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Hi, I'm Dr. Jackie Calhoun.
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And today we're going to talk
about Pediatric Constipation.
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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.
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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.
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And they often can be painful
and are accompanied
or characterized
and are accompanied
or characterized
by the passage of hard dry stools.
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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.
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So if we're going to
talk about constipation
then we need to talk about
normal stooling patterns in kids.
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Normally, an infant passes
meconium or their first stool
in the first 24 hours of life.
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Then, during the first week,
they pass about four stools per day.
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And the next three months,
a baby's stooling pattern
is related to what they're fed.
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Generally, breastfed babies stool
more often than formula fed babies.
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Breastfed babies,
usually stool three times per day,
and formula fed babies stool
about two times per day.
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Now let's talk about
toddlers and older kids.
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Toddler stool just
under two times per day.
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And children who are
four years or older
normally stool about
one time per day.
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Functional fecal intolerance,
also known as encopresis,
is involuntary stooling after
a child is toilet trained.
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It's defined by the
involuntary passage of stool
into the underwear after a child
is toilet trained.
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And you know they're able to use
the bathroom appropriately
but they're just not able
to stool appropriately.
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It's important to note that this
condition only happens in children
who have normal neuromuscular
and anal rectal function.
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So basically,
there's not another condition
that we can say is causing this.
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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.
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So what causes
pediatric constipation?
Children may become constipated,
if it hurts them to stool.
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They may try to not have a
bowel movement to avoid pain.
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They may not feel comfortable
using a toilet
and unfamiliar surroundings.
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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.
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Transitioning between developmental
stages, such as starting school,
or transitioning from
one type of diet to another
may be a cause.
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And lastly,
improper food or water intake
can result in constipation.
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Generally, if they're not
drinking enough water,
or they're not eating foods
with enough fiber
than they're going
to be constipated.
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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.
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It's the reason for up to 5%
of the visits to pediatricians.
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And it occurs most often
in preschool aged kids.
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And if you think about it, these are
the kids that are going through
those transitions, like we said.
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These are the ones that
just got toilet trained,
a year or so ago, or less, even if
they're just starting preschool.
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They're the ones that
are just starting school.
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And they're starting to develop
fears of different places.
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So it goes back to that
having to go to the bathroom
and unfamiliar surroundings.
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So now let's talk about
the signs and symptoms
of pediatric constipation
or the cues.
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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.
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Meconium it's that first
bowel movement that a baby has.
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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.
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If the baby doesn't pass
that muconium,
it can result in
severe abdominal distension.
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and potentially rectal bleeding
because the rectum
is holding in that stool.
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It's kind of getting stretched out,
and getting traumatized,
and it starts to bleed.
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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.
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If that muconium doesn't pass,
the baby can develop
fever, vomiting, or diarrhea.
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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.
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In chronic constipation.
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So this is constipation that happens
over a long period of time.
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A patient will likely have
straining with bowel movements.
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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.
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Those stools are probably
not going to look normal.
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They may have ribbon stools
where they're very narrow,
like long and skinny
and appear ribbon-like.
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like long and skinny
and appear ribbon-like.
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They may demonstrate
weight loss or poor growth,
because they're probably not
eating well if they're constipated.
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And then, they also may have
a delayed growth pattern.
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So this is where they just really
don't start growing on time.
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Finally, patients with
chronic constipation
may have urinary incontinence
or bladder disorders.
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And this is because,
if you can think about
where the urethra
and the rectum are,
they're right next to each other.
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And if the rectum is distended,
it's actually pushing on the urethra
and making it more
difficult to urinate.
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And that was the end of our
first pediatric conservation video.
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I hope you learned something.
And we'll see you next time.