From the emergency department onward: a practical overview of pediatric constipation management

REVIEW ARTICLE

From the Emergency Department Onward: A Practical Overview of Pediatric Constipation Management

Hajar Al Hoqani.

Department of Pediatrics Emergency Medicine, Sultan Qaboos university hospital – university medical city, Muscat, Oman.

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Abstract
Context: Constipation is a prevalent complaint among pediatric patients in emergency settings, often leading to significant discomfort and anxiety for both children and caregivers.
Objective: To provide a comprehensive, evidence-based approach for the assessment and management of pediatric constipation in emergency medicine and outpatient clinics, emphasizing the differentiation between functional and organic causes.
Data Sources: A review of current literature, including guidelines from the North American Society for Pediatric Gastroenterology, Hepatology and Nutrition (NASPGHAN) and relevant clinical studies.
Study Selection: Articles and guidelines focusing on pediatric constipation evaluation and management starting from emergency settings.
Data Extraction: Key recommendations and findings were extracted and synthesized to formulate a practical approach.
Results: A thorough assessment, including detailed history-taking and physical examination, is essential. Most cases are functional and can be managed with oral disimpaction using PEG, followed by maintenance therapy and education. Red flags require further investigation. Long-term follow-up is vital for complete recovery.
Conclusions: Adopting a systematic approach allows for effective management of pediatric constipation in emergency settings, decreasing unnecessary interventions and enhancing patient outcomes. Lifestyle changes and follow-up care are crucial for complete recovery.

Why this article important?

Pediatric constipation is a common presentation in emergency departments worldwide, yet its evaluation and management are often inconsistent, leading to unnecessary investigations, missed serious diagnoses, and inadequate follow-up. This manuscript addresses a critical clinical gap by presenting a structured, evidence-based approach that begins in the emergency department and extends into outpatient care. It emphasizes the ED physician’s responsibility to rapidly rule out life-threatening abdominal conditions while providing immediate relief through safe, effective disimpaction methods. Beyond acute care, it outlines clear pathways for maintenance therapy, behavioral strategies, and caregiver education—key elements in preventing relapse. By integrating guidelines from authoritative bodies like NASPGHAN with practical, real-world recommendations, the article serves as both a clinical reference and a training tool for healthcare providers. Its focus on continuity of care ensures that treatment initiated in the ED transitions seamlessly to primary care or specialty follow-up, improving patient comfort, reducing healthcare costs, and enhancing long-term outcomes. This comprehensive approach has the potential to standardize care, reduce variability in practice, and ultimately improve the quality of life for affected children and their families.

Summary of article

This manuscript presents a comprehensive, evidence-based overview of pediatric constipation management, starting in the emergency department (ED) and extending into outpatient and long-term care. It emphasizes the ED physician’s critical role in rapidly distinguishing functional constipation from life-threatening causes such as appendicitis, bowel obstruction, and pancreatitis. The article outlines a structured diagnostic approach using history, physical examination, and identification of red flags, with investigations reserved for selected cases. Management recommendations cover acute disimpaction—preferably with oral polyethylene glycol—followed by maintenance therapy, nutritional guidance, and basic caregiver education initiated in the ED. The paper highlights the importance of behavioral interventions, patient-specific action plans, and support tools for sustained improvement. It underscores that effective treatment should not end in the ED; instead, coordinated follow-up in outpatient clinics or primary care settings is essential for preventing recurrence, addressing psychosocial factors, and ensuring long-term success. This integrated approach aims to reduce unnecessary interventions, improve patient comfort, and promote durable outcomes.

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