Constipation in children

Bellomo-Brandao MA, Collares EF, da-Cos-ta-Pinto EA Use of erythromycin for the treatment of severe chronic constipation in children. Braz J Med Biol Res 2003 36 1391— 1396. 

Nurko S, Garcia-Aranda JA, Worona LB, Zlochisty Q. Cisapride for the treatment of constipation in children A double-blind study. J Pediatr 2000 136(1) 35 0. 

Cascio S, Flett ME, De la Hunt M, Barrett AM, Jaffray B (2004) MACE or caecostomy button for idiopathic constipation in children a comparison of complications and outcomes. Ped Surg Int 20 484-487... 

Lubiprostone (Amitiza), a bicyclic acid oral agent, is approved for treatment of chronic idiopathic constipation in adults. It has not been studied in children. Lubiprostone acts locally on intestinal chloride channels and increases intestinal fluid secretion, resulting in increased intestinal motility and thereby increasing the passage of stool.6... 

Colic is also a symptom of lead poisoning in children. EPA (1986a) has identified a LOAEL of approximately 60-100 pg/dL for children. This value apparently is based on a National Academy of Sciences (NAS 1972) compilation of unpublished data from the patient groups originally discussed in Chisolm (1962, 1965) and Chisolm and Harrison (1956) in which other signs of acute lead poisoning, such as severe constipation, anorexia, and intermittent vomiting, occurred at 60 pg/dL. 

The approach to the treatment of constipation in infants and children should consider neurologic, metabolic, or anatomic abnormalities when constipation is a persistent problem. When not related to an underlying disease, the approach to constipation is similar to that in an adult. High-fiber diet should be emphasized. 

Glycerin is considered a safe laxative, although it may occasionally cause rectal irritation. Its use is acceptable on an intermittent basis for constipation, particularly in children. 

Dextromethorphan is an opioid antitussive similar in action to codeine and pholcodine. Codeine and pholcodine are considered to be more potent than dextromethorphan. Dextromethorphan tends to cause less constipation and dependence than codeine. Cough suppressants are not usually recommended in children under 2 years. 

Symptoms of iead toxicity include gastrointestinal effects, such as vomiting, constipation, abdominal pain, and appetite loss, as well as neurologic effects, which manifest in children as decreased attention span, behavioral problems, and apparent learning disorders. 

Constipation bulk-forming laxatives by increasing faecal mass tend to soften stools and relieve constipation, and have value in a range of symptomatic problems associated with anal fissure, haemorrhoids, and with ileostomy and colostomy dysfunction. Faecal softeners, lactulose and macrogols (polyethylene glycol) retain fluid in the bowel. Stimulant laxatives, such as the anthraquinone, senna, and bisacodyl, increase motility and can cause colic verdoses can cause diarrhea and electrolyte depletion. Chronic treatment for constipation is seldom needed, but may be in children with a tendency to faecal impaction, specialist advice should be sought. 

Therapy is perfectly adequate with simple iron salts (Table 2). In adults ferrous gluconate, fumarate or sulphate are all of proven equal efficiency. Approximately 50 mg of iron is present in each tablet with the remaining 300 mg made up with an inert filler. These are given on an empty stomach at least twice a day but should nausea prevail they can be taken with food. Absorption of slow release preparations is not recommended since iron is detached from the carrier beyond the main areas of absorption in the duodenum or jejunum. Stools turn black in all cases and this is a useful index of patient compliance. In 25% of individuals gastrointestinal tract side effects are encountered in the form of diarrhoea or constipation and patients will often spontaneously discontinue medication. It is therefore essential that a tablet-count be carried out on a regular basis with a substitute being provided when this first-line medication is intolerable. In children the same preparations are favoured as syrups these are given twice... 

Fluoxetine s most notable side effect is nervousness (>10% in adults) (Preskorn, 2000), which may be more common in the pediatric population (Teicher and Baldessarini, 1987). Fluvoxamine is less stimulating than fluoxetine but is a significant inhibitor of CYP3A4, which metabolizes common pediatric medications (Michalets and Williams, 2000). Fluvoxamine is most likely to cause constipation in adults (>10%) (Preskorn, 2000). This is an important consideration in children, given the often comorbid symptoms of en-copresis from overflow constipation. 

Because of the multiple receptor sites that TCAs bind to, there are a variety of possible side effects that can be seen in treatment. The blockade of muscarinic receptors leads to increased anticholinergic tone and subsequent anti-cholinergic side effects, especially in the gastrointestinal system. These include delirium, dry mouth, tachycardia, constipation, and urinary retention in adults. In children, anticholinergic side effects are often not seen with treatment (Geller et ah, 1992). Tricyclic antidepressant blockade of the presynaptic a 2 receptors leads to increased autonomic tone throughout the body, causing elevations in heart rate and blood pressure. 

The aim is passage of at least one large, formed bowel movement every 1-2 days. "Recommended only for very severe constipation and only in children over 5 years old. 

Risperidone has been assessed in children with autistic disorder and disruptive behavior in a multicenter, two-part, open study (221). Part one consisted of a 4-month open phase in 63 children (aged 5-17 years 49 boys) taking risperidone 2.0 mg/day of the 12 dropouts, five were due to loss of efficacy and one to an adverse event (constipation) there was a mean weight gain of 5.1 kg, which was significantly greater than expected from developmental norms. Part two was a randomized, doubleblind study in which risperidone was either substituted by placebo (n = 16) or continued (n = 16) there were more relapses in those who took placebo (n = 10) than in... 

Stool softeners and cathartics can be used in children, as in adults, to relieve symptoms of constipation. Nausea and vomiting generally diminish as opioid therapy is continued, but antihistamines with antiemetic effects, such as hydroxyzine or promethazine, may be helpful as adjuvants to diminish impleasant G1 symptoms. Reducing the opioid dose to minimal analgesic levels may help to limit sedation or drowsiness. Mild respiratory depression, an uncommon side effect in children, may require only that the opioid dose be reduced. 

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