Disorders of Motility: Pediatric Constipation (Nursing)

by Jackie Calhoun, DNP, RN, CPNP-AC, CCRN

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    00:01 Hi, I'm Dr. Jackie Calhoun.

    00:03 And today we're going to talk about Pediatric Constipation.

    00:06 In this video, we're going to cover the definition, the causes the epidemiology, or who gets constipation, and the signs and symptoms, which are also known as the cues.

    00:18 So first, how do we define it? Pediatric Constipation is a common condition in which children experience bowel movements that are less frequent than normal.

    00:28 And they often can be painful and are accompanied or characterized and are accompanied or characterized by the passage of hard dry stools.

    00:36 Constipation can occur just one time Constipation can occur just one time or can be recurrent or chronic in which these symptoms occur over a longer period of time, such as months or even years.

    00:48 So if we're going to talk about constipation then we need to talk about normal stooling patterns in kids.

    00:56 Normally, an infant passes meconium or their first stool in the first 24 hours of life.

    01:02 Then, during the first week, they pass about four stools per day.

    01:07 And the next three months, a baby's stooling pattern is related to what they're fed.

    01:12 Generally, breastfed babies stool more often than formula fed babies.

    01:17 Breastfed babies, usually stool three times per day, and formula fed babies stool about two times per day.

    01:24 Now let's talk about toddlers and older kids.

    01:27 Toddler stool just under two times per day.

    01:31 And children who are four years or older normally stool about one time per day.

    01:36 Functional fecal intolerance, also known as encopresis, is involuntary stooling after a child is toilet trained.

    01:44 It's defined by the involuntary passage of stool into the underwear after a child is toilet trained.

    01:50 And you know they're able to use the bathroom appropriately but they're just not able to stool appropriately.

    01:57 It's important to note that this condition only happens in children who have normal neuromuscular and anal rectal function.

    02:04 So basically, there's not another condition that we can say is causing this.

    02:11 Functional fecal intolerance can be retentive, where a child attempts to hold in a bowel movement or nonretentive, where they've passed the stool into their underwear.

    02:20 So what causes pediatric constipation? Children may become constipated, if it hurts them to stool.

    02:27 They may try to not have a bowel movement to avoid pain.

    02:30 They may not feel comfortable using a toilet and unfamiliar surroundings.

    02:34 They may have medical problems such as anatomical issues that may make it just impossible to have a regular bowel movement or they may be taking medications that may cause constipation.

    02:45 Transitioning between developmental stages, such as starting school, or transitioning from one type of diet to another may be a cause.

    02:52 And lastly, improper food or water intake can result in constipation.

    02:56 Generally, if they're not drinking enough water, or they're not eating foods with enough fiber than they're going to be constipated.

    03:04 So now let's talk about the epidemiology or what kids are affected by constipation? As we said, constipation is really common, and it can occur in up to 30% of children.

    03:15 It's the reason for up to 5% of the visits to pediatricians.

    03:20 And it occurs most often in preschool aged kids.

    03:23 And if you think about it, these are the kids that are going through those transitions, like we said.

    03:27 These are the ones that just got toilet trained, a year or so ago, or less, even if they're just starting preschool.

    03:33 They're the ones that are just starting school.

    03:35 And they're starting to develop fears of different places.

    03:39 So it goes back to that having to go to the bathroom and unfamiliar surroundings.

    03:45 So now let's talk about the signs and symptoms of pediatric constipation or the cues.

    03:51 So, the first one we're going to talk about acute constipation that occurs from birth is delayed passage in meconium, or passage in meconium after more than 24 hours.

    04:02 Meconium it's that first bowel movement that a baby has.

    04:06 It's usually very sticky, it's very black, and it's actually made from the amniotic fluid that a baby was swallowing while it was in utero.

    04:14 If the baby doesn't pass that muconium, it can result in severe abdominal distension.

    04:21 and potentially rectal bleeding because the rectum is holding in that stool.

    04:26 It's kind of getting stretched out, and getting traumatized, and it starts to bleed.

    04:32 But the other thing that could be the cause of rectal bleeding aside from just being stretched out is potentially an anal fissure and that needs to be ruled out.

    04:40 If that muconium doesn't pass, the baby can develop fever, vomiting, or diarrhea.

    04:45 And it's always interesting to think about diarrhea and constipation together, but it can occur if a patient is constipated because watery stool material can pass around a harder stool blockage.

    04:57 In chronic constipation.

    04:59 So this is constipation that happens over a long period of time.

    05:02 A patient will likely have straining with bowel movements.

    05:05 And if they are having constipation for a long time, this is probably something that started early in their life, potentially from birth or even early infancy.

    05:14 Those stools are probably not going to look normal.

    05:18 They may have ribbon stools where they're very narrow, like long and skinny and appear ribbon-like.

    05:22 like long and skinny and appear ribbon-like.

    05:23 They may demonstrate weight loss or poor growth, because they're probably not eating well if they're constipated.

    05:32 And then, they also may have a delayed growth pattern.

    05:34 So this is where they just really don't start growing on time.

    05:39 Finally, patients with chronic constipation may have urinary incontinence or bladder disorders.

    05:44 And this is because, if you can think about where the urethra and the rectum are, they're right next to each other.

    05:50 And if the rectum is distended, it's actually pushing on the urethra and making it more difficult to urinate.

    05:56 And that was the end of our first pediatric conservation video.

    06:00 I hope you learned something. And we'll see you next time.

    About the Lecture

    The lecture Disorders of Motility: Pediatric Constipation (Nursing) by Jackie Calhoun, DNP, RN, CPNP-AC, CCRN is from the course Gastrointestinal Disorders – Pediatric Nursing.

    Included Quiz Questions

    1. Straining with bowel movements
    2. Ribbon stools
    3. Weight loss
    4. Urinary incontinence
    5. Fever
    1. It is relatively common.
    2. Developmental stages can trigger it.
    3. It can be caused by inadequate oral intake.
    4. It occurs most often in children under six months of age.
    5. It is rarely the cause of healthcare provider visits.
    1. “Depending on whether your baby is breast or formula fed, they will likely have around two to three bowel movements daily for the first three months of life.”
    2. “For the first two to three months of life, your baby will have around four bowel movements daily.”
    3. “After your baby’s first week of life, their bowel movements will increase to around five to seven times a day.”
    4. “By two months, your baby will have around four to five bowel movements a day if they are formula fed, or around two to three a day if they are breastfed.”

    Author of lecture Disorders of Motility: Pediatric Constipation (Nursing)

     Jackie Calhoun, DNP, RN, CPNP-AC, CCRN

    Jackie Calhoun, DNP, RN, CPNP-AC, CCRN

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