Pediatric Constipation is a common presentation to PED and large percentage of GI clinic patient volume

Defined as less than 2 stools per week for two weeks with hard, large pellet like stools

Broad Differential includes functional constipation (most common), stricture, obstruction, celiac disease, Hirschsprung, hypothyroid, Cow's milk protein allergy, CF and spina bifida.  Always inspect the spine and perform rectal

Success of treatment is based on the aggressive nature of treatment and timing of treatment.  Ttreatment is longer and more difficult if patient has to wait on referral to GI specialist.

• Clean out with enema and stool softener (miralax BID for two days, followed by daily maintenance regimen is most common)
• Cheaper and effective regimens include mineral oil, kondremul or lactulose
• Encourage behavioral therapy with routine toilet time and rewards
• Increase fiber in diet to 8-10 grams for toddlers, 12-14 preschool and 14-16 for school age
• Initial treatment is safe and does not require electrolyte monitoring.
• Failed treatment and bounceback may require GI consult, inpatient Golytely therapy with electrolyte monitoring