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Constipation in Children

Checked: 25-03-2024 by 3 Vicky Ryan Next Review: 24-04-2025

Overview

Please see the NHS England Guidelines: NHS England » National primary care clinical pathway for constipation in children) - these guidelines have replaced the local BRHC guidelines (1). 

Pages 3-8 are most relevant in primary care:

  • Clinical pathway for faecal impaction and constipation - page 3.
  • Red flags - page 4.
  • Principles of management for primary care - page 5.
  • Assessment including physical examination.- - page 6.
  • Disimpaction guide for primary care - page 7.
  • Maintenance guide for primary care - page 8.

There is also advice on:

  • Health and wellbeing reviews for under 5's - mainly directed towards heath visitors.
  • Principles of management when child presents in hospital. - mainly directed towards ED staff. Children with constipation should not attend ED unless acutely unwell.

For further information on support available across BNSSG, please see the Children's Bladder & Bowel Service page of Remedy.

Parent leaflet

 Constipation - A guide to parents and carers

Red Flags

Symptoms that commence from birth or in the first few weeks.

Failure or delay (>first 48 hours at term) in passing meconium.

Ribbon stools, leg weakness or locomotor delay.

Abdominal distension with vomiting.

Abnormal examination findings including:

  • Abnormal appearance of anus
  • Gross abdominal distension
  • Abnormal gluteal muscles, scoliosis, sacral agenesis, discoloured skin, naevi or sinus, hairy patch, or central pit.
  • Lower limb deformity including talipes
  • Abnormal lower limb reflexes or neuromuscular signs unexplained by
    existing conditions.

Other symptoms that cause concern.

Referral

Constipation can usually be managed in primary care using the pathways above and referral is not usually indicated unless there are red flags or other cause for concern.

If acutely unwell then consider referral to ED

  • Increasing abdominal pain
  • Increasing abdominal distention
  • Vomiting, unable to tolerate oral fluids
  • Reduced urine output

If not responding to management in primary care then consider referral for community support

If a secondary care opinion is required then consider:

  • Paediatric Advice and Guidance
  • Referral to general paediatrics via eRS - if there is a medical problem such as poor weight gain or developmental delay (1).

 

Resources

(1) BRHC guidelines on Constipation in Children - these guidelines have been superceded by the National guidelines above but do give useful advice on assessment and management of constipation in children including:

  • Hirshsprungs - when to suspect and refer.
  • Management of faecal impaction/overflow. 
  • Maintenance treatment and advice on laxative use


Efforts are made to ensure the accuracy and agreement of these guidelines, including any content uploaded, referred to or linked to from the system. However, BNSSG ICB cannot guarantee this. This guidance does not override the individual responsibility of healthcare professionals to make decisions appropriate to the circumstances of the individual patient, in consultation with the patient and/or guardian or carer, in accordance with the mental capacity act, and informed by the summary of product characteristics of any drugs they are considering. Practitioners are required to perform their duties in accordance with the law and their regulators and nothing in this guidance should be interpreted in a way that would be inconsistent with compliance with those duties.

Information provided through Remedy is continually updated so please be aware any printed copies may quickly become out of date.