National Institute for Health and Clinical Excellence (NICE)
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Taking the 'eww' out of constipation in children

NICE launches first ever guidelines on this taboo subject

NICE has today (Wednesday 26 May) launched the first ever national guidelines on childhood constipation. Whilst not life threatening, the condition is very common, affecting up to 30% of the child population in England. Those affected by constipation can experience real problems, socially and psychologically, often requiring long-term support. Their families can be affected too, some experiencing years of misery.

The signs and symptoms of constipation are rarely recognised. They include loss of appetite, stomach ache, and pain when going to the loo, but if identified early, and with the right treatment, problems can be resolved quickly and simply.

Fergus Macbeth, Director of the NICE Centre for Clinical Practice, said:

"Childhood constipation can have a terrible effect on children and indeed the entire family. It can lead to a number of problems both at home and in school, which require much support. But diagnosing the problem early and providing effective, simple treatment can really help children affected by this often debilitating condition."

Jenny Gordon, NICE Guideline Development Group Chair, said: “For years, I think perhaps there has been a real lack of understanding surrounding this condition - parents are often too slow to go to their GP, and may be very embarrassed or even ashamed if their child has constipation. We need to raise awareness of these issues, and be bolder in talking about childhood constipation, which can affect all areas of a child’s life. These guidelines are much needed and will help so many children. We now need to make sure that they are used and implemented.”

Adrian Thomas, Consultant Paediatric Gastroenterologist, Royal College of Paediatrics and Child Health, said:

"The RCPCH welcomes the publication of these guidelines. Constipation in children can be a very taboo subject, and often children and parents are too embarrassed to get help. These guidelines should lead to a change in the way childhood constipation is perceived, and will help healthcare professionals in helping to diagnose children with this condition earlier. This is not time-consuming or costly - it’s simply good old-fashioned medicine, which will help many children suffering from this upsetting condition."

June Rogers, Director, PromoCon(Promoting Continence and Product Awareness), said:

"I am very happy these guidelines are being launched. Childhood constipation is a tricky subject, and people are ashamed to talk about it. But too many children are affected and it’s time to speak out about it. These guidelines are incredibly helpful for those treating children with this condition, and show that it can quickly and easily be resolved."

The signs of constipation include:

  • loss of appetite
  • not going to the loo very often
  • soiling
  • tummy ache
  • passing hard, large poo or small, rabbit dropping-like poo
  • pain when going to the loo

The guidelines cover children and young people from birth to 18. The recommendations for those treating children with suspected constipation include:

  • The healthcare professional should feel the tummy of the child or young person to see if they have a blockage in the bowel caused by a build-up of poo. This must be cleared before ongoing treatment is given.
  • The child may then be prescribed medication called laxatives - the correct dose is very important.
  • The child must be followed up within one week to make sure the laxatives are working. The dose may have to be increased if they haven’t worked.
  • Once the blockage has been cleared, the laxatives should be prescribed as ongoing treatment to help the child go to the loo regularly. This could be for a few months, and it’s important the child is seen again during this time to make sure poo doesn’t build up again.
  • If this treatment does not work, the child will be referred to a specialist.
  • Diet alone is not recommended to help treat constipation but advice should be given by the healthcare professional on eating the right food and drinking enough water.

Parents should have a positive attitude towards children and their toilet habits, and children should be encouraged to take time to go to the loo and keep a diary, recording how often they use the loo. Children should be rewarded when they use the toilet.

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