Constipation (peds)

This page is for pediatric patients; for adult patients see constipation.

Clinical Features

  • There is a wide range of normal frequency of stools
  • Hard stools or painful defecation
  • May be associated with abdominal pain, rectal discomfort, withholding behavior, encopresis
  • May be complicated by rectal bleeding, anal fissures, fecal impaction

Differential Diagnosis

Infant Constipation

Children (older than 1 year) Constipation

Pediatric Abdominal Pain

0–3 Months Old

3 mo–3 y old

3 y old–adolescence

Management

Infants

Glycerin suppositories or rectal stimulation with a lubricated rectal thermometer can be used if there is very hard stool in rectum, but may cause irritation and develop tolerance.

  • Not yet begun solid foods
    • Sorbitol-containing juices (eg, apple, prune, or pear)
    • For infants four months and older, starting dose: 2-4 ounces of 100-percent fruit juice per day
    • Karo syrup, add 1 tsp to 4 oz cooled, boiled water; give 1 oz of solution to baby just before feeds twice a day until stool softens
  • Who have begun solid foods[1]
    • Sorbitol-containing fruit purees (e.g. pureed prunes).
    • Substitute multigrain or barley cereal for rice cereal

Toddlers and children

Disposition

  • Outpatient

See Also

  • Constipation
  • Tables on neonatal constipation differential and normal stool/urine output[2].

References

  1. Baby Care Advice. http://www.babycareadvice.com/babycare/microsites/infant_constipation/infant_constipation.old.htm.
  2. Helman, A. Morgenstern, J. Ivankovic, M. Long, B. Reid, S. Swaminathan, A. EM Quick Hits 25 – Cerebral Venous Thrombosis, Diphenhydramine Alternatives, Abdominal Compartment Syndrome, Neonatal Constipation, Intubating Metabolic Acidosis. Emergency Medicine Cases. January, 2021. https://emergencymedicinecases.com/em-quick-hits-jan2021/ Accessed 1/26/2021
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