Lightning Learning: Constipation in Kids
STOP!
Constipation is when hard stools are not passed regularly and become painful.
A very common cause of abdominal pain in the ED.
Also common amongst children with chronic constipation to go on to develop faecal overflow.
Idiopathic causes:
Infrequent or incomplete defecation that has no structural or biochemical cause
Underlying causes:
Hypothyroidism (uncommon), Hypercalcemia or Hirschsprung's disease
should be considered
LOOK
There are 3 periods when children may develop constipation: the introduction of solids; toilet training; and starting school.
Defecation can cause discomfort or pain prompting the child to consciously or subconsciously avoid repeating it. If it is painful, this can then lead to avoidance of defecation which results in stool accumulation in the rectum. The stool becomes harder resulting in it being more painful to pass.
Chronic rectal distension leads to relaxation of the internal anal sphincter and semi-solid stool leaks or soiling.
Finally, the rectum is unable to generate enough pressure to pass the stool.
LEARN
First treatment is to soften the stools. Next, give advice about diet and fluid intake.
Average radiation dose of an abdominal x-ray is 0.7mSv and should not be used as a diagnostic.
Also, a PR exam should not be undertaken.
