HNY Policy and Pathway Repository - North Yorkshire
Constipation management in children
Definition/Description
None provided
Red Flag Symptoms
RED FLAGS – For immediate referral to Paediatrician
- Symptoms that commence from birth or in the first few weeks.
- Failure or delay (>first 48 hours at term) in passing meconium.
- Ribbon Stools
- Leg Weakness or locomotor delay.
- Abdominal distension with vomiting.
- Abdominal examination findings including
- Abnormal appearance of the anus.
- Gross abdominal distension.
- Abnormal gluteal muscles, scoliosis, sacral agenesis, etc
- Limb deformity including talipes.
- Abnormal reflexes
Guidelines on Management
Safeguarding
Concerns about Safeguarding should be managed as per LSCB Procedures
Child Presents with Constipation
- Undertake assessment and eliminate RED FLAGS. Any RED FLAGS or underlying disease, refer to the paediatrician
- Disimpact if signs of impaction (overflow, soiling, or faecal mass identified on abdominal examination). Review within 1 week. Immediately commence maintenance medication of Macrogols as per Nice Guidelines. Review in 2 weeks.
- Patient not impacted commence maintenance medication as per NICE guidelines. Review in 2 weeks
Provide written and verbal information at this appointment. Consider behavioural modification, toileting regimes, physical activity, diet and fluids.
Improved
Continue successful medication until regular bowel habit and toilet training established. Reduce medication gradually, over months, as tolerated.
No Improvement
Add a Stimulant laxative such as Sodium Picosulphate as per NICE Guidance
Review in 2-4 weeks
If no improvement, refer to Nurse Led Specialist Services.
Nurse Led Specialist Services
Paediatric Continence Nurse Specialist
Assess and treat with medication, adjustment, advice, support and demystification. Implement schedule as per NICE
Progress made
Continue medication for several weeks after regular bowel habit/toilet training established. Reduce medication gradually as tolerated.
Constipation fails to resolve
Review medication – check adherence etc Adjust dose/ introduce stimulants if necessary Consider possibility of undetected coeliac disease/ cow’s milk allergy Consider transit study Liaise with GP/ Paediatrician as necessary
Constipation remains unresolved
Consider suppositories/ micro enemas if acceptable and tolerated by child.
Constipation continues to impact upon Quality of Life
Consider rectal irrigation Peristeen
Constipation and Soiling has considerably less impact upon Quality of life
Continue with rectal irrigation. Consider weaning and potentially stopping medication. Consider weaning frequency of irrigation, if good progress, to potential trial without. Continue irrigation and medication, if problems reoccur or failure to wean.
Poor Progress
Joint working with Paediatrician.
Parallel Plans
- Explanations and demystification for child and family.
- Ensure disimpacted if required.
- Medication regimes as required as per NICE Guidance.
- Consider toileting regimes.
- Diet and fluid advice.
- Correct management with school.
Referral Criteria/Information
None provided
Additional Resources & Reference
Associated Policies
Places covered by
- north-yorkshire
Hospital Trusts
south-tees-hospitals
