Trying very hard, not to push too many puns when talking about constipation. It has recently been in the media due to the blocking (damn) of emergency departments such as the Royal Children’s here in Melbourne. Each night up to 5 – 7% of emergency department consultations were due to constipation. Docs have to devise ways to give kids the shits.! The causes are well known but reversing these causes takes time, which is not much use in an emergency department. Unplugging kids requires fairly aggressive use of appropriate medications depending on the age.
In nearly all cases the causes of constipation are not due to a disease process or surgical problem with the gastrointestinal tract. Once an infant, toddler, or child experiences a painful hard bowel action then the subsequent bowel actions will be resisted. This can lead to quite severe constipation, distress in the child and hence the parents. The first thing to do is get the bowels moving again.
For infants the easiest method is with a microlax enema bought over the counter at the chemist. These are safe and effective and there is no risk if used as directed.
The idea of an enema in a toddler or older child can be quite distressing, so in this age group disimpaction requires the use of a powder that attracts water in the large intestine. Macrogol is marketed as osmolax or movicol and should be used aggressively then weaned. It is safe for use even in infants. The biggest problem tends to be parents (and some doctors !) not using enough. The dosage for a 4yo maybe as high as 4 to 5 scoops in a day (or sachets) to get things going again. After this the dosage should be tailored to get 1-2 comfortable soft bowel actions per day. Once things are unplugged this enables time to deal with the causative factors.
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