Constipation in child

HISTORY:

Constipation for ‍ ‍hoursdays

Frequency: ‍ times per week, with the last one ‍ days ago

Stools type: ‍hardlumpydrysmall in volumelarge in diameter, with ‍straining

Treatments tried: ‍nonedietary modificationslaxatives, ‍effectiveineffective

Diet: fiber intake ‍adequate, fruits and vegetables ‍adequate, fluid intake ‍adequate

‍abdominal pain

‍rectal pain or pressure

‍bloating

‍nausea

‍vomiting, ‍ episodes ‍per day, ‍, ‍hematemesis

‍loss of appetite

‍inability to pass gas

‍failure to thrive

‍fever, up to ‍°, over ‍ ‍hoursdays

‍fatigue

‍anal pain

‍rectal bleeding, ‍oncetwice ‍, ‍bright reddark red, ‍withwithout clots

‍dark, tarry stools

‍anxiety



EXAM:

General appearance: ‍well-appearing

Vital signs: ‍normal, BP ‍, HR ‍, RR ‍, SpO2 ‍ %, Temp ‍°

Measurements: height: ‍ cm - ‍ perc, weight: ‍ kg - ‍ perc, BMI: ‍

Ears: -R: ‍normal, -L: ‍normal

Throat: ‍normalrednessexudate

Neck: ‍normallymphadenopathy

Heart: ‍RRR, ‍normal S1 and S2

Lungs: ‍clearabnormal sounds, ‍retractions

Abdomen: ‍softsemi-softtense, ‍non-tender ‍, ‍non-distended, ‍

Anorectal: DRE ‍normal, anus ‍normal

Genital: ‍normal, testicles ‍normal, penis ‍normal, Tanner stage ‍

Extremities: ‍normal, ‍normal pulses, cap refill ‍< 3 sec> 3 sec

Skin: ‍no rash

Neurologic: cranial nerves ‍overall intact, global motricity ‍normal for age, muscle tone ‍normal for age, gait ‍age-appropriate



ASSESSMENT:

‍Constipation ‍likelysuspectedpossible

DDx: ‍



PLAN:

- Blood work: ‍CBC, ‍TSH, ‍electrolytes, ‍calcium, ‍glucose, ‍anti-transglutaminase

- Abdominal ultrasound

- Rectal biopsy if Hirschsprung's disease is suspected

- Increase dietary fiber (fruits, vegetables, whole grains)

- Increase fluid intake

- Regular physical activity

- Scheduled toileting: encourage child to sit on the toilet for 5 minutes after meals, up to 3 times per day, emphasized on making it a positive activity

- Parents advised not to insist on bowel movements

- Star chart to record progress

- ‍Polyethylene glycol

- ‍Laxatives and softeners

- ‍Suppositories

- ‍Enemas

- ‍Lidocaine

- Referral to pediatrician

- Referral to dietitian

- Follow-up in ‍ ‍weeksmonths

- Return if constipation worsens, if new symptoms develop such as abdominal pain, fever, or blood in stools