If the child or young person has constipation take a history using table below to establish a positive diagnosis of idiopathic constipation by excluding underlying causes
- if a child or young person has any 'red flag' symptoms, do not treat them for constipation. Instead, refer them urgently to a healthcare professional with experience in the specific aspect of child health that is causing concern
| Findings and diagnostic clues that indicate idiopathic constipation | 'Red flag' findings and diagnostic clues that indicate an underlying disorder or condition: not idiopathic constipation |
Timing of onset of constipation and potential precipitating factors | - in a child younger than 1 year:
- starts after a few weeks of life
- obvious precipitating factors coinciding with the start of symptoms: fissure, change of diet, infections
- in a child/young person older than 1 year:
- starts after a few weeks of life
- obvious precipitating factors coinciding with the start of symptoms: fissure, change of diet, timing of potty/toilet training or acute events such as infections, moving house, starting nursery/school, fears and phobias, major change in family, taking medicines
| - reported from birth or first few weeks of life
|
| - normal (within 48 hours after birth [in term baby])
| - failure to pass meconium/delay (more than 48 hours after birth [in term baby)
|
| | - 'ribbon stools' (more likely in a child younger than 1 year)
|
| - in a child younger than 1 year:
- generally well, weight and height within normal limits
- in a child/young person older than 1 year:
- generally well, weight and height within normal limits, fit and active
| - No 'red flag', but see 'amber flag' below
|
Symptoms in legs /locomotor development | - no neurological problems in legs (such as falling over in a child/young person older than 1 year), normal locomotor development
| - previously unknown or undiagnosed weakness in legs, locomotor delay
|
| | - abdominal distension with vomiting
|
| - in a child younger than 1 year:
- changes in infant formula, weaning, insufficient fluid intake
- in a child/young person older than 1 year:
- History of poor diet and/or insufficient fluid intake
| |
'Amber flag': possible idiopathic constipation
Growth and general wellbeing: Faltering growth
Personal/familial/social factors: Disclosure or evidence that raises concerns over possibility of child maltreatment
Reference: