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Functional Constipation — RACP Paediatrics MCQ

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EasyGastroenterologyFunctional ConstipationRACP Paediatrics

A 3-year-old presents with a 6-month history of constipation with large hard stools every 5–7 days, soiling between bowel motions, and abdominal distension. He has no red flag features. What is the most appropriate initial management?

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Correct answer: D — Disimpaction with PEG 3350 (Movicol) followed by maintenance osmotic laxative

Functional constipation with faecal loading requires initial disimpaction, most commonly achieved with escalating doses of PEG 3350 (Movicol) over 3–7 days, followed by maintenance therapy. The RCH Melbourne guidelines recommend this as first-line management. Dietary modifications alone are insufficient for established constipation with soiling. Rectal treatments should be avoided where possible.

Reference: RCH Melbourne – 2024 – Clinical Practice Guidelines: Constipation