Websites on paediatric constipation

Dr Keith Barnard recommends websites relating to this week's Clinical Review.

Website of the week

This colourfully presented 10-page booklet is an excellent find. The first six pages deal with the treatment of childhood constipation, and make as clear and straightforward an account of the management of this condition as you are likely to come across. The clear layout means you can easily find whatever you are looking for.

As the blurb says, if you read these pages you will be familiar with the likely causes of constipation, know the best way to resolve the problem, and learn about features that suggest more serious underlying disease. What more could you want? And there's the added bonus that the next five pages deal with diarrhoea in children in the same clear and precise manner.

Why go there: As good as anything you'll find.
Downside: None.
Information from: NHS Education for Scotland.
Address: Please click here

Guidelines for management
This little gem of just two pages covers everything related to management of childhood constipation and includes a useful flow chart for the treatment of functional constipation and faecal impaction.

This includes taking you through the various medications and their dosages.

The topics addressed include soiling and encopresis, which are important and often difficult-to-manage situations for the GP and often more distressing for the parents than for the child.

Print it out - you'll find it well worth keeping in the desk drawer.

Why go there: Excellent, GP-orientated coverage.
Downside: None.
Information from: Tameside and Glossop Primary Care Trust.
Address: Please click here

When to refer
This editorial from Canada points out that most referrals are based on a suspicion of Hirschsprung's disease.

This condition has held a particular fascination for me, ever since I saw an X-ray of the abdomen of a 12-year-old boy who was reputed to never have passed any faeces.

The amazing image looked like a bag of, well, more than a decade's worth of faeces.

The low incidence of Hirschsprung's disease among constipated children who are otherwise well is less than 5 per cent, but by my reckoning that's still a few.

The article also points out that the overwhelming majority of constipated children have functional constipation - a vicious cycle of pain on defaecation, faecal retention and chronic rectal distension.

This article is good value and takes less than a minute to read.

Why go there: brief and interesting.
Downside: no X-ray of accumulated faeces.
Information from: Canadian Paediatric Society.
Address: www.pulsus.com/Paeds/06_01/psn_ed.htm

Patient Information
This information comes from a good source, the Digestive Disorders Foundation.

Parents will find some nuggets here that I hope they take on board.

This includes the oh-so-true statement that some parents and children are more sensitive to worries about stools than others.

Parents can become worried about a child who is unable to defaecate. A battle then develops between the worried mum or dad and the child, who expresses independence by not defaecating.

How often do we see that scenario?

The pages also emphasise that an occasional difficulty in passing a stool is nothing to worry about.

Of course, if bouts of constipation become more frequent and last more than just a few days, the child does need to be seen.

Why go there: authoritative advice.
Downside: rather lengthy.
Information from: Digestive Disorders Foundation.
Address: Please click here

Dr Barnard is a former GP in Fareham, Hampshire.

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