Download THE STRAIGHT POOP ON CONSTIPATION

INFANTS SOMEWHERE BETWEEN
SIX A DAY AND ONE EVERY SIX DAYS
 IF
NO BM IN THE FIRST 24 HOURS THE INFANT
NEEDS A DIGITAL RECTAL EXAM
 LOOKING


FOR IMPERFORATE ANUS
A MECONIUM PLUG
MICROCOLON
 MAY
BE ASSOCIATED WITH CYSTIC FIBROSIS
At least 2 of 6, for over a month if under age 4
and for two months if developmentally over 4
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2 or fewer BM’s a week
Incontinence once a week after initial
continence
Excessive stool retention
Painful or Hard Bowel Movements
Large fecal mass in the rectum
Large stools that may obstruct the toilet
 IN
INFANCY MOST CONSTIPATION IS DIETARY
 CHANGING FORMULAS MAY HELP
 ADDING
SORBITOL CONTAINING JUICES AFTER
FOUR MONTHS OFTEN HELPS
 START
FEEDINGS WITH OAT OR BARLEY
CEREALS INSTEAD OF RICE CEREAL
 PAINFUL
STOOLS MAY LEAD TO WITHOLDING
STOOLING
 GLYCERIN SUPPOSITORY IF NO BM AFTER 2
DAYS
 IF THE INFANT HAS INFREQUENT SOFT STOOLS
THAT DON’T HURT AND IS GROWING – DON’T
LOOK HARD FOR A PROBLEM
 UNINTENDED
SLEEP”
CONSEQUENCE OF “BACK TO
 IF
THE PATIENT STOOLED IN THE FIRST 24 HRS
OF LIFE
 UNLESS THERE IS ASSOCIATED VOMITING
 OR THE EXAM IS C/W ACUTE ABDOMEN
 OR THERE IS A HISTORY OF TRAUMA
 OBSTRUCTION
– Atresia, Webs, Volvulus
 HIRSCHPRUNGS DISEASE- Empty rectal vault
 FUNCTIONAL ILEUS- Preemie, Sepsis, Lytes
 SMALL LEFT COLON-Maternal Diabetes, CF
 MATERNAL DRUGS- Magnesium, Opiates
 HYPOTHYROIDISM- Prolonged Jaundice,
Lethargy, or Low Body Temp
 CBC
 THYROID
STUDIES
 TTG (need total serum IGA as well)
 Barium Enema
 Anorectal Manometry
 Rectal Biopsy
 Motility Studies –Sitzmark Study
 OFTEN
DIETARY AND TREATED WITH DIETARY
CHANGES
 AVOID MILK, CHEESE, FF CHIPS & BRAT DIET
 OFFER JUICES, “P” FRUITS, AND FIBER IN
DIET
 PROBIOTICS
 POTTY
TRAINING IS LEARNING TO HOLD YOUR
STOOL
 THEN STOOLING WHEN IT IS APPROPRIATE
 IF YOU HOLD IT TOO LONG – IT HURTS
 PAY
ATTENTION TO WHERE THEY GO –
PUT THE POTTY CHAIR THERE
 PAY ATTENTION TO WHEN THEY GO BE ON THE LOOKOUT
 THEIR FEET NEED TO TOUCH THE FLOOR
 NO CONSTIPATING FOODS DURING TRAINING
 LOTS OF “P” FRUITS AND JUICES
 SLIP A TABLESPOON OF MINERAL OIL IN THEIR
JUICE DAILY
 NO
ONE POOPS AT SCHOOL
 WHAT TIME DO THEY DEFECATE AT HOME
 PARENTS MAY NEED TO ADJUST THAT WHEN THEIR
CHILD GOES TO SCHOOL
 OSMOTIC
LAXATIVES:
 MIRALAX - 0.8 gm/kg - 1 capful/8 ounces
 SORBITOL 70% - 0.5-2 ml/kg up to QID
 LACTULOSE – 15-30 ml (10-20 g/kg
MINERAL OIL
Not very Palatable – mix with syrup or juice
Often associated with leakage of stool
Usual dose is 1 ml / kg
Concern for aspiration with infants
 COLACE
(Docusate)
 Capsules, Syrup and Oral Solution
 <2 – use 25 mg/day
 2 -12 - use 50 – 150 mg daily
 > 12 50 -500 mg daily
 May use 50 – 100 mg as retention or flushing
enema
 CONCERNS
FOR HABITUATION
 Bisacodyl (Dulcolax)
 0.3 mg/kg – 5-10 mg/day
 SENNA
 Comes
as a tablet, liquid and a concentrate
 >2 – use 2-4 mg /day
 2-5 – use 4-6 mg/day
 6-11 – 5-8 mg/day
 Over 12 use adult dose 12- 25 mg / day
 The
Newer Laxatives:
 Lubiprostone (Amitiza); Linaclotide, and
Prucalopride have not been studied in
children
USED TO REMOVE FECAL IMPACTIONS
 SODIUM
PHOSPHATE
 MINERAL OIL ENEMA
 USUALLY
 MAY
USE 5-10 ML/KG
NEED REPEATED DOSES INITIALLY
 Is
by definition CHRONIC
 Will not be cured overnight and will need a
Plan that includes diet, meds and lifestyle
changes
 The Colon has been dilated by the retained
stool and the muscles have been stretched
and won’t be able to push as well
 Expect
to treat for a week for every month
 At a minimum using Miralax and Fiber
 May need Mineral Oil or Colace
 Possibly Bisacodyl
 Need
to attain good bowel habits
 Use the Gastro-Colic Reflex – have the pt sit
on the commode after a meal for 15-30 min
 Expect
to have to stay on top of this lifelong
 Reinforce the dietary habits
 Exercise also helps bowel function
 Will need follow-up in a week or two
 Again at 1-2 months
 Very often they slip
 UpToDate
: Gregory D. Ferry, William J. Klish,
Alison G Hopper
 MEDSCAPE:
Drug Doses