Every child must be fully assessed using the appropriate Continence Assessment Form. If constipation is identified, follow the flowchart below to ensure the child receives the correct assessment, treatment and management.

The ‘pop-up’ information boxes suggest who might deliver each intervention. In England the local CCG (Clinical Commissioning Group) can clarify who is commissioned to do so. Information to support the commissioning of children’s continence services can be found in the PCF’s Paediatric Continence Commissioning Guide. In Scotland and Wales, ask your GP, Health Visitor or School Health Nurse for advice on who provides local continence care.

Back to the Children's General Continence Flowchart

Constipation identified by GP
GP to inform/refer to School Health Nursing / Health Visiting / Children’s Community Nursing / Learning Disability Team
Constipation identified by School Health Nursing / Health Visiting / Children’s Community Nursing / Learning Disability Team
Child to be referred to GP
DEMYSTIFICATION
  • Discuss causes
  • Explain symptoms
  • Discuss treatments
  • Explain prognosis
CHILD TO BE ASSESSED for underlying organic cause:
  • Check appearance of anus and surrounding area to exclude anorectal anomaly
  • Check lower limb neurology and appearance of spine to exclude neurological link e.g. spinal anomaly
  • Check for abdominal mass
  • Check for faltering growth
  • See 'Constipation in kids' poster for visual guide to red flags
WHO DOES THIS?
Physical examinations are usually performed by doctors – this might be your GP, school doctor or paediatrician. Some nurse specialists / practitioners also do physical examinations
Breastfed baby? Provide Breastfed Babies and Constipation
No concerns. Idiopathic constipation diagnosed
If concerns refer as appropriate
Found or suspected
ASSESS FOR FAECAL IMPACTION: use a combination of history taking and physical examination – look for overflow soiling and/or faecal mass. DO NOT use rectal examination unless specifically indicated
WHO DOES THIS?
It may be apparent from discussion between child/parent and School Health Nurse / Health Visiting / Children’s Community Nursing / Learning Disability Team that the child is impacted. The doctor or nurse providing their prescription will confirm the suspicion
DISIMPACTION:
WHO DOES THIS?
The paediatric macrogol is usually prescribed by the GP or paediatrician. Some nurses prescribe too. The information may be provided by them but may be supplemented by the School Health Nurse / Health Visiting / Children’s Community Nursing / Learning Disability Team and/or ERIC
Not impacted
MAINTENANCE:
  • Demystify, reassure, educate
  • Offer Poo Diary
  • Signpost to ERIC for further information/reassurance and advice on toileting, children’s disposable pads etc
  • Provide leaflet ERIC’s Guide to Children's Bowel Problems
  • Do not use dietary interventions alone as first-line treatment
  • Continue oral macrogol titrating dose to achieve at least one soft stool per day. Write to GP to request macrogol laxative if necessary – see Template Letter for GP re Macrogols
  • Provide family with How to Prepare Macrogol Laxatives
  • Reassure regarding safety of long term use of laxatives
  • Advise family to maintain adequate fluid intake and dietary fibre
  • Advise daily physical activity
  • Advise regular toileting programme – offer Toileting Reward Chart
  • Advise re management of any Smearing
WHO DOES THIS?
The paediatric macrogol is usually prescribed by the GP or paediatrician. Some nurses prescribe too. The information may be provided by them but may be supplemented by the School Health Nurse / Health Visiting / Children’s Community Nursing / Learning Disability Team and/or ERIC
NICE
Symptoms improved
Symptoms ongoing
Provide information and leaflets as appropriate and discharge
Refer to Paediatric Continence Service or equivalent local service using Referral Form