Bergeson has provided an excellent discussion of constipation in infants and children. Although usually a short-lived problem, constipation may cause significant distress to the child and family. As mentioned in the article, parents often initially seek advice from family and friends. When the issue is finally brought to the attention of a primary care physician, he or she should consider it serious and follow it through to resolution. A persistent problem may result if management of an acute problem is inadequate.
Thorough evaluation is warranted when an infant has difficulty passing stool.
Often, anal and digital rectal examinations allow definition of the problem. If Hirschsprung's disease is suspected, a radiologist experienced in examining children should perform a barium enema study of the unprepared bowel. In an older child in whom soiling is occurring, use of dietary measures and stool softeners alone is inadequate. Because families often find repeated discussion of the problem embarrassing, time should be scheduled for a session in which the four components discussed by Dr Bergeson can be reviewed before the bowel program's initiation. Failure of the program is largely related to poor compliance.