Hello, I'm here to talk to you about the treatment of childhood constipation.
If this problem is not treated appropriately outcomes can be poor and
this can have an impact on the lives of children and young people for years to come.
This presentation is based on NICE
guidelines which we know are often not implemented in practice. I'll run through
them now. First-line treatment at presentation is a Macrogol solution
this will soften the stool by ensuring fluid is retained in the colon which is
then absorbed by the stool. 1 to 2 sachets should be an adequate maintenance dose,
the effectiveness of the Macrogol treatment should be reviewed after 6 weeks.
If at presentation the history is prolonged, there is soiling and an
abdominal examination reveals a palpable mass then disimpaction is recommended
this involves taking increasing doses of a peadiatric Macrogol solution to a
maximum daily dose of 8 sachets for children aged 5 and under and 12 sachets
for children over 5 years. This equates to a daily total of 500 ml and
750 ml respectively when correctly reconstituted according to
manufacturer's instructions. This should be divided between three or four drinks
throughout the day. It's worth mentioning here that the soiling may get worse
before it gets better but it's important that the disimpaction regime is not
stopped until the stool is watery without any hard lumps like brown and
inoffensive. The stool should remain in this state for 48 hours before the dose
of paediatric Macrogol solution is reduced to a maintenance dose of 2
sachets. There is no need to reduce the dose gradually but the child should be
reviewed on completion of the disimpaction regime to ensure that the
process is complete.
Following disimpaction, due to physical changes to the rectum that occurs in
long-term constipation most children will need both daily paediatric Macrogol
solution to soften the stool and a stimulant medication such as Senna or
Sodium Picosulphate to encourage full emptying of the bowel. For the child who
does not require disimpaction it may still be necessary to introduce a
stimulant medication in addition to paediatric Macrogol solution if this
alone does not result in a bowel motion more than four times a week after six
weeks of treatment. Rectal preparations should not be used as first-line
treatment and ideally their use in children should be avoided outside of
the hospital setting. The child should also be encouraged to sit on the toilet
after meals to promote a regular bowel habit and of course a healthy diet and
adequate clear fluid intake should also be promoted. If there is poor progress
with this plan after three months it is recommended that children are referred
to a specialist service for management of their constipation.