Evaluation and treatment of constipation in infants and children.
Evaluation and treatment of constipation in infants and children.
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发表时间：
2006-02
影响因子：
4
通讯作者：
W. Biggs;William H Dery
中科院分区：
文献类型：
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作者：
W. Biggs;William H Dery
儿童便秘通常是功能性的，是粪便潴留的结果。然而，家庭医生必须警惕危险信号，这些信号可能表明存在不常见但严重的器质性便秘原因，例如先天性无神经节巨结肠、假性梗阻、脊髓异常、甲状腺功能减退、尿崩症、囊性纤维化、麸质肠病或先天性肛门直肠畸形。功能性便秘的治疗包括使用口服或直肠药物解除嵌塞。聚乙二醇有效且耐受性良好，但有许多替代品可供选择。解除嵌塞后，可能需要数月至数年的维持计划，因为功能性便秘复发很常见。维持药物包括矿物油、乳果糖、氧化镁乳、聚乙二醇粉和山梨糖醇。对家庭和儿童（如果可能）的教育有助于改善功能性便秘。行为教育提高对治疗的反应；生物反馈训练则不然。由于牛奶可能会导致某些儿童便秘，因此可以考虑尝试不喝牛奶。在饮食中添加纤维可以改善便秘。尽管进行了治疗，但只有 50% 至 70% 的功能性便秘儿童表现出长期改善。
Constipation in children usually is functional and the result of stool retention. However, family physicians must be alert for red flags that may indicate the presence of an uncommon but serious organic cause of constipation, such as Hirschsprung's disease (congenital aganglionic megacolon), pseudo-obstruction, spinal cord abnormality, hypothyroidism, diabetes insipidus, cystic fibrosis, gluten enteropathy, or congenital anorectal malformation. Treatment of functional constipation involves disimpaction using oral or rectal medication. Polyethylene glycol is effective and well tolerated, but a number of alternatives are available. After disimpaction, a maintenance program may be required for months to years because relapse of functional constipation is common. Maintenance medications include mineral oil, lactulose, milk of magnesia, polyethylene glycol powder, and sorbitol. Education of the family and, when possible, the child is instrumental in improving functional constipation. Behavioral education improves response to treatment; biofeedback training does not. Because cow's milk may promote constipation in some children, a trial of withholding milk may be considered. Adding fiber to the diet may improve constipation. Despite treatment, only 50 to 70 percent of children with functional constipation demonstrate long-term improvement.