| Abstract: |
This article reviews the evaluation and treatment of constipation in infants and children, a problem that is usually functional and the result of stool retention. However, the authors encourage family physicians to be alert for indications of the presence of an uncommon but serious organic cause of constipation, such as Hirschsprung's disease, also called congenital aganglionic megacolon; pseudo-obstruction; spinal cord abnormality; hypothyroidism; diabetes insipidus; cystic fibrosis; gluten enteropathy; or congenital anorectal malformation. Functional constipation is treated with disimpaction using oral or rectal medication. Polyethylene glycol is effective and well-tolerated, but a number of alternatives are also available. After disimpaction, children may need to be on a maintenance program for months to years because relapse of functional constipation is common. Education of the family and, when possible, the child is important for improving functional constipation. Cow's milk may promote constipation in some children, so a trial period of withholding milk may be considered. Adding fiber to the diet is another recommended strategy. The authors conclude that, despite treatment, only 50 to 70 percent of children with functional constipation demonstrate long-term improvement. Two patient care algorithms are provided. 2 figures. 6 tables. 18 references. |