CONSTIPATION: (Pediatric)

Constipation History Infrequent bowel movements? Hard, small stools? Painful evacuation? Overflow encopresis? Detailed abdominal and neurological physical exams Neonate / Infant Dietary / Functional Insufficient intake / Nutrition and feeding issues* Systemic Disease Hypothyroidism Anatomic Intestinal atresia Cystic fibrosis Imperforate anus Anal atresia Intestinal stenosis Neurologic Hirschsprung’s disease Older Child Dietary / Functional Insufficient intake / Nutrition and feeding issues* Withholding Painful (e.g., fissures) Drugs (narcotics, psychotropics) Systemic Disease Celiac disease Hypothyroidism Neurologic Hirschsprung’s disease Spinal cord lesions Guillain-Barré syndrome Neglect? / Physical abuse / Sexual abuse Anatomic Bowel obstruction Pseudo-obstruction *Indicates Key Condition This is not an exhaustive list of medical conditions.