{"id":21311,"date":"2024-10-24T12:58:01","date_gmt":"2024-10-24T11:58:01","guid":{"rendered":"https:\/\/apps.nhslothian.scot\/refhelp\/?page_id=21311"},"modified":"2025-09-24T10:35:29","modified_gmt":"2025-09-24T09:35:29","slug":"constipation","status":"publish","type":"page","link":"https:\/\/apps.nhslothian.scot\/refhelp\/guidelines\/paediatrics\/medical-paediatrics\/constipation\/","title":{"rendered":"Constipation"},"content":{"rendered":"\n<p><strong>Information<\/strong><\/p>\n\n\n\n<p><strong>Constipation in children &nbsp;<\/strong><\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Early intervention with oral laxatives in addition to non-pharmacological management is crucial&nbsp;to prevent chronicity, overstretched bowels with reduced motility, withholding behaviours and overflow soiling<\/li>\n\n\n\n<li>Affects 1 in 3 children; 95% cases are idiopathic with no pathological cause.&nbsp;<\/li>\n\n\n\n<li>Most patients with constipation can be managed in primary care.&nbsp;<\/li>\n\n\n\n<li>This RefHelp page can be used to guide assessment and need for referral.<\/li>\n\n\n\n<li>We are happy to see any child if there are concerns even if they strictly fall out with the referral criteria.&nbsp; These children should be referred to medical paediatrics; GI only see more complex patients.<\/li>\n<\/ul>\n\n\n\n<p>Dyschezia is the term given to the apparent discomfort infants can experience prior to passing stool.&nbsp; It can often be mistaken for constipation but is managed differently.&nbsp; Please see this helpful PIL for parents:&nbsp; <a href=\"https:\/\/policyonline.nhslothian.scot\/wp-content\/uploads\/2024\/10\/Dyschezia-in-babies.pdf\" target=\"_blank\" rel=\"noreferrer noopener\">Dyschezia in babies v1.0.pdf<\/a><\/p>\n\n\n\n<p><strong>D.R.M &amp; M.B. 25-11-24<\/strong><\/p>\n\n\n\n<div class=\"wp-block-getwid-tabs\" data-active-tab=\"0\"><ul class=\"wp-block-getwid-tabs__nav-links\"><\/ul>\n<div class=\"wp-block-getwid-tabs__nav-link\"><span class=\"wp-block-getwid-tabs__title-wrapper\"><a href=\"#\"><span class=\"wp-block-getwid-tabs__title\">Referral Guidelines<\/span><\/a><\/span><\/div><div class=\"wp-block-getwid-tabs__tab-content-wrapper\"><div class=\"wp-block-getwid-tabs__tab-content\">\n<h4 class=\"wp-block-heading\">Who to refer:<\/h4>\n\n\n\n<p><strong>1<\/strong>. Any child with a \u2018red\u2019 or \u2018amber\u2019 flag according to the NHS Lothian constipation guidelines i.e: <a href=\"https:\/\/apps.nhslothian.scot\/files\/sites\/2\/Guidelines-for-management-of-idiopathic-childhood-constipation.pdf\" target=\"_blank\" rel=\"noreferrer noopener\">Guidelines-for-management-of-idiopathic-childhood-constipation.pdf<\/a><\/p>\n\n\n<div class=\"wp-block-image\">\n<figure class=\"aligncenter size-full\"><img loading=\"lazy\" decoding=\"async\" width=\"943\" height=\"309\" src=\"https:\/\/apps.nhslothian.scot\/files\/sites\/2\/Constipation-Redflags.png\" alt=\"Constipation Redflags\" class=\"wp-image-21473\" srcset=\"https:\/\/apps.nhslothian.scot\/files\/sites\/2\/Constipation-Redflags.png 943w, https:\/\/apps.nhslothian.scot\/files\/sites\/2\/Constipation-Redflags-300x98.png 300w, https:\/\/apps.nhslothian.scot\/files\/sites\/2\/Constipation-Redflags-768x252.png 768w\" sizes=\"auto, (max-width: 943px) 100vw, 943px\" \/><figcaption><span class=\"media-credit\">NHS Lothian<\/span><\/figcaption><\/figure>\n<\/div>\n\n\n<p>Screening bloods for children with suspected non-idiopathic constipation mentioned above:<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Full blood count<\/li>\n\n\n\n<li>Urea and electrolytes<\/li>\n\n\n\n<li>Liver function tests<\/li>\n\n\n\n<li>Calcium<\/li>\n\n\n\n<li>Thyroid function tests<\/li>\n\n\n\n<li>Coeliac screen  (if gluten exposed)<\/li>\n<\/ul>\n\n\n\n<p><strong>2<\/strong>. Any child with chronic constipation not responding to recommended doses of laxatives (see Primary Care Management tab)<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Refer children &lt; 1yr after 4 weeks optimal treatment.<\/li>\n<\/ul>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Refer children &gt;1yr after 3 months optimal treatment.&nbsp;&nbsp;<\/li>\n<\/ul>\n\n\n\n<p><strong>3.<\/strong> Any child with faecal impaction +\/- overflow who fails to respond to disimpaction regimens (see Primary Care Management tab)<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>These children should be discussed with on-call paediatric team (link to urgent telephone advice main page) regarding possible admission for supervised inpatient disimpaction.&nbsp;<\/li>\n<\/ul>\n\n\n\n<p><strong>4.<\/strong> If you wish to refer a child who falls out with the above criteria, please state reason for referral.&nbsp;<\/p>\n<\/div><\/div>\n\n\n\n<div class=\"wp-block-getwid-tabs__nav-link\"><span class=\"wp-block-getwid-tabs__title-wrapper\"><a href=\"#\"><span class=\"wp-block-getwid-tabs__title\">Primary Care Management<\/span><\/a><\/span><\/div><div class=\"wp-block-getwid-tabs__tab-content-wrapper\"><div class=\"wp-block-getwid-tabs__tab-content\">\n<p><strong>Useful additional information for GPs and families<\/strong><\/p>\n\n\n\n<h4 class=\"wp-block-heading\">Diet&nbsp;<\/h4>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Milk &#8211; too much milk can cause constipation, affect appetite, and cause iron deficiency anaemia.\n<ul class=\"wp-block-list\">\n<li>Over 1 year: aim to reduce intake to 400ml maximum\/day (plus dairy in diet).<\/li>\n\n\n\n<li>Switching from a bottle to a sippy cup often leads to reduced intake, dilute milk if necessary.<\/li>\n<\/ul>\n<\/li>\n\n\n\n<li>Fluid intake \u2013 aim for at least 5 drinks of water per day; more specific volume guide <a href=\"https:\/\/cks.nice.org.uk\/topics\/constipation-in-children\/management\/management\/#recommended-fluid-intake\">https:\/\/cks.nice.org.uk\/topics\/constipation-in-children\/management\/management\/#recommended-fluid-intake<\/a><\/li>\n\n\n\n<li>Diet &#8211; increase fruit, vegetables, fibre.&nbsp;&nbsp;<\/li>\n<\/ul>\n\n\n\n<h4 class=\"wp-block-heading\"><strong>Laxatives&nbsp;<\/strong><\/h4>\n\n\n\n<p>Disimpaction (see  <a href=\"https:\/\/apps.nhslothian.scot\/files\/sites\/2\/Disimpaction-regimens.pdf\" target=\"_blank\" rel=\"noreferrer noopener\">Disimpaction-regimens.pdf<\/a> for treatment regimen)&nbsp;<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Any child being disimpacted should be reviewed 1 week after treatment to ensure disimpaction successful and taking adequate maintenance therapy.&nbsp;&nbsp;<\/li>\n\n\n\n<li>Macrogol (Movicol\/Laxido) can be difficult to get a child to take more than a few sachets per day due to high volumes required. Consider using Sodium Picosulphate (only needed for 2-3 days and easier to give).&nbsp;<\/li>\n\n\n\n<li>Abdo cramps are a common side effect of disimpaction treatment \u2013 do mention to parents \u2013 can treat with paracetamol, if concerns\/abdo pain severe\/concerned about child seek medical advice.&nbsp;<\/li>\n\n\n\n<li>If soiling, likely to be impacted \u2013 disimpact and start maintenance laxatives then review after 1 week.&nbsp;<\/li>\n<\/ul>\n\n\n\n<p><\/p>\n\n\n\n<p>Maintenance treatment (see <a href=\"https:\/\/apps.nhslothian.scot\/files\/sites\/2\/Maintenance-Laxative-Therapy-v2.docx\" target=\"_blank\" rel=\"noreferrer noopener\">Maintenance-Laxative-Therapy.pdf<\/a> for treatment regimen)&nbsp;<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Always start on maintenance therapy immediately after disimpaction.&nbsp;<\/li>\n\n\n\n<li>Aim for one or two soft stools (type 3-4)&nbsp;most days.<\/li>\n\n\n\n<li>Children may require many months of maintenance treatment.&nbsp;<\/li>\n\n\n\n<li>Consider combination laxatives:&nbsp;<ul><li>If stool still too hard on one laxative, consider adding in a softener.&nbsp;&nbsp;<\/li><\/ul>\n<ul class=\"wp-block-list\">\n<li>If stool frequency too low on one laxative, consider adding in a stimulant.&nbsp;&nbsp;&nbsp;<\/li>\n<\/ul>\n<\/li>\n\n\n\n<li>Softener\/stimulant:&nbsp;<ul><li>Macrogols are combined softener and stimulant&nbsp;laxatives.<\/li><\/ul><ul><li>Softeners: Lactulose, liquid Paraffin. &nbsp;<\/li><\/ul>\n<ul class=\"wp-block-list\">\n<li>Stimulants: Sodium Picosulphate; Senna; Bisacodyl; Docusate.&nbsp;<\/li>\n<\/ul>\n<\/li>\n\n\n\n<li>Lactulose \u2013 can cause tooth decay &#8211; make a note on script \u2013 give before brushing teeth.&nbsp;&nbsp;<\/li>\n\n\n\n<li>Stopping laxatives &#8211; once stable for a period of time can trial off laxatives but wean off slowly (particularly if have been on for a long time), low threshold to restart \/ use on an as required basis. &nbsp;<\/li>\n\n\n\n<li>Macrogol (Movicol\/Laxido) more palatable when chilled in the fridge, can be mixed with any fluid the child will drink (milk, squash)<\/li>\n<\/ul>\n\n\n\n<h4 class=\"wp-block-heading\">Toileting behaviour&nbsp;<\/h4>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Toileting \u2013 encourage sitting on the toilet\/potty for short periods after meals e.g. to sit for 10 minutes shortly (5-10 minutes) after meals (at least once per day).<\/li>\n\n\n\n<li>Avoid punitive measures &#8211; constipation is not the child&#8217;s fault &amp; punitive measures can make things worse<\/li>\n\n\n\n<li>Positive reinforcement &#8211; of good behaviours (rather than success which leads to despondency &amp; disengagement) helps to establish regular bowel habit&nbsp;<\/li>\n<\/ul>\n<\/div><\/div>\n\n\n\n<div class=\"wp-block-getwid-tabs__nav-link\"><span class=\"wp-block-getwid-tabs__title-wrapper\"><a href=\"#\"><span class=\"wp-block-getwid-tabs__title\">Resources and Links<\/span><\/a><\/span><\/div><div class=\"wp-block-getwid-tabs__tab-content-wrapper\"><div class=\"wp-block-getwid-tabs__tab-content\">\n<h3 class=\"wp-block-heading\"><strong><u>Information for GPs<\/u><\/strong>&nbsp;<\/h3>\n\n\n\n<p>Constipation guideline NHS Lothian \u2013 <a href=\"https:\/\/apps.nhslothian.scot\/files\/sites\/2\/Guidelines-for-management-of-idiopathic-childhood-constipation.pdf\" target=\"_blank\" rel=\"noreferrer noopener\">https:\/\/apps.nhslothian.scot\/files\/sites\/2\/Guidelines-for-Management-of-Idiopathic-Childhood-Constipation.pdf<\/a>&nbsp;&nbsp;<\/p>\n\n\n\n<p>Bristol stool chart <a href=\"https:\/\/eric.org.uk\/poo-checker\/\" target=\"_blank\" rel=\"noreferrer noopener\">https:\/\/eric.org.uk\/poo-checker\/<\/a>&nbsp;<\/p>\n\n\n\n<p>Lothian Joint Formulary Child chronic constipation; faecal impaction <a href=\"https:\/\/formulary.nhs.scot\/east\/gastro-intestinal-system\/colonic-disorders\/constipation\/\" target=\"_blank\" rel=\"noreferrer noopener\">https:\/\/formulary.nhs.scot\/east\/gastro-intestinal-system\/colonic-disorders\/constipation\/<\/a>&nbsp;<\/p>\n\n\n\n<p>Clinical knowledge summary <em>The Managment of Idiopathic Constipation in Children <\/em><a href=\"https:\/\/cks.nice.org.uk\/topics\/constipation-in-children\/management\/management\/#overview-of-management\" target=\"_blank\" rel=\"noreferrer noopener\">https:\/\/cks.nice.org.uk\/topics\/constipation-in-children\/management\/management\/#overview-of-management<\/a>&nbsp;<\/p>\n\n\n\n<p><\/p>\n\n\n\n<h3 class=\"wp-block-heading\"><strong><u>Information for Parents&nbsp;<\/u><\/strong>&nbsp;<\/h3>\n\n\n\n<p>Videos for parents &#8211; eric (resources in constipation section) or youtube <a href=\"https:\/\/www.youtube.com\/watch?v=A_EfabHuwuI&amp;t=4s\" target=\"_blank\" rel=\"noreferrer noopener\">Constipation &#8211; YouTube<\/a>&nbsp;<\/p>\n\n\n\n<p>ERIC \u2013 <a href=\"https:\/\/eric.org.uk\/childrens-bowels\/constipation-in-children\/\" target=\"_blank\" rel=\"noreferrer noopener\">https:\/\/eric.org.uk\/childrens-bowels\/constipation-in-children\/<\/a> on this link, click resources, there are several PILs that can be printed including \u2018a parents\u2019 guide to disimpaction\u2019 and \u2018how to use macrogol laxatives\u2019&nbsp;<\/p>\n\n\n\n<p>Eric &#8211; advice on toilet anxiety for parents &#8211; <a href=\"https:\/\/eur01.safelinks.protection.outlook.com\/?url=https%3A%2F%2Feric.org.uk%2Finformation%2Ftoilet-anxiety%2F&amp;data=05%7C02%7CHeather.Levy%40nhs.scot%7Cf7910361bbc545ba406708dd07139323%7C10efe0bda0304bca809cb5e6745e499a%7C0%7C0%7C638674502842835861%7CUnknown%7CTWFpbGZsb3d8eyJFbXB0eU1hcGkiOnRydWUsIlYiOiIwLjAuMDAwMCIsIlAiOiJXaW4zMiIsIkFOIjoiTWFpbCIsIldUIjoyfQ%3D%3D%7C0%7C%7C%7C&amp;sdata=2ukNgqb9iLDf8EgKZ7I%2FRDN1L%2B8yCLpKr9NKDWHou8E%3D&amp;reserved=0\" target=\"_blank\" rel=\"noreferrer noopener\">Toilet anxiety and toilet phobia in children &#8211; ERIC<\/a>&nbsp;<\/p>\n\n\n\n<p>Poo diary &#8211; can print and give to take home prior to next review <a href=\"https:\/\/eric.org.uk\/wp-content\/uploads\/2022\/08\/poodiary.pdf\" target=\"_blank\" rel=\"noreferrer noopener\">https:\/\/eric.org.uk\/wp-content\/uploads\/2022\/08\/poodiary.pdf<\/a>&nbsp;<\/p>\n\n\n\n<p>Constipation in children general information for parents which includes links to information on diet <a href=\"https:\/\/www.nhs.uk\/conditions\/baby\/health\/constipation-in-children\/\" target=\"_blank\" rel=\"noreferrer noopener\">https:\/\/www.nhs.uk\/conditions\/baby\/health\/constipation-in-children\/<\/a>&nbsp;&nbsp;<\/p>\n\n\n\n<p>Info on fibre (link on above website page) <a href=\"https:\/\/www.nhs.uk\/live-well\/eat-well\/digestive-health\/how-to-get-more-fibre-into-your-diet\/\" target=\"_blank\" rel=\"noreferrer noopener\">https:\/\/www.nhs.uk\/live-well\/eat-well\/digestive-health\/how-to-get-more-fibre-into-your-diet\/<\/a>&nbsp;<\/p>\n\n\n\n<p>Please see this helpful PIL for parents:&nbsp; <a href=\"https:\/\/policyonline.nhslothian.scot\/wp-content\/uploads\/2024\/10\/Dyschezia-in-babies.pdf\" target=\"_blank\" rel=\"noreferrer noopener\">Dyschezia in babies v1.0.pdf<\/a><\/p>\n<\/div><\/div>\n<\/div>\n\n\n\n<p><\/p>\n","protected":false},"excerpt":{"rendered":"<p>Information Constipation in children &nbsp; Dyschezia is the term given to the apparent discomfort infants can experience prior to passing stool.&nbsp; It can often be mistaken for constipation but is managed differently.&nbsp; Please see this helpful PIL for parents:&nbsp; Dyschezia in babies v1.0.pdf D.R.M &amp; M.B. 25-11-24<\/p>\n","protected":false},"author":6,"featured_media":0,"parent":21301,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"footnotes":""},"categories":[1177],"class_list":["post-21311","page","type-page","status-publish","hentry","category-constipation"],"publishpress_future_workflow_manual_trigger":{"enabledWorkflows":[]},"rttpg_featured_image_url":null,"rttpg_author":{"display_name":"heatherlevy","author_link":"https:\/\/apps.nhslothian.scot\/refhelp\/author\/heatherlevy\/"},"rttpg_comment":0,"rttpg_category":" <a href=\"https:\/\/apps.nhslothian.scot\/refhelp\/category\/https-apps-nhslothian-scot-refhelp-medical-paediatrics\/constipation\/\" rel=\"tag\">Constipation<\/a>","rttpg_excerpt":"Information Constipation in children &nbsp; Dyschezia is the term given to the apparent discomfort infants can experience prior to passing stool.&nbsp; It can often be mistaken for constipation but is managed differently.&nbsp; Please see this helpful PIL for parents:&nbsp; Dyschezia in babies v1.0.pdf D.R.M &amp; M.B. 25-11-24","_links":{"self":[{"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/pages\/21311","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/users\/6"}],"replies":[{"embeddable":true,"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/comments?post=21311"}],"version-history":[{"count":33,"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/pages\/21311\/revisions"}],"predecessor-version":[{"id":25433,"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/pages\/21311\/revisions\/25433"}],"up":[{"embeddable":true,"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/pages\/21301"}],"wp:attachment":[{"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/media?parent=21311"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/categories?post=21311"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}