Chronic constipation in infants and children.

Constipation is common in infants and children. Helping parents understand the vicious cycle of childhood chronic constipation is the key to successful management. Weaning, toilet training, transitions to kindergarten/school, a bout of febrile illness and overseas holidays are common life milestones that may be associated with an increased risk of constipation. A detailed history and targeted physical examination can rule out most organic causes of chronic constipation. Infrequent defecation (≤ 2 per week), faecal incontinence, retentive posturing, painful or hard bowel movements or large diameter of stool suggest functional constipation. The Bristol stool chart is a free, useful tool for parents or caregivers to report and monitor the child's stools. Red flags in constipation include delayed passage of meconium beyond 48 hours of life, associated intestinal obstruction symptoms, developmental delays, behavioural problems and frequent soiling of underwear. Behavioural modifications should be considered in primary care, together with pharmacotherapy such as laxatives.