Abstract Ref Number = APCP84
Constipation in Children
Department of Pediatrics, Universitas Padjajaran Dr Hasan Sadikin General Hospital Indonesia
Constipation is typically characterized by lack of periodicity in defecating, bulky stools and difficulty or pain during defecation. Constipation is one of the ten most frequent problems that a general pediatrician deals with 25% of referrals to pediatric gastroenterologists worldwide. According to the diagnostic criteria for constipation, a patient must have experienced less than 3 bowel movements per week. The Northern American Society of Gastroenterology, Hepatology and Nutrition defines constipation as a delay or difficulty in the defecation present for two weeks or more. Specific criteria that have been developed and complete the Rome IV. Prevalence rates of constipation range from 0.7% to 29.6% of the worldwide general population.
The majority of children with constipation have functional constipation (95%). The peak incidence of constipation occurs between 2 and 4 years of age. Several factors may contribute to constipation, such as lower parental educational level, increased body weight, reduced physical activity, a low fiber diet, positive family history and psychological factors. However, only 5% of children experiences an organic cause of constipation, such as neuromuscular diseases, drug side effects, food allergies, celiac disease and Hirschsprung’s disease.
The approach to making diagnosis includes the patient’s medical history, physical examination and laboratory investigation. Although the most common type of constipation is functional constipation, an underlying pathology should be excluded. An examination of the thorax, the abdomen, the lumbosacral part of the vertebral column and the perineum should be performed as well. Plain radiographs of the abdomen may be necessary to establish fecal impaction. Barium enema, rectal biopsy in case of suspicion of Hirschsprung’s disease.
The treatment of functional constipation requires parental education, behavior interventions, dietary changes, when fecal impaction is present disim¬paction with oral or rectal medication is required, maintenance therapy and all of the children followed for 6 to 12 months.