Pediatric Constipation Etiologies

Aka: Pediatric Constipation Etiologies, Pediatric Constipation Causes, Constipation Causes in Children

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II. Causes: Common

  1. Functional Constipation is most common cause
  2. Infants
    1. Consider maternal medications in Breast fed infants
    2. Cystic Fibrosis
    3. Hirschsprung's Disease (delayed meconium passage >48 hours)
    4. Congenital disorders
    5. Anteriorly displaced anus
  3. Older children
    1. Hypothyroidism
    2. Anorexia
    3. Neuromuscular disorders
  4. References
    1. Claudius in Majoewsky (2012) EM:RAP - C3 2(3):2

III. Causes: Dietary

  1. Excessive cows milk
  2. Cow's Milk Protein Intolerance (blood in stool)
  3. Transition from Breast Milk to formula
  4. Transition from strained foods to table foods
  5. Lack of privacy (e.g. start of daycare or school)
  6. Lack of bulk in diet
  7. Under-nutrition
  8. Pediatric Dehydration
  9. Celiac Disease
  10. Vitamin D Toxicity

IV. Causes: Medications and toxins

  1. See Medication Causes of Constipation
  2. Lead Poisoning

V. Causes: Structural defects

  1. Duodenal Atresia
  2. Anal stenosis
  3. Imperforate anus
  4. Small colon Syndrome
  5. Intussusception
  6. Volvulus
  7. Malrotation
  8. Presacral Teratoma (or other pelvic mass)
  9. Meconium plug
  10. Rectal Prolapse
  11. Inflammatory Bowel Disease
  12. Anteriorly displaced anus
  13. Anal Fissure
  14. Bowel stricture

VI. Causes: Muscle Diseases

  1. Scleroderma
  2. Dermatomyositis
  3. Systemic Lupus Erythematosus
  4. Disordered or absent abdominal musculature
    1. Prune Belly
    2. Gastroschisis
    3. Down Syndrome

VII. Causes: Abnormal mysenteric Ganglion cells

  1. Aganglionic Megacolon (Hirschprung's Disease)
  2. Chagas' Disease
  3. Von Recklinghausen's Disease
  4. Multiple Endocrine Neoplasm (MEN) Type 2
  5. Internal anal sphincter Achalasia
  6. Neuronal intestinal dysplasia
  7. Visceral Myopathy

VIII. Causes: Spinal Cord defects

  1. See Spinal Dysraphism
  2. Spina Bifida Occulta
  3. Myelomeningocele
  4. Meningocele
  5. Diastematomyelia
  6. Paraplegia
  7. Cauda equina tumor
  8. Sacral agenesis
  9. Cerebral Palsy
  10. Tethered Cord

IX. Causes: Metabolic and endocrine disorders

  1. Hypothyroidism
  2. Hypoparathyroidism
  3. Renal Tubular Acidosis
  4. Diabetes Insipidus
  5. Diabetes Mellitus
  6. Vitamin D Intoxication
  7. Idiopathic Hypercalcemia
  8. Hypokalemia
  9. Hypercalcemia
  10. Cystic Fibrosis
  11. Uremia
  12. Porphyria
  13. Mitochondrial Disorders
  14. Connective Tissue Disorders

X. Causes: Infectious conditions

  1. Infant Botulism
  2. Necrotizing Enterocolitis

XI. Causes: Neurologic or Psychiatric Conditions

  1. Myotonic Dystrophy
  2. Amyotonia congenita
  3. Mental Retardation
  4. Psychosis
  5. Prune-Belly Syndrome
  6. Pseudo-obstruction syndrome

XII. Causes: Social Factors (Functional Constipation)

  1. Mood Disorder (Major Depression, Generalized Anxiety Disorder)
  2. Changes in home (birth of sibling, parents divorce)
  3. Starting at a new school
  4. Toilet Phobia
  5. Sexual abuse

XIII. References

  1. Bergeson (1996) Med J Allina 5(2):6-10
  2. Abi-Hanna (1998) Pediatr Rev 19:23-30 [PubMed]
  3. Leleiko (2020) Pediatric Rev 41(8): 379-92 [PubMed]
  4. Leung (1996) Am Fam Physician 54(2):611-18 [PubMed]
  5. Mulhem (2022) Am Fam Physician 105(5): 469-78 [PubMed]
  6. Nurko (2014) Am Fam Physician 90(2): 82-90 [PubMed]

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