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.

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.

Have you registered with us yet?

Register now to enjoy more articles and free email bulletins


Already registered?

Sign in

Follow Us:

Just published

UK Houses of Parliament

Scrapping partnership model will not solve crisis in general practice, say NHS leaders

Scrapping the partnership model and moving to a salaried service will not solve the...

Dr Jackie Applebee

Doctors tell BMA to pull GP practices out of PCNs by 2023

The BMA has been told to organise the withdrawal of GP practices from PCNs by 2023...

GP consultation

3 in 10 doctors fear being blamed or facing legal action after admitting mistakes

Three in 10 doctors are worried about the repercussions of admitting to clinical...

BMA House entrance

Only 55% of Romney review recommendations on BMA sexism fully implemented

Only just over half of recommendations from the 2019 Romney review into sexism in...

BMA House entrance

GPs face pension tax penalties worth 'half their post-tax income'

Rapid swings in inflation could leave GPs facing pension tax penalties worth 'half...


BMA to demand significant pay rises to combat 15 years of real-term cuts

The BMA is set to demand significant pay rises for all doctors to undo over a decade...