Excerpt

Without early diagnosis and treatment, an acute episode of constipation can lead to anal fissure and become chronic. By the time the child or young person is seen they may be in a vicious cycle. Children and young people and their families are often given conflicting advice and practice is inconsistent, making treatment potentially less effective and frustrating for all concerned. Early identification of constipation and effective treatment can improve outcomes for children and young people. This guideline provides strategies based on the best available evidence to support early identification, positive diagnosis and timely, effective management. Implementation of this guideline will provide a consistent, coordinated approach and will improve outcomes for children and young people.

Contents

• Guideline Development Group membership and acknowledgements
• 1. Guidance summary
  • 1.1. Key priorities for implementation
  • 1.2. Recommendations
  • 1.3. Key research recommendations
  • 1.4. Additional research recommendations
  • 1.5. Care pathway
• 2. Introduction
  • 2.1. Idiopathic constipation in children
  • 2.2. Aim and scope of the guideline
  • 2.3. Abbreviations and glossary
  • 2.4. For whom is the guidance intended?
  • 2.5. Other relevant documents
  • 2.6. Who has developed the guidance?
  • 2.7. Guideline development methodology
  • 2.8. Schedule for updating the guidance
• 3. Assessment and diagnosis
  • 3.1. History-taking and physical examination
  • 3.2. Digital rectal examination
• 4. Clinical investigations
  • 4.1. Introduction
  • 4.2. Endoscopy
  • 4.3. Hypothyroidism and coeliac disease
  • 4.4. Manometry
  • 4.5. Radiography
  • 4.6. Rectal biopsy
  • 4.7. Transit studies
  • 4.8. Ultrasound
• 5. Clinical management
  • 5.1. Disimpaction
  • 5.2. Maintenance therapy
  • 5.3. Adverse effects of laxative use
  • 5.4. Diet and lifestyle
  • 5.5. Psychological interventions
  • 5.6. Complementary therapies
  • 5.7. Antegrade colonic enema procedure
• 6. Information and support
  • Introduction
  • Clinical question
  • Studies considered in this section
  • Overview of available evidence
  • Narrative summary
  • Evidence statement
  • GDG interpretation of the evidence
• Appendix A. Scope of the guideline
• Appendix B. Declarations of interest
• Appendix C. Registered stakeholder organisations
• Appendix D. Clinical questions
• Appendix E. Health economics
• Appendix F. Involving children in guideline development
• Appendix G. Bristol Stool Form Scale
• Appendix H. References
• Appendix I. Search Strategies
• Appendix J. Evidence tables
• Appendix K. Excluded studies

While every effort has been made to ensure the accuracy of the information contained within this publication, the publisher can give no guarantee for information about drug dosage and application thereof contained in this book. In every individual case the respective user must check current indications and accuracy by consulting other pharmaceutical literature and following the guidelines laid down by the manufacturers of specific products and the relevant authorities in the country in which they are practising.

This guideline has been fully funded by NICE. Healthcare professionals are expected to take it fully into account when exercising their clinical judgement. However, the guidance does not override the individual responsibility of healthcare professionals to make decisions appropriate to the circumstances of the individual patient.

Implementation of this guidance is the responsibility of local commissioners and/or providers.