children s health issues
Constipation in Children
Evaluation of Constipation in Children
Doctors first try to determine whether constipation results from dietary or behavioral issues (functional) or from a disorder, toxin, or drug (organic). Certain symptoms are cause for concern and should raise suspicion for an organic cause of constipation: No bowel movements (BMs) during the first 24 to 48 hours after birth Weight loss or poor growth Decreased appetite Blood in the stools Fever Vomiting Abdominal swelling Abdominal pain (in children old enough to communicate this) In infants, loss of muscle tone (the infant appears floppy or weak) and reduced ability to suck In older children, an involuntary release of urine ( Urinary Incontinence in Children ), back pain, leg weakness, or problems with walking Children should be evaluated by a doctor right away if they have any warning signs. If no warning signs are present but the child is passing infrequent, hard, or painful BMs, then the doctor should be called. Depending on the child's other symptoms (if any), the doctor may advise trying simple home Treatment or ask the parents to bring the child for an examination. Doctors first ask questions about the child's symptoms and medical history. Doctors then do a physical examination. What they find during the history and physical examination often suggests a cause of the constipation and the tests that may need to be done (see table Some Physical Causes and Features of Constipation in Infants and Children ). Doctors determine whether newborns have ever had a BM (the first BM is called meconium). Newborns who have not had a BM within 24 to 48 hours after birth should have a thorough examination to rule out the possibility of Hirschsprung disease, anorectal malformations, or other serious disorder. For infants and older children, doctors ask whether constipation began after a specific event, such as introducing cereal or other solid foods, eating honey under 12 months of age, beginning toilet training, or starting school. For all age groups, doctors ask about diet and about disorders, toxins, and drugs that can cause constipation. For the physical examination, doctors first look at the child overall for signs of illness and measure height and weight to check for signs of delayed growth. Doctors then focus on the abdomen, the anus (including examination of the rectum using a gloved finger), and nerve function (which can affect how the digestive tract functions). If the cause of constipation appears to be functional, no tests are needed unless children do not respond to treatment. If children do not respond or if doctors suspect that the cause is another disorder, an X-Rays of the abdomen is taken, and tests for other disorders are done based on the results of the examination. 