Paediatrics - Queensland Health - Queensland Government

Gastrointestinal problems
4. Management
• Dietary interventions:
- - encourage a healthy diet with fruit and vegetables and wholegrain cereals
- - encourage drinking plenty of water
- - pears (fresh or pureed) or prunes will stimulate the gut gently and soften
stools
- - excessive dietary intake can cause constipation in children
• Encourage physical activity
• Toileting programs:
-- -take advantage of the gastrocolic reflex. Most people, especially children
have the urge to pass a motion after eating a meal, especially breakfast
-- -advise that the child should sit on the toilet after each meal and attempt to
pass a motion without straining
-- -positively reinforce good behaviour. A reward for sitting on the toilet and
passing a motion is often beneficial
• Disimpaction:
-- -oral laxatives
○ liquid paraffin, chocolate flavoured liquid paraffin i.e. Parachoc. Avoid
in infants under 12 months of age
○ lactulose, senna, Movicol Half ®
-- enemas
○ micro-enemas such as Microlax®
• Most constipation in children will resolve with these measures. If it persists, refer
to the next Child Health Nurse or MO clinic or Continence Advisor
5. Follow up
Children with constipation should be reviewed regularly to assess progress.
Once the problem settles remember to continue with dietary improvement and
increased water intake to prevent recurrence
Advise parent / carer to use appropriate gentle fibre or laxative (prune / pear juice
/ psyllium) for at least 3 months to regulate peristalsis
6. Referral / consultation
Consult MO if constipation is severe, or the child is unwell in any other way
Child Health Nurse
Continence Advisor (if available)
MO may consider referral to a Paediatrician
Children with chronic constipation require long term management with multiple
laxatives to keep their stool soft and prevent recurrence of painful anal fissures.
It is important to ensure observance with laxative regimes
Primary Clinical Care Manual 2011 Controlled copy V 1.0 617