Constipation - Paediatric Palliative Care
Description General and supportive measures Medicine treatment ICD-10 code: K59.0 DESCRIPTION The infrequent passage of hard stools. See: Constipation/ Faecal Loading . In palliative care, the most frequent causes are drug related (especially opioids), pain, immobility and neurological impairment (e.g. cerebral palsy). GENERAL AND SUPPORTIVE MEASURES Review medications causing constipation.
General and supportive measures
ICD-10 code: K59.0
DESCRIPTION
The infrequent passage of hard stools. See: Constipation/ Faecal Loading.
In palliative care, the most frequent causes are drug related (especially opioids), pain, immobility and neurological impairment (e.g. cerebral palsy).
GENERAL AND SUPPORTIVE MEASURES
- Review medications causing constipation.
- Ensure adequate intake of fluids and fibre when dietary measures are appropriate.
- Mobilize where possible.
- Consider abdominal massage in bed-bound patients: massage in small clockwise circles in the periumbilical area for small bowel and in Ushaped pattern following the direction of stool in colon.
MEDICINE TREATMENT
See: Constipation/ Faecal Loading.
Laxatives should be used prophylactically in all older children receiving morphine. This is not usually needed in infants and younger children.
In bed-bound patients, sometimes disimpaction is needed with the help of a glycerine suppository or enema. Do not use the rectal route in paediatric oncology patients with neutropenia or thrombocytopenia.
Be wary of peristalsis-inducing laxatives in children, especially those with neurological conditions: this may cause cramping pain and irritability.
- Lactulose, oral, 2.5–10 mL 12 hourly.
OR
- Sorbitol:
- Children 2–11 years: 2 mL/kg, oral, (70% solution) once.
- Children 12 years and older: 30–150 mL, oral, (70% solution) once.
Severe constipation in patients unable to swallow:
- Glycerine (glycerol) suppositories:
- 2 to less than 6 years: 0.891 mL/1.26 g suppository when necessary.
- 6 years and older: 1.698 mL/2.4 g suppository when necessary.
OR
- Phosphate enema (sodium phosphate 6 g, sodium biphosphate 16 g/100 mL):
- 2–5 years: 32 mL.
- 5–11 years: 64 mL.
- Repeat once, if necessary.
OR
- Polyethylene glycol 59 g/L solution with sodium sulphate and electrolytes, oral/naso-gastric tube, 10–25 mL/kg/hour until clear fluid is passed rectally.
Note:
No additional ingredient should be added to the solution, e.g. flavourings or sugar containing cold drinks.
Standard Treatment Guidelines And Essential Medicines List For South Africa, Hospital Level, Paediatrics, 2023 Edition
Chapter: 21. Palliative Care, 21.1 Symptom Control, 21.1.1 Gastro-intestinal Symptoms, 21.1.1.4 Constipation