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The Evaluation And Management Of Constipation In The Pediatric Emergency Department - $30.00
Publication Date
February 2012 (Volume 9, Number 2)
CME
This issue includes 4 AMA PRA Category 1 CreditsTM, 4 ACEP Category 1 credits, 4 AAP Prescribed credits, and 4 AOA Category 2A or 2B CME credits.
Author
Brandon C. Carr, MD, FAAP, FACEP
Assistant Clinical Professor of Pediatric Emergency Medicine, Bert Martin’s Champions for Children Emergency Department and Trauma Center, Arnold Palmer Hospital for Children, Orlando Health, Orlando, FL
Peer Reviewers
John Cheng, MD, FAAP
Assistant Professor, Department of Pediatrics, Division of Emergency Medicine, Emory School of Medicine, Atlanta, GA
Madeline Matar Joseph, MD, FACEP, FAAP
Associate Professor of Emergency Medicine and Pediatrics, Assistant Chair for Pediatrics - Emergency Medicine Department, Chief - Pediatric Emergency Medicine Division, Medical Director - Pediatric Emergency Department, University of Florida Health Science Center Jacksonville, Jacksonville, FL
Abstract
A 1992 study showed that 7% of patients presenting to a pediatric emergency department (ED) with abdominal pain were diagnosed with constipation. Misdiagnosis of constipation may lead to multiple unresolved physician visits, utilization of emergency medical services, high doses of ionizing radiation, unnecessary laboratory tests, and even surgical procedures. This issue examines existing literature on constipation, though few randomized double-blind, controlled clinical trials of good quality existed in the literature until recently. The study populations in many articles are obtained from pediatric specialty clinics with subjects who carry a known diagnosis of chronic and often poorly controlled constipation. Analysis of the literature is hampered by lack of a concrete definition of constipation and the variability in outcome measures. The primary evidence-based recommendations are based on published guidelines and include management of constipation in children divided into 3 stages of therapy: (1) disimpaction, (2) maintenance therapy, and (3) behavior modification. Special consideration should be given to neonates and to children with pre-existing medical conditions.