MANAGEMENT OF CHRONIC CONSTIPATION IN INFANTS AND TODDLERS

Infants and toddlers with constipation usually have a history of infre quent, hard and painful bowel movements, often accompanied by screamin g and stool-holding maneuvers. Encopresis, the intermittent and involu ntary passage of formed-to-liquid feces, is common. Although constipat ion most often has a functional cause, the history and physical examin ation should rule out anatomic, endocrinologic, metabolic or neurologi c causes. Hirschsprung's disease-aganglionic megacolon-is a congenital cause of severe constipation that occurs in one of every 5,000 births . Treatment consists of fecal disimpaction, laxatives to prevent futur e impaction, promotion of regular bowel habits and, finally, toilet tr aining. Parents should be reassured that although this disorder is not life-threatening, several months to years of supportive intervention may be required for effective treatment.