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Constipation in children is nearly always idiopathic. Onset with weaning and potty training is common. Blood tests and imaging are not usually required. Faecal incontinence is commonly due to constipation with impaction.
A diagnosis of constipation can be made if
two or more of the following:
Typically the child with 'overflow' faecal incontinence due to constipation will pass small amounts of stool into their pants and seem unaware that they have done so. See constipation management below. Disimpaction is usually required before starting maintenance laxative.
Bloody diarrhoea, faecal urgency or nocturnal diarrhoea suggests colitis. Refer to paediatrics.
Constipation from birth, passage of meconium after 48 hours old, passage of 'ribbon like' stools or chronic severe abdominal distension suggest Hirschsprungs or anal stenosis. A period of normal bowel habit makes Hirschsprungs or anal stenosis unlikely.
Child under 1 year that doesn't respond to laxatives after 4 weeks.
Abnormal growth, weight loss or chronic vomiting suggests coeliac disease or other chronic disorders.
Abnormal lower limb neurology or cutaneous lesion over spine suggests spinal cord lesion.
Suspicion of abuse (sexual, emotional, physical or neglect).
For advice on the management of constipation in children refer to the formulary chapter 1 "Management of constipation in children"
Children whose constipation doesn't improve after 3 months of laxative treatment refer to health visitor (pre-school child) or school nurse via single point of access VCL.DevonSpa@nhs.net
Children whose constipation doesn't improve despite input from health visitor or school nurse refer to bladder and bowel care nurses via Northern Devon Health Care Trust.
If red flags or concern about organic cause refer to paediatric gastroenterology.
This service is not available on e-Referrals therefore send an email with attached referral letter to:
e-Referral Service Selection:
ERIC (Education and Resources for Improving Childhood Continence)
NICE clinical guideline 99. NICE guideline on constipation in children and young people. May 2010
This guideline has been signed off by the Eastern Locality on behalf of NEW Devon CCG.
Publication date: February 2017
Updated: December 2018