Children constipation

With infants and children, constipation may occur commonly. In patients with persistent problems, the underlying etiology may be neurologic, metabolic, or secondary to anatomic abnormalities. Management of constipation in this age group should consist of dietary modification with an emphasis on high-fiber foods. 

Fecal and urinary incontinence are significantly more commonly observed in constipated than non-constipated children. Constipation and/or encopresis is commonly associated with nonneurogenic bladder-sphincter dysfunction. Comprehensive treatment is mandatory for successful management of affected children. Idiopathic urethritis might be a manifestation of underlying dysfunctional elimination syndromes. 

A 5-year-old girl is taken to the doctor s office by her mother following a conference with her kindergarten teacher. The teacher is concerned because compared to her kindergarten classmates, she is hyperactive, restless, and easily distracted. Recent testing revealed that the child s vision was normal but hearing acuity was below normal. Recently the child has complained of abdominal pain and has had occasional constipation. About 3 years ago the parents moved into a 75-year-old house in the inner city and have been renovating it extensively. Within the past year, the parents separated and the father moved out of the house. 

Ondansetron could be used, but the dose should be reduced to 8 mg daily in divided doses, as this patient has severe hepatic impairment (Child-Pugh C). Ondansetron should be used with caution as it can cause constipation, which may worsen encephalopathy. A laxative should be co-prescribed if necessary. 

First you need to check that the mother actually means constipation, which she does. The stools have been hard and pellet-like and the child seems to strain. She has been like this for a week to ten days. The child has no other medical conditions and takes no medication. On questioning you find that the child does not like going to school and cries every day. She is a picky eater and does not like school dinners. 

The problem appears to be constipation aggravated by emotional and dietary issues. It should improve as the child settles into school and if she is encouraged to eat a diet increased in fibre, wholemeal bread instead of cereals, with more fruit and vegetables. If the new diet is accepted there should be an improvement in symptoms. The mother should be advised to take the child to the doctor if there is no improvement after two weeks. 

Acute renal failure that persisted for 10 days was observed in a 19-month-old child who ingested an unknown amount of powdered mercuric chloride (Samuels et al. 1982). Several children who were treated with medications containing mercurous chloride for constipation, worms, or teething discomfort exhibited flushing of the palms of the hands and soles of the feet (Warkany and Hubbard 1953). The flushing was frequently accompanied by itching, swelling, and desquamation of these areas. 

Benning MA, Duller HA, Heymans HAS et al (1994) Is encop-resis always the result of constipation Arch Dis Child 59 649-652... 

Rebecca s baby always cried, and never slept longer than an hour and a half at a time. She alternated between having diarrhea and being constipated for days at a time. One day Rebecca happened to pick up a brochure at Toys R Us entitled Safety Tips. It listed a number of symptoms of lead poisoning—every one of them described her child. She immediately asked her pediatrician to screen the baby for lead poisoning. 

In 1890, Alice worked in Leicester, England, as a machinist. She was thirty-three, married, and had four children. She was pregnant with yet another child. Perhaps her motivation was financial—she worked in an era when married women worked not by choice but out of necessity— or perhaps she just did not want another child. Whatever the case, Alice wanted an abortion. She purchased diachylon (lead plaster), rolled it into pills, and ate the pills. An abortion was induced a short time later. But Alice s homemade pills had some undesired side effects. She developed severe pains in her abdomen and extremities, javmdice, constipation, vomiting, and tremors in her hands. She entered the Leicester Infirmary on September 10, 1890, and by September 13, she had become comatose. She died soon thereafter. Alice s pills had not only terminated her pregnancy, they had also delivered her a fatal dose of lead. ... 

Benoit RM, Wise BV, Naslund MJ et al (2002) The effect of dysfunctional voiding on the costs of treating vesicoureteral reflux a computer model. J Urol 168 2173-2f76 Blethyn AJ, Jenkins HR, Roberts R et al (1995) Radiological evidence of constipation in urinary tract infection. Arch Dis Child 73 534-535... 

Dohil R, Roberts E, Verrier-Jones K et al (1994) Constipation and reversible urinary tract abnormalities. Arch Dis Child 70 56-57... 

Loening-Baucke VA (2006) Prevalence rates for constipation and faecal and urinary incontinence. Arch Dis Child Jul... 

Yong D, Beattie RM (1998) Normal bowel habit and prevalence of constipation in primary-school children. Amb Child Health 4 277-282... 

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