Table 2, Key components of history-taking to diagnose idiopathic constipation - Constipation in Children and Young People

Key components	Findings and diagnostic clues that indicate idiopathic constipation	‘Red flag’ findings and diagnostic clues that indicate an underlying disorder or condition: not idiopathic constipation
Timing of onset of constipation and potential precipitating factors	In a child younger than 1 year: Starts after a few weeks of life Obvious precipitating factors coinciding with the start of symptoms: fissure, change of diet, infections In a child/young person older than 1 year: Starts after a few weeks of life Obvious precipitating factors coinciding with the start of symptoms: fissure, change of diet, timing of potty/toilet training and acute event such as infections, moving house, starting nursery/school, fears and phobias, major change in family, taking medicines	Reported from birth or first few weeks of life
Passage of meconium	Normal (within 48 hours after birth [in term baby])	Failure to pass meconium/delay (more than 48 hours after birth [in term baby])
Stool patterns		‘Ribbon stools’ (more likely in a child younger than 1 year)
Growth and general wellbeing	In a child younger than 1 year: Generally well, weight and height within normal limits In a child/young person older than 1 year: Generally well, weight and height within normal limits, fit and active	No ‘red flag’, but see ‘amber flag’ below.
Symptoms in legs /locomotor development	No neurological problems in legs (such as falling over in a child/young person older than 1 year), normal locomotor development	Previously unknown or undiagnosed weakness in legs, locomotor delay
Abdomen		Abdominal distension with vomiting
Diet and fluid intake	In a child younger than 1 year: Changes in infant formula, weaning, insufficient fluid intake In a child/young person older than 1 year: History of poor diet and/or insufficient fluid intake
‘Amber flag’, possible idiopathic constipation Growth and general wellbeing: Faltering growth (see recommendation on faltering growth, below) Personal/familial/social factors: Disclosure or evidence that raises concerns over possibility of child maltreatment (see recommendation on possible maltreatment, below)

Key components

Findings and diagnostic clues that indicate idiopathic constipation

‘Red flag’ findings and diagnostic clues that indicate an underlying disorder or condition: not idiopathic constipation

Timing of onset of constipation and potential precipitating factors

In a child younger than 1 year:
Starts after a few weeks of life
Obvious precipitating factors coinciding with the start of symptoms: fissure, change of diet, infections

In a child/young person older than 1 year:
Starts after a few weeks of life
Obvious precipitating factors coinciding with the start of symptoms: fissure, change of diet, timing of potty/toilet training and acute event such as infections, moving house, starting nursery/school, fears and phobias, major change in family, taking medicines

Reported from birth or first few weeks of life

Passage of meconium

Normal (within 48 hours after birth [in term baby])

Failure to pass meconium/delay (more than 48 hours after birth [in term baby])

Stool patterns

‘Ribbon stools’ (more likely in a child younger than 1 year)

Growth and general wellbeing

In a child younger than 1 year:
Generally well, weight and height within normal limits

In a child/young person older than 1 year:
Generally well, weight and height within normal limits, fit and active

No ‘red flag’, but see ‘amber flag’ below.

Symptoms in legs /locomotor development

No neurological problems in legs (such as falling over in a child/young person older than 1 year), normal locomotor development

Previously unknown or undiagnosed weakness in legs, locomotor delay

Abdomen

Abdominal distension with vomiting

Diet and fluid intake

In a child younger than 1 year:
Changes in infant formula, weaning, insufficient fluid intake

In a child/young person older than 1 year:
History of poor diet and/or insufficient fluid intake

‘Amber flag’, possible idiopathic constipation
Growth and general wellbeing:

Faltering growth (see recommendation on faltering growth, below)

Personal/familial/social factors:

Disclosure or evidence that raises concerns over possibility of child maltreatment (see recommendation on possible maltreatment, below)

From: 1, Guidance summary

Cover of Constipation in Children and Young People

Constipation in Children and Young People: Diagnosis and Management of Idiopathic Childhood Constipation in Primary and Secondary Care.

NICE Clinical Guidelines, No. 99.

National Collaborating Centre for Women's and Children's Health (UK).

London: RCOG Press; 2010.

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Table 2Key components of history-taking to diagnose idiopathic constipation