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Chronic constipation with impaction — RACP Paediatrics MCQ

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EasyGIChronic constipation with impactionRACP Paediatrics

A 3-year-old presents with chronic constipation and soiling. Abdominal examination reveals a palpable faecal mass. The child is passing large hard stools every 5-7 days with pain. What is the most appropriate first-line management?

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Correct answer: E — Oral macrogol (polyethylene glycol)

Oral macrogol (PEG 3350, e.g., Movicol) is the first-line treatment for faecal impaction and chronic constipation in children. A disimpaction regimen with escalating doses is recommended initially, followed by maintenance dosing. It is superior to lactulose for disimpaction.

Reference: RCH Melbourne – 2023 – Constipation CPG; Australian Therapeutic Guidelines – 2024 – GI