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History taking in children with constipation

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Establish during history-taking whether the child or young person has constipation.

Two or more findings from the table below indicate constipation:

Key components	Potential findings in a child younger than 1 year	Potential findings in a child/young person older than 1 year
Stool patterns	fewer than three complete stools per week (type 3 or 4, see Bristol Stool Form Scale) this does not apply to exclusively breastfed babies after 6 weeks of age) hard large stool 'rabbit droppings' (type 1, Bristol Stool Form Scale)	fewer than three complete stools per week (type 3 or 4, see Bristol Stool Form Scale) overflow soiling (commonly very loose [no form], very smelly [smells more unpleasant than normal stools], stool passed without sensation. Can also be thick and sticky or dry and flaky.) " 'rabbit droppings' (type 1 Bristol Stool Form Scale ) large, infrequent stools that can block the toilet
Symptoms associated with defecation	distress on stooling bleeding associated with hard stool straining	poor appetite that improves with passage of large stool waxing and waning of abdominal pain with passage of stool evidence of retentive posturing: typical straight legged, tiptoed, back arching posture straining anal pain
History	previous episode(s) of constipation previous or current anal fissure	previous episode(s) of constipation previous or current anal fissure painful bowel movements and bleeding associated with hard stools

Bristol Stool Scale or Bristol Stool Chart is a medical aid designed to classify the form of human faeces into seven categories. Sometimes referred to in the UK as the "Meyers Scale", it was developed by Heaton at the University of Bristol and was first published in the Scandinavian Journal of Gastroenterology in 1997)

form of the stool depends on the time it spends in the colon
- Types 1 and 2 indicate constipation, with 3 and 4 being the "ideal stools" especially the latter, as they are the easiest to pass, and 5-7 being further tending towards diarrhoea or urgency.

Reference:

1) NICE (May 2010). Constipation in chidren

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History taking in children with constipation

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