Pediatric constipation

Rationale

Constipation is a common problem in pediatric patients. It is important to differentiate functional from organic causes, recognizing that the vast majority of cases are functional.

Causal Conditions

(list not exhaustive)

1. Neonate and infant
   1. Dietary
   2. Anatomic (e.g., Hirschsprung disease, imperforate anus)
   3. Neuromuscular (e.g., cerebral palsy, myopathy, global developmental delay)
   4. Endocrine and/or metabolic (e.g., hypothyroidism)
   5. Genetic (e.g., cystic fibrosis)
   6. Drug or toxin exposure (e.g., infantile botulism)
2. Older child
   1. Dietary
   2. Functional
   3. Psychosocial
   4. Anatomic (e.g., bowel obstruction)
   5. Neurologic (e.g., spinal cord tumour, trauma, neuromuscular disorders)
   6. Endocrine and/or metabolic (e.g., hypercalcemia, hypothyroidism)
   7. Genetic (e.g., cystic fibrosis)
   8. Other (e.g., celiac disease)

Key Objectives

Given a pediatric patient with constipation, the candidate will diagnose the cause, severity, and complications, and initiate an appropriate management plan.

Enabling Objectives

Given a pediatric patient with constipation, the candidate will

1. list and interpret critical clinical findings, including those based on
   1. clinical features that help distinguish functional from organic causes, and
   2. the social and psychological effects of chronic constipation;
2. list critical clinical investigations and interpret the results of the investigations while recognizing the possibility that no investigation may be necessary;
3. construct an effective initial management plan, including
   1. providing initial and long-term therapy, including laxatives, diet, and education, and
   2. using a multidisciplinary approach as needed.