Constipation (peds) - Revision history

Ostermayer: Marked this version for translation

2026-01-14T12:54:39Z

Marked this version for translation

← Older revision		Revision as of 12:54, 14 January 2026
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			<!--T:1-->
	''This page is for '''pediatric''' patients; for adult patients see [[Special:MyLanguage/constipation\|constipation]].''		''This page is for '''pediatric''' patients; for adult patients see [[Special:MyLanguage/constipation\|constipation]].''

	==Background==		==Background== <!--T:2-->

			<!--T:3-->
	*Functional constipation is the most common, but must evaluate for concerning/organic causes (see DDX)		*Functional constipation is the most common, but must evaluate for concerning/organic causes (see DDX)
	*There is a wide range of normal frequency of stools and no widely-accepted definition of pediatric constipation.		*There is a wide range of normal frequency of stools and no widely-accepted definition of pediatric constipation.
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	==Clinical Features==		==Clinical Features== <!--T:4-->

			<!--T:5-->
	[[File:BristolStoolChart.png\|thumb\|Bristol Stool Chart.]]		[[File:BristolStoolChart.png\|thumb\|Bristol Stool Chart.]]
	*Most patients note some combination of withholding/infrequent defecation, painful defecation, or crampy abdominal pain		*Most patients note some combination of withholding/infrequent defecation, painful defecation, or crampy abdominal pain
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	===Red flags===		===Red flags=== <!--T:6-->

			<!--T:7-->
	*Significant or constant/unrelenting [[Special:MyLanguage/abdominal pain (peds)\|abdominal pain]]		*Significant or constant/unrelenting [[Special:MyLanguage/abdominal pain (peds)\|abdominal pain]]
	*[[Special:MyLanguage/Failure to thrive\|Failure to thrive]]		*[[Special:MyLanguage/Failure to thrive\|Failure to thrive]]
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	==Differential Diagnosis==		==Differential Diagnosis== <!--T:8-->

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	===Children (older than 1 year) Constipation===		===Children (older than 1 year) Constipation=== <!--T:9-->

			<!--T:10-->
	*Functional constipation (>95% of cases)		*Functional constipation (>95% of cases)
	*Organic causes		*Organic causes
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	==Evaluation==		==Evaluation== <!--T:11-->


	===Workup===		===Workup=== <!--T:12-->

			<!--T:13-->
	[[File:Constipation(lots).png\|thumb\|Stool burden that may be consistent with constipation on [[Special:MyLanguage/KUB\|KUB]]. '''Use of a KUB to diagnose constipation in pediatric patients is generally NOT indicated,''' as other serious pathology may also result in the imaging findings.]]		[[File:Constipation(lots).png\|thumb\|Stool burden that may be consistent with constipation on [[Special:MyLanguage/KUB\|KUB]]. '''Use of a KUB to diagnose constipation in pediatric patients is generally NOT indicated,''' as other serious pathology may also result in the imaging findings.]]
	;Use of a KUB to diagnose constipation in pediatric patients is generally NOT indicated, as [[Special:MyLanguage/acute appendicitis\|acute appendicitis]] and other serious pathology may also result in increased stool burden. If the abdominal exam is concerning, proceed to ultrasound/CT.		;Use of a KUB to diagnose constipation in pediatric patients is generally NOT indicated, as [[Special:MyLanguage/acute appendicitis\|acute appendicitis]] and other serious pathology may also result in increased stool burden. If the abdominal exam is concerning, proceed to ultrasound/CT.
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	===Diagnosis===		===Diagnosis=== <!--T:14-->

			<!--T:15-->
	*'''Note that the emergency physician's primary role is to rule out organic and life-threatening causes of constipation'''		*'''Note that the emergency physician's primary role is to rule out organic and life-threatening causes of constipation'''
	**[[Special:MyLanguage/Acute appendicitis\|Acute appendicitis]] and other causes of surgical abdomen may present as constipation, in which case the primary emergency medicine goal is ruling out these other conditions		**[[Special:MyLanguage/Acute appendicitis\|Acute appendicitis]] and other causes of surgical abdomen may present as constipation, in which case the primary emergency medicine goal is ruling out these other conditions
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	==Management==		==Management== <!--T:16-->

			<!--T:17-->
	''While acute disimpaction (oral, rectal, or both) in the ED may be helpful, maintenance therapy (to prevent stool re-impaction) and family education is equally important and may prevent future ED visits.''		''While acute disimpaction (oral, rectal, or both) in the ED may be helpful, maintenance therapy (to prevent stool re-impaction) and family education is equally important and may prevent future ED visits.''


	===Infants===		===Infants=== <!--T:18-->

			<!--T:19-->
	*Dietary interventions		*Dietary interventions
	**Not yet begun solid foods		**Not yet begun solid foods
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	===Toddlers and children===		===Toddlers and children=== <!--T:20-->

			<!--T:21-->
	*WITHOUT withholding behavior, bleeding, or [[Special:MyLanguage/anal fissure\|anal fissure]]		*WITHOUT withholding behavior, bleeding, or [[Special:MyLanguage/anal fissure\|anal fissure]]
	**Fiber: age + (5 to 10) grams daily		**Fiber: age + (5 to 10) grams daily
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	==Disposition==		==Disposition== <!--T:22-->

			<!--T:23-->
	*Outpatient pediatrician follow-up		*Outpatient pediatrician follow-up
	*Consider urgent vs nonurgent referral to a pediatric gastroenterologist if red-flag symptoms are present		*Consider urgent vs nonurgent referral to a pediatric gastroenterologist if red-flag symptoms are present


	==See Also==		==See Also== <!--T:24-->

			<!--T:25-->
	*[[Special:MyLanguage/Constipation\|Constipation]]		*[[Special:MyLanguage/Constipation\|Constipation]]
	*Tables on neonatal constipation differential and normal stool/urine output<ref>Helman, A. Morgenstern, J. Ivankovic, M. Long, B. Reid, S. Swaminathan, A. EM Quick Hits 25 – Cerebral Venous Thrombosis, Diphenhydramine Alternatives, Abdominal Compartment Syndrome, Neonatal Constipation, Intubating Metabolic Acidosis. Emergency Medicine Cases. January, 2021. https://emergencymedicinecases.com/em-quick-hits-jan2021/ Accessed 1/26/2021</ref>.		*Tables on neonatal constipation differential and normal stool/urine output<ref>Helman, A. Morgenstern, J. Ivankovic, M. Long, B. Reid, S. Swaminathan, A. EM Quick Hits 25 – Cerebral Venous Thrombosis, Diphenhydramine Alternatives, Abdominal Compartment Syndrome, Neonatal Constipation, Intubating Metabolic Acidosis. Emergency Medicine Cases. January, 2021. https://emergencymedicinecases.com/em-quick-hits-jan2021/ Accessed 1/26/2021</ref>.


	==References==		==References== <!--T:26-->

			<!--T:27-->
	<references/>		<references/>

			<!--T:28-->
	[[Category:Pediatrics]]		[[Category:Pediatrics]]
	[[Category:GI]]		[[Category:GI]]
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Ostermayer: Prepared the page for translation

2026-01-04T21:58:12Z

Prepared the page for translation

Show changes

Rossdonaldson1: /* Red flags */

2025-01-29T16:54:10Z

Red flags

← Older revision		Revision as of 16:54, 29 January 2025
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	===Red flags===		===Red flags===
	*Significant or constant [[abdominal pain (peds)\|abdominal pain]]		*Significant or constant/unrelenting [[abdominal pain (peds)\|abdominal pain]]
	*[[Failure to thrive]]		*[[Failure to thrive]]
	**Delayed meconium passage		**Delayed meconium passage

Rossdonaldson1: /* Clinical Features */

2025-01-29T16:53:51Z

Clinical Features

← Older revision		Revision as of 16:53, 29 January 2025
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	*May be complicated by [[rectal bleeding]], [[anal fissures]], [[fecal impaction]]		*May be complicated by [[rectal bleeding]], [[anal fissures]], [[fecal impaction]]
	*'''Should have a benign "soft" abdominal exam (vs. more concerning abdominal pathologies)'''		*'''Should have a benign "soft" abdominal exam (vs. more concerning abdominal pathologies)'''
	**Red flags include failure to thrive, delayed meconium passage, bilious vomiting, melena, severe abdominal distention, or fever

			===Red flags===
			*Significant or constant [[abdominal pain (peds)\|abdominal pain]]
			*[[Failure to thrive]]
			**Delayed meconium passage
			**Bilious vomiting
			**Melena
			**Severe abdominal distention
			**[[Fever]]

	==Differential Diagnosis==		==Differential Diagnosis==

Rossdonaldson1: /* Disposition */

2025-01-29T16:51:30Z

Disposition

← Older revision		Revision as of 16:51, 29 January 2025
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	*Outpatient pediatrician follow-up		*Outpatient pediatrician follow-up
	*Consider urgent vs nonurgent referral to a pediatric gastroenterologist if red-flag symptoms are present		*Consider urgent vs nonurgent referral to a pediatric gastroenterologist if red-flag symptoms are present


	==See Also==		==See Also==

Rossdonaldson1: /* Management */

2025-01-29T16:51:15Z

Management

← Older revision		Revision as of 16:51, 29 January 2025
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	==Management==		==Management==
	*While acute disimpaction (oral, rectal, or both) in the ED is helpful, maintenance therapy (to prevent stool re-impaction) and family education is equally important and may prevent future ED visits		''While acute disimpaction (oral, rectal, or both) in the ED may be helpful, maintenance therapy (to prevent stool re-impaction) and family education is equally important and may prevent future ED visits.''

	===Infants===		===Infants===
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	**PO: Consider [[Polyethylene glycol 3350]] 0.4 g/kg/day PO as a first-line agent, followed by [[Lactulose]] 1 mL/kg PO as a second-line agent		**PO: Consider [[Polyethylene glycol 3350]] 0.4 g/kg/day PO as a first-line agent, followed by [[Lactulose]] 1 mL/kg PO as a second-line agent
	**Note that enemas are often not recommended for infants < 2 years due to increased risk of iatrogenic electrolyte derangements or rectal perforation.<ref>Soumoy MP, Bachy A. Danger des lavements phosphatés chez le nourrisson [Risk of phosphate enemas in the infant]. Arch Pediatr. 1998 Nov;5(11):1221-3. French. doi: 10.1016/s0929-693x(98)81238-4. PMID: 9853060.</ref>		**Note that enemas are often not recommended for infants < 2 years due to increased risk of iatrogenic electrolyte derangements or rectal perforation.<ref>Soumoy MP, Bachy A. Danger des lavements phosphatés chez le nourrisson [Risk of phosphate enemas in the infant]. Arch Pediatr. 1998 Nov;5(11):1221-3. French. doi: 10.1016/s0929-693x(98)81238-4. PMID: 9853060.</ref>


	===Toddlers and children===		===Toddlers and children===

Rossdonaldson1: /* Workup */

2025-01-29T16:50:09Z

Workup

← Older revision		Revision as of 16:50, 29 January 2025
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	**Coagulation studies (PT, PTT, INR), as a marker of liver function		**Coagulation studies (PT, PTT, INR), as a marker of liver function
	*Consider [[TSH]] if concern for [[hypothyroid]] related [[constipation]]		*Consider [[TSH]] if concern for [[hypothyroid]] related [[constipation]]
	*Consider [[UA]]
	*Consider diagnostic imaging		*Consider diagnostic imaging
	**'''Constipation should not cause abdominal tenderness on exam'''		**'''Constipation should not cause abdominal tenderness on exam'''

Rossdonaldson1: /* Workup */

2025-01-29T16:49:41Z

Workup

← Older revision		Revision as of 16:49, 29 January 2025
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	[[File:Constipation(lots).png\|thumb\|Stool burden that may be consistent with constipation on [[KUB]]. '''Use of a KUB to diagnose constipation in pediatric patients is generally NOT indicated,''' as other serious pathology may also result in the imaging findings.]]		[[File:Constipation(lots).png\|thumb\|Stool burden that may be consistent with constipation on [[KUB]]. '''Use of a KUB to diagnose constipation in pediatric patients is generally NOT indicated,''' as other serious pathology may also result in the imaging findings.]]
	;Use of a KUB to diagnose constipation in pediatric patients is generally NOT indicated, as [[acute appendicitis]] and other serious pathology may also result in increased stool burden. If the abdominal exam is concerning, proceed to ultrasound/CT.		;Use of a KUB to diagnose constipation in pediatric patients is generally NOT indicated, as [[acute appendicitis]] and other serious pathology may also result in increased stool burden. If the abdominal exam is concerning, proceed to ultrasound/CT.
	*In many cases, may require no workup and diagnosis can be made clinically		*''In many cases, may require no workup and diagnosis can be made clinically''
	*Consider digital rectal exam		*Consider digital rectal exam
	**Although generally not necessary, this may be done to assess for organic causes or to assess for disimpaction success		**Although generally not necessary, this may be done to assess for organic causes or to assess for disimpaction success

Rossdonaldson1: /* Evaluation */

2025-01-29T16:49:04Z

Evaluation

← Older revision		Revision as of 16:49, 29 January 2025
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	===Workup===		===Workup===
	[[File:Constipation(lots).png\|thumb\|Stool burden that may be consistent with constipation on [[KUB]]. '''Use of a KUB to diagnose constipation in pediatric patients is generally NOT indicated,''' as other serious pathology may also result in the imaging findings.]]		[[File:Constipation(lots).png\|thumb\|Stool burden that may be consistent with constipation on [[KUB]]. '''Use of a KUB to diagnose constipation in pediatric patients is generally NOT indicated,''' as other serious pathology may also result in the imaging findings.]]
			;Use of a KUB to diagnose constipation in pediatric patients is generally NOT indicated, as [[acute appendicitis]] and other serious pathology may also result in increased stool burden. If the abdominal exam is concerning, proceed to ultrasound/CT.
	*In many cases, may require no workup and diagnosis can be made clinically		*In many cases, may require no workup and diagnosis can be made clinically
	*Consider digital rectal exam		*Consider digital rectal exam
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	**CT abdomen/pelvis with IV contrast if concern for surgical abdomen		**CT abdomen/pelvis with IV contrast if concern for surgical abdomen
	***CT may show stool burden in colon/rectum		***CT may show stool burden in colon/rectum

	;Use of a KUB to diagnose constipation in pediatric patients is generally NOT indicated, as [[acute appendicitis]] and other serious pathology may also result in increased stool burden. If the abdominal exam is concerning, proceed to ultrasound/CT.

	===Diagnosis===		===Diagnosis===

Rossdonaldson1: /* Evaluation */

2025-01-29T16:48:25Z

Evaluation

← Older revision		Revision as of 16:48, 29 January 2025
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	==Evaluation==		==Evaluation==
	*'''Note that the emergency physician's primary role is to rule out organic and life-threatening causes of constipation'''
	*Pediatric constipation is frequently a clinical diagnosis; the ROME IV criteria may be utilized to diagnose pediatric constipation, but this is not necessary to do in ED

	===Workup===		===Workup===
	[[File:Constipation(lots).png\|thumb\|Stool burden that may be consistent with constipation on [[KUB]]. '''Use of a KUB to diagnose constipation in pediatric patients is generally NOT indicated,''' as other serious pathology may also result in the imaging findings.]]		[[File:Constipation(lots).png\|thumb\|Stool burden that may be consistent with constipation on [[KUB]]. '''Use of a KUB to diagnose constipation in pediatric patients is generally NOT indicated,''' as other serious pathology may also result in the imaging findings.]]
			*In many cases, may require no workup and diagnosis can be made clinically
	*Consider digital rectal exam		*Consider digital rectal exam
	**Although generally not necessary, this ~~should~~ be done to assess for organic causes or to assess for disimpaction success		**Although generally not necessary, this may be done to assess for organic causes or to assess for disimpaction success
	*Consider abdominal ~~panel~~		*Consider abdominal labs
	**CBC		**CBC
	**Chemistry ([[hypokalemia]] or [[hypercalcemia]])		**Chemistry ([[hypokalemia]] or [[hypercalcemia]])
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	;Use of a KUB to diagnose constipation in pediatric patients is generally NOT indicated, as [[acute appendicitis]] and other serious pathology may also result in increased stool burden. If the abdominal exam is concerning, proceed to ultrasound/CT.		;Use of a KUB to diagnose constipation in pediatric patients is generally NOT indicated, as [[acute appendicitis]] and other serious pathology may also result in increased stool burden. If the abdominal exam is concerning, proceed to ultrasound/CT.

			===Diagnosis===
			*'''Note that the emergency physician's primary role is to rule out organic and life-threatening causes of constipation'''
			**[[Acute appendicitis]] and other causes of surgical abdomen may present as constipation, in which case the primary emergency medicine goal is ruling out these other conditions
			*Pediatric constipation is frequently a clinical diagnosis; the ROME IV criteria may be utilized to diagnose pediatric constipation, but this is not necessary to do in ED

	==Management==		==Management==