Background and aims Constipation developing at < 6 months of age (early onset constipation-EOC) is common and distressing for infants and carers. It challenges paediatricians, as it may indicate an uncommon but serious, organic cause, especially Hirschsprung’s disease (HD).
Aims Evaluate the outcome of EOC and role of rectal biopsy.
Methods We reviewed all children diagnosed as EOC between 2008–2013 referred to the Gastroenterology clinic. We analysed 31 case notes and recorded their demographics, investigations and outcome.
Results Of 31 children, 61% female, all caucasian except one mixed race. Age of onset reported as since birth in 61% and 1–5 months in 39%.
14/31 children were referred for rectal biopsy when clinically suspected to have HD. 3 were positive (all preterm) and 1 anteriorly placed anus missed on routine neonatal examination. The need for further investigation was driven by red flag symptoms. Passing meconium was delayed in only 8%.
Children on hydrolysed milk prior to referral reported no benefit. All were treated with 1/2 laxatives and intermittent suppository.
Over 4–12 months 65% fully recovered, (4 underwent surgery) and 13% were controlled with medication.
Conclusion EOC is common and has significant impact on the QoL for infant and carer. No association between delayed meconium and HD was noted.
The importance of vigilance for diagnosing HD especially in pre-terms must be stressed, also educating trainees about abnormally placed anus. Change in hydrolysed formulae may not be an option but support, advice and medication is the key to success.