The effective treatment of childhood constipation according to NICE guidelines.

By Adem Lewis / in , , , , , , , , /

Hello, I’m here to talk to you about the
treatment of childhood constipation. If this problem is not treated
appropriately outcomes can be poor and this can have an impact on the lives of
children and young people for years to come. This presentation is based on NICE guidelines which we know are often not
implemented in practice. I’ll run through them now. First-line treatment at
presentation is a Macrogol solution this will soften the stool by ensuring
fluid is retained in the colon which is then absorbed by the stool. 1 to 2 sachets
should be an adequate maintenance dose, the effectiveness of the Macrogol
treatment should be reviewed after 6 weeks. If at presentation the history is
prolonged, there is soiling and an abdominal examination reveals a palpable
mass then disimpaction is recommended this involves taking increasing doses of
a peadiatric Macrogol solution to a maximum daily dose of 8 sachets for
children aged 5 and under and 12 sachets for children over 5 years. This equates
to a daily total of 500 ml and 750 ml respectively when
correctly reconstituted according to manufacturer’s instructions. This should
be divided between three or four drinks throughout the day. It’s worth mentioning
here that the soiling may get worse before it gets better but it’s important
that the disimpaction regime is not stopped until the stool is watery
without any hard lumps like brown and inoffensive. The stool should remain in
this state for 48 hours before the dose of paediatric Macrogol solution is
reduced to a maintenance dose of 2 sachets. There is no need to reduce the
dose gradually but the child should be reviewed on completion of the
disimpaction regime to ensure that the process is complete. Following disimpaction, due to physical
changes to the rectum that occurs in long-term constipation most children
will need both daily paediatric Macrogol solution to soften the stool and
a stimulant medication such as Senna or Sodium Picosulphate to encourage full
emptying of the bowel. For the child who does not require disimpaction it may
still be necessary to introduce a stimulant medication in addition to
paediatric Macrogol solution if this alone does not result in a bowel motion
more than four times a week after six weeks of treatment. Rectal preparations
should not be used as first-line treatment and ideally their use in
children should be avoided outside of the hospital setting. The child should
also be encouraged to sit on the toilet after meals to promote a regular bowel
habit and of course a healthy diet and adequate clear fluid intake should also
be promoted. If there is poor progress with this plan after three months it is
recommended that children are referred to a specialist service for management
of their constipation.

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