Functional Constipation Infants & Children,nestle.pptx

functional constipation etiology pathophysiology and management

1. Functional Constipation Infants & Children Material For Healthcare Professionals Only BREASTFEEDING IS BEST FOR BABIES Dr. Hooria Rehman Assistant Professor (Pediatrician, Pediatric Gastroenterologist) Lahore General Hospital

2. Which of the following is the most common organic cause of constipation in pediatric patients? A. Hirschsprung disease B. Hypokalaemia C. Imperforate anus D. Occult spina bifida

3. Which of the following is the most common organic cause of constipation in pediatric patients? A . Hirschsprung disease B. Hypokalaemia C. Imperforate anus D. Occult spina bifida

4. Definition I nfrequent, difficult, painful or incomplete evacuation of hard stools F unctional constipation describes all children in whom constipation does not have an organic etiology. Commonly the result of withholding of feces in a child who wants to avoid painful defecation. Frequently, children will also experience recurrent episodes of fecal incontinence due to overflow caused by fecal impaction (known as encopresis).

5. STAGES OF CONSTIPATION https:// www.physio-pedia.com / Pediatric_Functional_Constipation

6. Functional Constipation Constipation affects up to 30 percent of children Nearly 10% of all pediatric hospital visits can be attributable to constipation Functional constipation is responsible for more than 95 percent of cases of constipation in healthy children one year and older and is particularly common among preschool-age children. It causes morbidity on both a physical and psychological level https:// pjmhsonline.com / index.php / pjmhs /article/view/4983/4927 https:// ferozsons-labs.com /functional-constipation/

7. Prevalence of Constipation in Different Ages https:// www.becares.in / Scientific_Articles /modulating-the-gut-microbiome-to-manage-pediatric-functional-constipation

8. Diagnostic Criteria, Rome IV for Functional Constipation Infants and toddlers up to 4 years old Children and adolescents age >4 years At least 2 of the following present for at least 1 month At least 2 of the following present at least once per week for at least 1 month 2 or fewer defecations per week History of excessive stool retention History of painful or hard bowel movements History of large diameter stools Presence of large fecal mass in the rectum *In toilet trained children At least 1 episode/week of incontinence History of large diameter stools that may obstruct the toilet 2 or fewer defecations per week At least 1 episode/week of incontinence History of retentive posturing or excessive volitional stool retention History of painful or hard bowel movements Presence of large fecal mass in the rectum History of large diameter stools that may obstruct the toilet Symptoms cannot be explained by another medical condition

9. POTENTIAL ALARM FEATURES in Constipation

10. CONSEQUENCES 1: http:// www.cps.ca /documents/position/functional-constipation 2:http :// www.ncbi.nlm.nih.gov / pmc /articles/ PMC3042216 / Approximately 30% of affected children will continue to have symptoms beyond puberty contrary to the common belief that children outgrow constipation

11. How to Approach Functional Constipation https:// www.physio-pedia.com / Pediatric_Functional_Constipation

12. Medical History & Physical Exam HISTORY Age of onset Passage of first meconium Frequency and consistency of stools Abdominal pain, Vomiting , Weight loss Fecal incontinence, Withholding behavior Dietary history Stressful life events Neurodevelopmental delay positive family history for gastrointestinal disease EXAMINATION Growth Parameters Abdominal Exam Inspection :Perianal Region Inspection : Lumbosacral Region Digital Rectal Exam https://www.physio-pedia.com/Pediatric_Functional_Constipation

13. Management

14. Management Nelson Textbook of Pediatrics, 21st Edition 2020

15. Can The Gut Microbiome Be Modulated to Tackle Functional Constipation? Gut microbiological imbalance is an important factor associated with functional constipation.

16. EMERGING ROLE OF PROBIOTICS Administration of  Bifidobacterium  or  Lactobacillus  h as also been shown to improve colonic transit times in constipated patients The administration of L reuteri (DSM 17938) in infants with functional chronic constipation has a positive effect on bowel frequency . Because of their safety profile, probiotics may be an attractive option in the treatment of functional constipation. https:// www.uptodate.com /contents/chronic-functional-constipation-and-fecal-incontinence-in-infants-children-and-adolescents-treatment?search=management%20of%20functional%20constipation%20in%20toddlers&source= search_result&selectedTitle = 1~30&usage_type = default&display_rank = 1#H4 Coccorullo P et al” Lactobacillus reuteri (DSM 17938) in infants with functional chronic constipation: a double-blind, randomized, placebo-controlled study; J Pediatr . 2010 Oct;157 (4):598-602.

17. EMERGING ROLE OF PROBIOTICS One RCT involved 44 infants aged ≥6 months with functional constipation according to the Rome III criteria who were randomly assigned to receive L. reuteri DSM 17938 ( Limosilactobacillus   reuteri)- or placebo for 8 weeks. Compared with the placebo group, infants in the L. reuteri group had a significantly higher frequency of bowel movements at week 2 (P = 0.042), week 4 (P = 0.008), and week 8 (P = 0.027). Magdalena Urbańska and Hania Szajewska ;” The efficacy of Lactobacillus reuteri DSM 17938 in infants and children: a review of the current evidence”: Eur J Pediatr. 2014; 173(10): 1327–1337.

18. EMERGING ROLE OF PROBIOTICS Paola Coccorullo et al” Lactobacillus reuteri (DSM 17938) in Infants with Functional Chronic Constipation: A Double-Blind, Randomized, Placebo-Controlled Study ; The Journal of Pediatrics;Volume 157, Issue 4, October 2010, Pages 598–602

19. EMERGING ROLE OF LACTOSE Oscar O Segarra et al ‘  Modification of stool’s water content in constipated infants: management with an adapted infant formula” Infante et al. Nutrition Journal 2011, 10:55 http:// www.nutritionj.com /content/10/1/55

20. EMERGING ROLE OF MAGNESIUM Magnesium has an osmotic effect which draws water into gut, thus increase intestinal motility Oscar O Segarra et al ‘  Modification of stool’s water content in constipated infants: management with an adapted infant formula” Infante et al. Nutrition Journal 2011, 10:55 http:// www.nutritionj.com /content/10/1/55

21. A 4-month-old male infant is brought to the emergency department by his grandmother because he has had constipation, irritability, and weakness and has been feeding poorly during the past 4 days. The grandmother has custody of the patient. She says she has been introducing many new foods to the infant on a weekly basis. On physical examination, ptosis is noted, and the patient has a weak cry. Based on these findings, which of the following is the most appropriate next step in management? A. Barium enema B. Measurement of blood lead level C. Referral for genetic testing D. Test of the stool for botulinum toxin

22. Test of the stool for botulinum toxin. This patient has constipation in addition to other symptoms that are indicative of infant botulism, which could result from his caregiver feeding him honey before the appropriate age. Choice A is an appropriate test only if Hirschsprung disease were suspected. Choice B is an appropriate next step if lead poisoning were suspected. Choice C is an appropriate test if cystic fibrosis were suspected.  A 4-month-old male infant is brought to the emergency department by his grandmother because he has had constipation, irritability, and weakness and has been feeding poorly during the past 4 days. The grandmother has custody of the patient. She says she has been introducing many new foods to the infant on a weekly basis. On physical examination, ptosis is noted, and the patient has a weak cry. Based on these findings, which of the following is the most appropriate next step in management? A. Barium enema B. Measurement of blood lead level C. Referral for genetic testing D. Test of the stool for botulinum toxin Material For Healthcare Professionals Only BREASTFEEDING IS BEST FOR BABIES

23. With microbiome enabling ingredients & Iron for depleting stores Follow-up formula (In the absence of breastfeeding) 935-OL6-EOEE

24. THANK YOU Material For Healthcare Professionals Only BREASTFEEDING IS BEST FOR BABIES