.

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

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

  Education is the first step in treatment. […] Behavior modification with regular toileting (for five to 10 minutes) after meals combined with a reward system is often helpful. […] Dietary changes are often advised in children with constipation. […] When fecal impaction is present, disimpaction with oral or rectal medication is required before initiation of maintenance therapy. […] The goal of maintenance therapy is to avoid reaccumulation of stool by maintaining soft bowel movements, preferably occurring once a day. […] Most children with functional constipation require prolonged treatment and have frequent relapses. […] 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.

• #2 Management of Functional Constipation in Children: Therapy in Practice

  https://pmc.ncbi.nlm.nih.gov/articles/PMC4768242/

  Functional constipation is a common healthcare problem among children worldwide and accounts for high healthcare usage and costs. Treatment consists of non-pharmacological and pharmacological interventions. Non-pharmacological interventions involve education and demystification, toilet training (with a reward system), and a defecation diary. Pharmacological treatment comprises three steps: disimpaction, maintenance treatment, and weaning. The treatment of first choice is oral laxatives, preferably polyethylene glycol. When this is insufficient, other therapeutic agents are available. […] In the treatment of functional constipation, the medication of first choice for both disimpaction and maintenance treatment is polyethylene glycol. Other therapeutic agents (e.g., stimulant laxatives or lubricants) may be useful as additional or second-line therapy if adequate treatment with oral laxatives is insufficient.

• #2 NHS England » National clinical constipation pathway for primary care for children

  https://www.england.nhs.uk/long-read/national-clinical-constipation-pathway-for-primary-care-for-children/

  This guidance supports clinicians in the prevention and management of constipation in children and young people with the following actions: providing a clear and standardised approach based on guidelines from the National Institute for Health and Care Excellence (NICE), the British National Formulary for Children (BNFc) and clinical expert groups […] Laxatives are always first line management of acute or chronic constipation in children. The aim is to titrate doses to ensure the passage of soft, pain free stools and to overcome any withholding behaviours. […] Do not use diet and fluids alone as treatment. Diet and fluid adjustments do not break down hard faeces and there is evidence that constipation is unrelated to diet and fluid intake in about 59% of affected children. […] When constipation has persisted for more than four weeks it is considered chronic. Resolution can take six months or more if the child has developed mega-rectum or mega-colon. Maintenance doses of laxatives for chronic constipation should be continued for at least three to six months after symptoms resolve and toilet training is established unless loose stools develop. They should then be slowly and cautiously titrated down as the child tolerates. The aim is to prevent relapse.

• #2 Constipation in children – Symptoms & causes – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/constipation-in-children/symptoms-causes/syc-20354242

  Constipation in children is a common problem. A constipated child has infrequent bowel movements or hard, dry stools. […] Encouraging your child to make simple dietary changes such as eating more fiber-rich fruits and vegetables and drinking more water can go a long way toward alleviating constipation. If your child’s doctor approves, it may be possible to treat a child’s constipation with laxatives. […] To help prevent constipation in children: Offer your child high-fiber foods. A diet rich in fiber can help your child’s body form soft, bulky stool. Serve your child more high-fiber foods, such as fruits, vegetables, beans, and whole-grain cereals and breads. […] Encourage your child to drink plenty of fluids. Water is often the best. […] Promote physical activity. Regular physical activity helps stimulate normal bowel function. […] Create a toilet routine. Regularly set aside time after meals for your child to use the toilet. […] Review medications. If your child is taking a medication that causes constipation, ask his or her doctor about other options.

• #2 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. […] The first goal of managing constipation is to treat fecal impaction, and then maintenance therapy is used to prevent a recurrence. Polyethylene glycol is the first-line treatment for constipation. […] Increasing dietary fiber and fluid intake above usual daily recommendations and adding probiotics provide no additional benefits for treating constipation. […] Frequent follow-up visits and referrals to a psychologist can assist in reaching some treatment goals. […] Referral to a pediatric gastroenterologist is recommended when there is a concern for organic causes or constipation persists despite adequate therapy. […] Management of constipation includes dietary modifications, behavior interventions, medications, and disimpaction if needed.

• #2 Treatment for Constipation in Children – NIDDK

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

  You can most often treat your childs constipation at home by doing the following: […] Changing what your child eats and drinks may make his or her stools softer and easier to pass. […] To help relieve symptoms, have him or her eat more high-fiber foods. […] Drink plenty of water and other liquids if your child eats more fiber. […] Changing your childs bowel movement patterns and behaviors may help treat constipation. […] Your childs doctor may recommend giving your child an enema or laxative to help treat his or her constipation. […] Most laxatives are over-the-counter medicines taken by mouth until your childs bowel movements are normal. […] Your childs doctor may recommend stopping the laxative once your child has better eating and bowel habits. […] Your doctor may recommend treating your childs hemorrhoids or anal fissures by making changes in his or her diet to prevent constipation. […] Doctors may be able to treat complications of constipation in children during an office visit. […] For a child age 2 or older, your doctor may recommend giving mineral oil. […] You can help prevent constipation in your child with the same things that treat constipation.

• #2 Patient education: Constipation in infants and children (Beyond the Basics) – UpToDate

  https://www.uptodate.com/contents/constipation-in-infants-and-children-beyond-the-basics/print

  After the „clean out” treatment, most infants and children are treated with a laxative for several months or longer. PEG is often used for this purpose. […] Using appropriate laxatives, as recommended by your child’s doctor or nurse, does not increase the risk of constipation in the future. Instead, careful use of laxatives can actually prevent long-term problems with constipation by breaking the cycle of pain and withholding and helping the child to develop healthy toileting habits.

• #2 Pediatric Constipation Treatment & Management: Approach Considerations, Colon Evacuation, Removal of Pain-Associated Defecation

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

  Although constipation is an extremely common problem among children, few studies have systematically evaluated different management strategies. Childhood constipation is treated in many ways, and virtually any therapeutic regimen is likely to be effective as long as it is sufficiently aggressive and persistent. Because of the medical profession’s understanding of the pathophysiology of the problem, the basic tenets of therapy include evacuation of the colon, elimination of pain with defecation, and establishing regular bowel habits. […] A group of patients with severe constipation that does not respond to conservative medical therapy may require more aggressive treatments, including surgery. […] When there is evidence of a fecal impaction, initial therapy should be directed at evacuating the colon.

• #2 Pediatric Constipation Treatment & Management: Approach Considerations, Colon Evacuation, Removal of Pain-Associated Defecation

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

  Aggressive use of oral cathartics such as polyethylene glycol, sodium phosphate, magnesium citrate, or a balanced electrolyte solution with polyethylene glycol or a series of enemas can accomplish disimpaction. […] Once the colon has been evacuated, chronic laxative therapy is generally required. Virtually any laxative can be used as long as it is used in sufficient quantity to produce 1-2 soft stools daily. In young children, eliminating any pain associated with the passage of bowel movements is extremely important. […] In many cases, long-term success in the management of constipation depends on the child establishing regular and routine toilet times. […] Dietary changes, such as increasing the child’s intake of fluids and carbohydrates, are commonly recommended as part of the treatment of constipation.

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

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

  Allergy testing is not recommended to diagnose suspected cows milk allergy in children with constipation, as it is usually not IgE mediated. A one-month trial of avoiding cows milk and soy protein may be indicated in children with intractable constipation. […] For children who are not yet toilet-trained for stool, and who feel more secure defaecating in a diaper, this should be encouraged while the stool is softened with laxatives and the child regains confidence. […] Goals of drug therapy are to soften stools to eliminate the child’s fear of painful defaecation. […] Oral polyethylene glycol (PEG) 3350 with or without electrolytes is the most effective first-line treatment for disimpaction in the outpatient setting. […] Treatment of constipation is not effective if faecal impaction is not treated. Disimpaction dose for children is 11.5 g/kg/day of PEG for 36 days.

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

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

  Never give your child a laxative or enema without the doctor’s OK and instructions on the proper dose. […] Hospital enema. Sometimes a child may be so severely constipated that he or she needs to be hospitalized for a short time to be given a stronger enema that will clear the bowel (disimpaction).

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

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

  Depending on the circumstances, your child’s doctor may recommend: […] Over-the-counter fiber supplements or stool softeners. If your child doesn’t get a lot of fiber in his or her diet, adding an over-the-counter fiber supplement, such as Metamucil or Citrucel, might help. However, your child needs to drink at least 32 ounces (about 1 liter) of water daily for these products to work well. Check with your child’s doctor to find out the right dose for your child’s age and weight. […] Glycerin suppositories can be used to soften the stool in children who can’t swallow pills. Talk with your child’s doctor about the right way to use these products. […] A laxative or enema. If an accumulation of fecal material creates a blockage, your child’s doctor may suggest a laxative or enema to help remove the blockage. Examples include polyethylene glycol (GlycoLax, MiraLax, others) and mineral oil.

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

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

  For children presenting with fecal impaction, removing the hard stool from the colon is the first step in treating constipation. […] Polyethylene glycol is the first-line treatment because it is more effective than other agents for disimpaction and maintenance therapy, is well-tolerated, and has a low risk of adverse effects. […] Maintenance therapy should be started in children without impaction or when disimpaction is achieved. […] Polyethylene glycol is superior to other oral laxatives and is recommended as a first-line maintenance treatment for constipation. […] Relapses are common and should be treated with maintenance therapy or disimpaction therapy when appropriate. […] Rarely, surgical intervention is required to treat refractory constipation.

• #2

  https://www.healthychildren.org/English/health-issues/conditions/abdominal/Pages/constipation.aspx

  Examples include: senna (and other sennokot plant derivates), bisacodyl and sodium picosulfate (not sold in United States). […] These are highly specialized medications that should be used by pediatric gastroenterologists. […] Rectal therapies include suppositories (which give medicine directly to the rectum) and enemas (which given medicine higher into the colon to provide additional hydration, lubrication or stimulation to evacuate poop). […] There is research showing that children and parents benefit from receiving a Constipation Action Plan at the time of diagnosis. […] Some children may need a medical disimpaction (or cleanout) before starting maintenance therapy. […] Constipation should be treated with maintenance medications for at least 2 months. […] If this happens, your child should CONTINUE toilet training and take their medicines until toilet training is completed and they have been free of symptoms for one additional month.

• #2 Management of Functional Constipation in Children: Therapy in Practice

  https://pmc.ncbi.nlm.nih.gov/articles/PMC4768242/

  Non-pharmacological management involves education, demystification, a toilet program with a reward system, and a daily bowel diary. Pharmacological treatment with laxatives consists of disimpaction, maintenance treatment, and eventually weaning off medication. PEG is the laxative of first choice for both disimpaction (high-dose: 11.5 g/kg/day) and maintenance treatment (0.20.8 g/kg/day). If PEG is not available or is poorly tolerated, lactulose is recommended. Stimulant laxatives (bisacodyl, senna, sodium picosulfate), magnesium hydroxide, and/or mineral oil may be considered as second-line or additional treatment if treatment with osmotic laxatives is insufficient. Maintenance treatment should be continued for at least 2 months, and FC symptoms should be resolved for at least 1 month before a gradually reduction of the medication.

• #2

  https://www.healthychildren.org/English/health-issues/conditions/abdominal/Pages/constipation.aspx

  A simple way to make sure your child is getting enough fiber is by making healthful food choices. […] If you find it helpful to keep track of total grams of fiber that your child is eating, add 5 to your child’s age. […] It is important to note that fiber supplements taken without enough water can worsen your child’s constipation! […] One tool to improve toilet posture is the defecation posture modification device, a potty stool. […] There are many laxative medicines available to treat children with functional constipation including stool softeners, osmotic laxatives, stimulant laxatives, secretagogue laxatives and rectal therapies. […] Examples include docusate sodium. […] Examples include polyethylene glycol 3350 (PEG), PEG 4000, Milk of Magnesia (magnesium hydroxide), and Magnesium Citrate.

• #2 FDA approves first treatment for pediatric functional constipation | FDA

  https://www.fda.gov/drugs/news-events-human-drugs/fda-approves-first-treatment-pediatric-functional-constipation

  FDA has approved Linzess (linaclotide) capsules to treat functional constipation in pediatric patients 6 to 17 years of age. Linzess is the first treatment for pediatric functional constipation. The recommended dosage in pediatric patients 6 to 17 years is 72 mcg orally once daily. […] The efficacy of Linzess for the treatment of functional constipation in pediatric patients 6 to 17 years of age was established in a 12-week double-blind, placebo-controlled, randomized, multicenter clinical trial (Trial 7; NCT04026113) and supported by efficacy data from adequate and well-controlled trials in adults with chronic idiopathic constipation (constipation that persists and isnt connected to an underlying illness). […] Patients who received Linzess experienced a greater improvement in the average number of SBMs per week than patients who received placebo. SBM frequency improved during week one and was maintained throughout the remainder of the 12-week treatment period.

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

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

  In the case of chronic constipation, families should continue with PEG and aim for extra soft stools, type 5 or 6 on the Bristol stool scale. […] If a brief period of constipation occurs while on adequate softener treatment, a stimulant laxative can be added. […] 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.

• #2

  https://link.springer.com/article/10.1007/s40272-015-0142-4

  Pharmacological treatment for FC consists of treatment with laxatives and involves three steps: disimpaction, maintenance treatment, and, eventually, weaning. The pharmacological treatment options will be discussed below and are summarized in Table 2, including recommended dosages. […] Fecal impaction, defined as the presence of a large fecal mass in the rectum or abdomen, occurs in approximately 50 % of children with FC. Removal of this fecal mass (disimpaction) is recommended prior to initiation of maintenance treatment in order to increase treatment success. […] After successful disimpaction, maintenance therapy should be initiated to prevent re-accumulation of feces. The aim of maintenance treatment is to soften the stools, which facilitates easy and frequent defecation. Several laxatives (oral and rectal), as well as stool softeners, are available for maintenance treatment. Again, PEG is the oral laxative of first choice, in a dosage of 0.20.8 g/kg/day. […] Approximately 50 % of children with FC on maintenance treatment can stop using their medication within 612 months after initiation of treatment. Maintenance medication should be gradually reduced, rather than abruptly discontinued, in order to prevent a relapse.

• #2 Constipation and children | Better Health Channel

  https://www.betterhealth.vic.gov.au/health/conditionsandtreatments/constipation-and-children

  See a doctor if constipation is a long-term problem. […] A healthy diet is very important. Suggestions for improving your childs diet include: Offer more wholegrain or wholemeal breads, rice, cereals and biscuits with high fibre. […] Offer more fruits, dried fruits and vegetables. […] Encourage your child to drink lots of water. […] Suggestions to treat constipation in babies include: If your baby is bottle-fed, check the formula tin to make sure the formula is being made correctly. Always measure the water first and then add formula powder. […] Offer extra drinks of water. […] Gentle tummy massage can help. […] A warm bath may help the babys muscles to relax (be prepared for them to poo in the bath). […] Give only medication prescribed by your doctor.

• #2 Surgical Treatment for Children With Functional Constipation | Children’s National Hospital

  https://www.childrensnational.org/get-care/departments/colorectal/provider-resources/surgical-treatment-constipation

  In a cecostomy, the healthcare provider puts a tube (catheter) into the large intestines (cecum) located in the lower right abdomen, also for access to place an enema used to empty the colon. […] In cases in which a child requires long-term bowel management and the colon is difficult to empty, a segmental colon resection may be performed to reduce either their daily laxative intake or the needed daily enema volume. It is recommended to perform a colon resection in children only after they have had a thorough motility assessment. The procedure does not cure the constipation, but rather will assist in subsequent bowel management, making it easier to empty the colon, either by laxatives or flushes. […] Bowel management is considered successful when a child can wear normal underwear and stay totally clean for 24 hours. This is achievable in the majority of children with anorectal malformations, Hirschsprung’s disease or severe functional constipation.

• #2 Comparing Treatments for Intractable Functional Constipation – Pediatrics Nationwide

  https://pediatricsnationwide.org/2020/06/04/comparing-treatments-for-intractable-functional-constipation/

  “Our takeaway from this study is that if the child’s main symptom is fecal incontinence, and especially if they have urinary symptoms too, SNS may be a good option,” says Dr. Lu. “Whereas if the fecal incontinence is secondary to not being able to go and having a lot of pain, maybe ACE would be the better option.” […] Since this study was retrospective, Dr. Lu says that larger, randomized, prospective studies are needed to gather even more evidence for the optimal uses of these two treatments. Future studies could also examine other treatment options that are considered for these patients, such as surgically removing part of the colon. […] “Ongoing constipation and stool accidents are common and have a huge impact on a child’s self-esteem and quality of life,” says Dr. Lu.

• #2 Surgical Treatment for Children With Functional Constipation | Children’s National Hospital

  https://www.childrensnational.org/get-care/departments/colorectal/provider-resources/surgical-treatment-constipation

  When a typical bowel management program is not effective, surgery may need to be performed depending on your child’s condition and individual case. For most children with colorectal disorders, surgical intervention can be life-changing. […] Pediatric surgeons are often consulted by pediatricians, emergency physicians or pediatric gastroenterologists to assist treating children with severe cases of constipation, fecal impaction and fecal incontinence. Pediatric surgeons perform the following procedures that help improve these conditions: Antegrade continence enema (ACE) procedure, also called a Malone appendicostomy; Cecostomy; Neo-appendicostomy; Colon resection. […] An antegrade continence enema (ACE) procedure, also known as a Malone procedure, is a surgical procedure that involves constructing a tube from the appendix through the belly button through which an enema can be given. This provides an alternative route for the enema, and can more easily be performed by the patient, promoting their independence.

• #2 Comparing Treatments for Intractable Functional Constipation – Pediatrics Nationwide

  https://pediatricsnationwide.org/2020/06/04/comparing-treatments-for-intractable-functional-constipation/

  Constipation is a common problem in children. While a majority of kids respond to traditional treatments, including behavioral interventions and laxatives, a sizable number continue to have problems with intractable constipation that can lead to fecal incontinence. […] For these children, treatment options include minimally invasive surgical procedures such as antegrade continence enemas (ACE) and sacral nerve stimulation (SNS). However, there is little data comparing these procedures and guidelines for their use are lacking, leading to variation in treatment practices between centers. […] The research team, led by Peter Lu, MD, MS, an attending pediatric gastroenterologist at Nationwide Children’s, found that both ACE and SNS led to durable improvement of functional constipation in children, although the two treatments had different effects on specific symptoms.

• #2 NHS England » National clinical constipation pathway for primary care for children

  https://www.england.nhs.uk/long-read/national-clinical-constipation-pathway-for-primary-care-for-children/

  Children with disabilities are more prone to constipation than their typically developing peers. It must be treated proactively to prevent long-term morbidities and potential mortality in the young person or young adult with a learning disability. […] Continued provision of prescriptions for laxatives is essential to allow the bowel to recover and prevent withholding due to fear of painful bowel actions. […] Laxatives should not be stopped abruptly. […] If stools are too loose with macrogol alone, or if macrogol alone is insufficiently effective, add a stimulant laxative (sodium picosulfate or senna). Start with a lower dose and titrate upwards until desired effect achieved. […] Regular follow up improves outcomes. Family should be contacted one week after commencing disimpaction, two weeks after commencing maintenance, then within a further four weeks and then within eight weeks. Further follow up should continue as appropriate to the child and family.

• #2 NHS England » National clinical constipation pathway for primary care for children

  https://www.england.nhs.uk/long-read/national-clinical-constipation-pathway-for-primary-care-for-children/

  If no improvement within four weeks in children under one year, refer urgently to a paediatrician. […] If no or limited improvement after three months, in children over one year old, or additional concerns refer to specialist service. […] First line treatment of all idiopathic constipation in children is with laxatives, usually macrogols. Prompt treatment may prevent constipation becoming chronic. […] Chronic constipation requires long-term treatment to overcome fear of painful defecation and subsequent withholding and establishment of toilet training in younger children. […] Many children require laxatives for months. […] Adjust laxative dose according to response. Consider adding stimulants if macrogols insufficiently effective, not tolerated or refused by the child. Children who are on a stimulant laxative only may benefit from the addition of an osmotic laxative such as lactulose or docusate. […] Reassess as appropriate to the child and family. If no improvement after three months refer to specialist service (local childrens bladder and bowel service if there is one or to a paediatrician).

• #3 Constipation in children – Symptoms & causes – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/constipation-in-children/symptoms-causes/syc-20354242

  Constipation in children is a common problem. A constipated child has infrequent bowel movements or hard, dry stools. […] Encouraging your child to make simple dietary changes such as eating more fiber-rich fruits and vegetables and drinking more water can go a long way toward alleviating constipation. If your child’s doctor approves, it may be possible to treat a child’s constipation with laxatives. […] To help prevent constipation in children: Offer your child high-fiber foods. A diet rich in fiber can help your child’s body form soft, bulky stool. Serve your child more high-fiber foods, such as fruits, vegetables, beans, and whole-grain cereals and breads. […] Encourage your child to drink plenty of fluids. Water is often the best. […] Promote physical activity. Regular physical activity helps stimulate normal bowel function. […] Create a toilet routine. Regularly set aside time after meals for your child to use the toilet. […] Review medications. If your child is taking a medication that causes constipation, ask his or her doctor about other options.

• #3 Management of Functional Constipation in Children: Therapy in Practice

  https://pmc.ncbi.nlm.nih.gov/articles/PMC4768242/

  Non-pharmacological management involves education, demystification, a toilet program with a reward system, and a daily bowel diary. Pharmacological treatment with laxatives consists of disimpaction, maintenance treatment, and eventually weaning off medication. PEG is the laxative of first choice for both disimpaction (high-dose: 11.5 g/kg/day) and maintenance treatment (0.20.8 g/kg/day). If PEG is not available or is poorly tolerated, lactulose is recommended. Stimulant laxatives (bisacodyl, senna, sodium picosulfate), magnesium hydroxide, and/or mineral oil may be considered as second-line or additional treatment if treatment with osmotic laxatives is insufficient. Maintenance treatment should be continued for at least 2 months, and FC symptoms should be resolved for at least 1 month before a gradually reduction of the medication.

• #3

  https://www.healthychildren.org/English/health-issues/conditions/abdominal/Pages/constipation.aspx

  A simple way to make sure your child is getting enough fiber is by making healthful food choices. […] If you find it helpful to keep track of total grams of fiber that your child is eating, add 5 to your child’s age. […] It is important to note that fiber supplements taken without enough water can worsen your child’s constipation! […] One tool to improve toilet posture is the defecation posture modification device, a potty stool. […] There are many laxative medicines available to treat children with functional constipation including stool softeners, osmotic laxatives, stimulant laxatives, secretagogue laxatives and rectal therapies. […] Examples include docusate sodium. […] Examples include polyethylene glycol 3350 (PEG), PEG 4000, Milk of Magnesia (magnesium hydroxide), and Magnesium Citrate.

• #3

  https://www.healthychildren.org/English/health-issues/conditions/abdominal/Pages/constipation.aspx

  Examples include: senna (and other sennokot plant derivates), bisacodyl and sodium picosulfate (not sold in United States). […] These are highly specialized medications that should be used by pediatric gastroenterologists. […] Rectal therapies include suppositories (which give medicine directly to the rectum) and enemas (which given medicine higher into the colon to provide additional hydration, lubrication or stimulation to evacuate poop). […] There is research showing that children and parents benefit from receiving a Constipation Action Plan at the time of diagnosis. […] Some children may need a medical disimpaction (or cleanout) before starting maintenance therapy. […] Constipation should be treated with maintenance medications for at least 2 months. […] If this happens, your child should CONTINUE toilet training and take their medicines until toilet training is completed and they have been free of symptoms for one additional month.

• #3 NHS England » National clinical constipation pathway for primary care for children

  https://www.england.nhs.uk/long-read/national-clinical-constipation-pathway-for-primary-care-for-children/

  If no improvement within four weeks in children under one year, refer urgently to a paediatrician. […] If no or limited improvement after three months, in children over one year old, or additional concerns refer to specialist service. […] First line treatment of all idiopathic constipation in children is with laxatives, usually macrogols. Prompt treatment may prevent constipation becoming chronic. […] Chronic constipation requires long-term treatment to overcome fear of painful defecation and subsequent withholding and establishment of toilet training in younger children. […] Many children require laxatives for months. […] Adjust laxative dose according to response. Consider adding stimulants if macrogols insufficiently effective, not tolerated or refused by the child. Children who are on a stimulant laxative only may benefit from the addition of an osmotic laxative such as lactulose or docusate. […] Reassess as appropriate to the child and family. If no improvement after three months refer to specialist service (local childrens bladder and bowel service if there is one or to a paediatrician).

• #3 Constipation and children | Better Health Channel

  https://www.betterhealth.vic.gov.au/health/conditionsandtreatments/constipation-and-children

  See a doctor if constipation is a long-term problem. […] A healthy diet is very important. Suggestions for improving your childs diet include: Offer more wholegrain or wholemeal breads, rice, cereals and biscuits with high fibre. […] Offer more fruits, dried fruits and vegetables. […] Encourage your child to drink lots of water. […] Suggestions to treat constipation in babies include: If your baby is bottle-fed, check the formula tin to make sure the formula is being made correctly. Always measure the water first and then add formula powder. […] Offer extra drinks of water. […] Gentle tummy massage can help. […] A warm bath may help the babys muscles to relax (be prepared for them to poo in the bath). […] Give only medication prescribed by your doctor.

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

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

  Education is the first step in treatment. […] Behavior modification with regular toileting (for five to 10 minutes) after meals combined with a reward system is often helpful. […] Dietary changes are often advised in children with constipation. […] When fecal impaction is present, disimpaction with oral or rectal medication is required before initiation of maintenance therapy. […] The goal of maintenance therapy is to avoid reaccumulation of stool by maintaining soft bowel movements, preferably occurring once a day. […] Most children with functional constipation require prolonged treatment and have frequent relapses. […] 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.

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

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

  In the case of chronic constipation, families should continue with PEG and aim for extra soft stools, type 5 or 6 on the Bristol stool scale. […] If a brief period of constipation occurs while on adequate softener treatment, a stimulant laxative can be added. […] 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.

• #4

  https://www.healthychildren.org/English/health-issues/conditions/abdominal/Pages/constipation.aspx

  Examples include: senna (and other sennokot plant derivates), bisacodyl and sodium picosulfate (not sold in United States). […] These are highly specialized medications that should be used by pediatric gastroenterologists. […] Rectal therapies include suppositories (which give medicine directly to the rectum) and enemas (which given medicine higher into the colon to provide additional hydration, lubrication or stimulation to evacuate poop). […] There is research showing that children and parents benefit from receiving a Constipation Action Plan at the time of diagnosis. […] Some children may need a medical disimpaction (or cleanout) before starting maintenance therapy. […] Constipation should be treated with maintenance medications for at least 2 months. […] If this happens, your child should CONTINUE toilet training and take their medicines until toilet training is completed and they have been free of symptoms for one additional month.

• #4 Constipation and children | Better Health Channel

  https://www.betterhealth.vic.gov.au/health/conditionsandtreatments/constipation-and-children

  See a doctor if constipation is a long-term problem. […] A healthy diet is very important. Suggestions for improving your childs diet include: Offer more wholegrain or wholemeal breads, rice, cereals and biscuits with high fibre. […] Offer more fruits, dried fruits and vegetables. […] Encourage your child to drink lots of water. […] Suggestions to treat constipation in babies include: If your baby is bottle-fed, check the formula tin to make sure the formula is being made correctly. Always measure the water first and then add formula powder. […] Offer extra drinks of water. […] Gentle tummy massage can help. […] A warm bath may help the babys muscles to relax (be prepared for them to poo in the bath). […] Give only medication prescribed by your doctor.

• #5 Constipation and children | Better Health Channel

  https://www.betterhealth.vic.gov.au/health/conditionsandtreatments/constipation-and-children

  See a doctor if constipation is a long-term problem. […] A healthy diet is very important. Suggestions for improving your childs diet include: Offer more wholegrain or wholemeal breads, rice, cereals and biscuits with high fibre. […] Offer more fruits, dried fruits and vegetables. […] Encourage your child to drink lots of water. […] Suggestions to treat constipation in babies include: If your baby is bottle-fed, check the formula tin to make sure the formula is being made correctly. Always measure the water first and then add formula powder. […] Offer extra drinks of water. […] Gentle tummy massage can help. […] A warm bath may help the babys muscles to relax (be prepared for them to poo in the bath). […] Give only medication prescribed by your doctor.

Zobacz więcej