Constipation is a common issue that we encounter in the pediatric emergency department. It’s important to distinguish between different types of constipation and understand the best approaches to treatment. Here’s an evidence-based review of pediatric constipation, focusing on what matters most in the ED and when to image.
🚩 Red Flags
- Infants under six weeks old presenting with constipation
- Delayed passage of meconium
- Ribbon-like stools, which may indicate a rectal obstruction
- Weight loss or poor growth
- Persistent vomiting or gross blood without anal fissures
- Abdominal distension or mass
- Neurological signs like decreased lower extremity tone
📸 Imaging in the ED: To X-Ray or Not?
While the AAP Choosing Wisely Campaign advises against imaging for constipation, the reality is that a significant percentage of ED clinicians still order abdominal x-rays when diagnosing constipation. However, the recommendation from Choosing Wisely is clear: avoid abdominal x-rays when constipation is suspected, unless you have specific concerns about surgical conditions or abnormalities that imaging could identify.
Key Takeaways
- Know the Rome Criteria for diagnosing functional constipation.
- Be aware of red flags that may indicate serious underlying conditions.
- Avoid unnecessary abdominal x-rays for suspected constipation.
- Treat with laxatives and titrate to the effect for long-term success.
- Educate families that this is a long-term treatment plan, not a quick fix.
Constipation is a long game, and families need to understand that resolution takes time. By employing evidence-based approaches and prioritizing the child’s long-term well-being, we can effectively manage constipation and help children return to a healthier state.
Note: This post is based on a presentation given by Dr. Josh Rocker at the Annual Pediatric Emergency Medicine Symposium held by Cohen Children’s Medical Center. For more information about attending future symposiums, please email Dr. Josh Rocker at jrocker@northwell.edu
Dr. Josh Rocker, MD, is the Chief of the Pediatric Emergency Medicine Division at Cohen Children’s Medical Center. He can be reached at jrocker@northwell.edu.
