For practical clinical purposes, constipation is generally defined as infrequent defecation, painful defecation, or both. In most cases, parents are worried that their child’s stools are too large, too hard, not frequent enough, and/or painful to pass.

Functional constipation that is not due to organic or anatomic causes is encountered most commonly. ‘Encopresis’, also known as faecal incontinence, is faecal soiling that occurs in the presence of chronic functional constipation. Occasionally, a parent will misinterpret the signs of encopresis as diarrhoea.

When the constipation is severe and if it has been a longstanding problem since early infancy, it is necessary to visit a Pediatrician and rule out an underlying organic disorder.

Do check specifically about intermittent large stools, because some children with constipation will have a daily bowel movements but with incomplete emptying and retention of a large stool mass.

The most common causes of Constipation in children are:
— Functional constipation.
— Behavioural/ situational constipation (phobias, abuse, toilet training).
— Milk protein intolerance.
— Irritable bowel syndrome .
— A diet history ingestion of large amounts of cow’s milk )
— Metabolic causes:( Hypercalcemia, hypokalaemia lead toxicity, hypothyroidism, celiac disease)
— Anorectal lesions (fissures, haemorrhoids, Hirschsprung disease , abscess, trauma)
— Anorectal malformations (stenosis, anterior anal displacement, ectopic anus, imperforate anus)
— Abnormal abdominal musculature (prune belly, gastroschisis)
— Spinal cord lesions (tethered cord, spina bifida)
— Neurologic (Botulism, cerebral palsy, myotonic dystrophy)
— Connective tissue disorders (SLE, scleroderma).
— Meconium ileus (i.e., small bowel obstruction) appears in the Newburn period in approximately 10% of infants with cystic fibrosis.

How can we establish the actual diagnosis?
— Via proper assessment of history (Excessive cow’s milk intake, Poor diet, Toilet training problems etc.)
— Complete physical examination.
— Consider: Free T4/ TSH, Calcium, Lead, Electrolytes, Celiac panel (TTG) as needed.
— Consider: Abdominal x-ray ,Barium enema ,Referral for rectal manometry/ rectal biopsy as need.

The Medical management:
— Osmotic laxatives : polyethylene glycol, lactulose ,Magnesium hydroxide.
— Lubricants : mineral oil.
— Stimulant Laxatives : Senna , Bisacodyl .

The Surgical Management if needed, is guided according to the underlying cause of constipation.

Mothers and fathers, if your child is suffering from constipation this SHOULD NOT BE NEGLECTED, otherwise the child will suffer from serious complications in the long run.

It is important to distinguish normal (constitutional or familial) short stature from that due to a medical problem.

Short stature must also be distinguished from failure to thrive (FTT), with associated poor weight gain.

If the child has decelerating growth patterns or is significantly short (#2 SD), further evaluation should be guided
by the clinical findings.

In general, however, weight for age less than height for age may indicate chronic illness or malnutrition,
and weight for age greater than height for age may indicate endocrine disorders or genetic disorders and syndromes.

The common causes of short stature :
–Familial short stature:
Normal pubertal development, (Bone age = chronological age).
–Constitutional growth delay:
Pubertal delay,( Bone age = height age), (Bone age < chronological age).
— Malnutrition.
— Malabsorption.
— Diabetes mellitus. (poorly controlled) .
— Celiac disease.
— Chronic illness: Cystic fibrosis, Sickle cell disease, Cardiac disease,
Renal dysfunction, Severe asthma, inflammatory bowel disease Psychosocial dwarfism (may retard growth and
mimic hypopituitarism).

— Endocrine causes:
Hypothyroidism, Growth hormone deficiency, Cushing syndrome,
Precocious puberty, Diabetes mellitus, Rickets.
— Syndromes/genetic disorders/ Skeletal dysplasia.

How can we approach to the short stature?

The first step in the evaluation of a child with suspected short stature is to obtain accurate measurements and plot them on the appropriate growth chart.

When the child is diagnosed to have “Short stature”, wide Laboratory investigations should be done to roll out the underlying cause. Such as:

Bone age, CBC , Chemistry profile, Urine study, Celiac panel, Thyroid function test, Growth hormone study, Cortisol study, Karyotype , Sweet chloride test, Stool study… etc. according to the suspicion.
Once the tests have been performed, then the management will be decided.

If you would like to book an appointment with our Pediatric Specialist Dr Bahaa Abdulhai,

Call 04 3990022 or #BookOnline: https://armadahospital.com/book-online/