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Evaluation and Treatment of Constipation in Infants and Children

Introduction
Constipation is a delay or difficulty in defecation, present two or more weeks, sufficient to cause significant distress to the patient. It is common in infants and children since they are growing and there are some physiologic changes occur in the intestines and colon. This results in decrease amount of stools.

Discussion
Constipation occurs in one third of children ages six to twelve years and it is more common in boys than in girls, but in toddlers it is equal between boys and girls. A child feels like defecating when the stools come into contact with the lower part of rectum. This happens because the stools move through the intestines and the colon into the rectum by involuntary and voluntary muscle contractions. But if a child does not defecate, some muscle actions would occur and this makes the stools move higher. If this happens frequently, the rectum will stretch and eventually would lose power to push stools out of the rectum. In neonates, Hirschsprungs disease should be considered if neonate fails to pass meconium within 48 hours of births. The anatomical aspect also should be considered. Abdominal distension, pencil-thin stools, failure to thrive, and vomiting raise the suspicion of Hirschsprungs disease in infants. Other possibilities are hypothyroidism and cystic fibrosis. Usually constipation in children is just a functional constipation. The differential diagnosis is different in neonates, infants, and children. In children older than 1 year old, constipation is usually functional constipation. But in neonates and infants, constipation usually has some other organic causes. Factors that should be considered is the toileting behavior, such as the time of defecating, postures when defecating, access to toilet facilities, etc. the diagnostic testing that could be used are abdominal radiography, barium enema, radiopaque markers, or anal manometry if Hirschsprungs disease is suspected. Family education is very important in treating constipation. If it is possible the child should be educated too. In educating the patient and family, the difference between functional constipation and organic constipation should be explained, because if it happens to be organic constipation, action should be taken as soon as possible. As for functional constipation, dietary modification is usually advised. Rectal disimpaction is usually done to evacuate stools out of a child by inserting agents to soften stools, but it is sometimes invasive. Maintenance is required to prevent the constipation from being worst or reoccur. The family should educate to do simple rectal washing at home. Functional constipation is not easy to treat and if it reoccurs or even gets worst, other causes should be considered and some tests should be done.