Causes of constipation in children

Physiologic causes of constipation

Functional constipation* (may have dietary or behavioral triggers, exacerbated by painful defecation and stool withholding)

Cow's milk or other dietary protein intolerance*

Low dietary fiber*

Slow-transit constipation

Inadequate fluid intake (during fever or hot weather)

Immobility

Anorexia nervosa

Starvation

Neurogenic causes

Hirschsprung disease^¶^Δ

Cerebral palsy

Myelomeningocele

Spinal cord injury

Closed spinal dysraphism^¶^◊ (eg, tethered cord, sacral agenesis, split spinal cord malformation [diastematomyelia])

Sacral teratoma^¶^Δ

Neurofibromatosis

Muscular weakness (may be generalized, as in Down syndrome, or due to abnormal abdominal musculature,^Δ as in prune belly syndrome or gastroschisis)

Infantile botulism^¶^Δ (constipation is an early complaint; other features are facial and ocular palsies, poor suck and hypotonia)

Pseudo-obstruction (eg, visceral neuropathies, myopathies, mitochondrial disorders)

Intestinal neuronal dysplasia

Familial or acquired dysautonomia

Duchenne muscular dystrophy

Endocrine and metabolic causes

Cystic fibrosis^¶ (with meconium ileus in neonates^Δ or distal intestinal obstruction syndrome in older children)

Hypokalemia

Lead poisoning^¶

Vitamin D intoxication

Hypo- or hypercalcemia

Hypothyroidism

Diabetes mellitus

Pheochromocytoma

Multiple endocrine neoplasia type 2B (MEN2B)

Polyuria (leading to dehydration)

Juvenile systemic sclerosis (scleroderma) or mixed connective tissue disease

Acute intermittent porphyria

Anatomic causes

Anorectal anomalies (imperforate anus,^Δ anteriorly displaced anus)

Intestinal obstruction^¶ (in neonates, consider atresia, webs, or volvulus)^Δ

Small left colon syndrome^Δ^§

Other causes

Celiac disease*

Medications (opiates, anticholinergics, antidepressants, chemotherapy, aluminum-containing antacids)

Generalized joint hypermobility

* Relatively common cause.
¶ Prompt diagnosis is important to the outcome.
Δ Generally presents during infancy.
◊ Refer to UpToDate topic reviews on closed spinal dysraphism (spina bifida occulta).
§ Similar findings may occur in infants with Hirschsprung disease.

Data from:

Tunnessen WJ. Constipation and fecal retention. In: Signs and Symptoms in Pediatrics, 3rd ed, Lippincott, Williams & Wilkins, Philadelphia 1999. p.518.
Tabbers MM, Dilorenzo C, Berger MY, et al. Evaluation and Treatment of Functional Constipation in Infants and Children: Evidence-Based Recommendations From ESPGHAN and NASPGHAN. J Pediatr Gastroenterol Nutr 2014; 58:265.
Kajbafzadeh AM, Sharifi-Rad L, Seyedian SS, et al. Generalized joint hypermobility and voiding dysfunction in children: is there any relationship? Eur J Pediatr 2014; 173:197.
Kraus D, Wong BL, Horn PS, Kaul A. Constipation in Duchenne Muscular Dystrophy: Prevalence, Diagnosis, and Treatment. J Pediatr 2016; 171:183.

Graphic 94998 Version 7.0

خرید پکیج

Causes of constipation in children