A cretin has typical appearance along with delayed milestones which makes diagnosis easy. Treatment would naturally involve hormone supplementation but may also need proper bowel evacuation if the bowel has accumulated large amounts of faecal matter. Habitual constipation is fortunately not commonly encountered in India. It results probably from forced toilet training and the affected child resists evacuating its bowels. A detailed history will suggest the diagnosis, as in a case like this, the onset of complaint would more or less coincide with the timing of toilet training.
Treatment involves the help of a child psychotherapist and a gradual bowel training programme.
Thus it is clear that a large variety of causes are responsible for constipation in infants and children, some of which may be serious and life threatening, warranting careful management and early referral of these children.