Certain findings in a pediatric patient with constipation may be signs of a serious underlying condition. These alarm signs should prompt a more complete evaluation of the patient.
Alarms signs in a pediatric patient with constipation:
(1) passage of meconium >48 h after birth in a term newborn
(2) constipation starting during the first month of life
(3) family history of Hirschsprung’ disease
(4) ribbon stools
(5) blood in the stools in the absence of anal fissure
(6) failure to thrive
(7) bilious vomiting
(8) severe abdominal distention
(9) abnormal thyroid gland
(10) abnormal position of the anus
(11) absent anal or cremasteric reflex
(12) abnormal neurologic exam in the lower extremity
(13) sacral dimpleor tuft of hair on the spine
(14) gluteal cleft deviation
(15) anal scarring
The presence of one or more of these findings in a pediatric patient with constipation should prompt a more aggressive investigation.
