CONSULT REQUEST GUIDELINES                                                                         Print


Suggested Pre-Referral Evaluation and Management Guidelines
  1. Rectal exam to ensure normal muscle tone, no narrowing, etc.
  2. If no clinical concerns of Hirschprung¿s and palpable stool is felt in the abdomen/rectum, use either of the following options:
    • Miralax: 1.5gm/kg/day x 3 days as a clean-out, then decrease to 1gm/kg/day on following days. Mix 17gm in 8oz water or juice and give whatever dose it takes to have soft, applesauce-consistency stools on a daily basis. (Adjust dose in small amounts every 3-4 days until desired consistency is reached.)
    • Milk of Magnesia, regular concentrate 400mg/5ml. For children <2 years, 0.5ml/kg/dose, 2-5 years 5-15ml/day, 6-11 years 15-30 ml/day, >12 years 30-60ml/day. If using the concentrated (strawberry) flavor, divide the dose in half. Note: This medicine is much more palatable if refrigerated.
  3. Regular toilet-sitting program: recommend sitting for 5 minutes after each meal (3 times/day).
  4. Sticker or reward chart to encourage toilet-sitting and successful stools in the toilet.
  5. High-fiber diet recommendation: age in years +5 = grams/fiber per day with double that amount in ounces of water daily (i.e. 10gms fiber with 20 oz water/day, minimum). Maximum 20-25 grams/fiber/day.

  6. Miralax should be used in addition to regular toilet sitting program for 6 months for the intestines to shrink back to a normal size and for the child to make regular toilet sitting a habit. If after 6 months there are no problems with constipation, slowly decrease dose. Refer to GI after 6-8 weeks of Miralax/toilet-sitting if still having problems, if encopresis continues, or if there is difficulty in regulating the dose of Miralax, and for any other concerns once on Miralax.
Suggested Additional Test/Management Prior to Specialty Visit Constipation Management Guidelines

If soiling continues despite Miralax clean-out and regular toilet-sitting program, could do an abdominal x-ray to assess for continued presence of fecal loading.
Patient Education/Information (includes preps) - Functional Constipation and Soiling in Children
- Functional Constipation and Soiling in Children (Spanish version)
- Bowel Movement Monitoring Sheet
- General Fiber Content List
- Fiber Content in Common Toddler Foods
Appointment Timeframe 3 months, sooner for Nurse Practitioners (typically 1-2 months)
How to Get Results to Consultant UMHS Patients: See MiChart
External Patients: Fax records to 734-763-7359 prior to appointment.
A referral from the primary care physician is required prior to the appointment. Consult for a second opinion requires approval by a staff Pediatric Gastroenterologist. The covering staff physician may be reached by M-line.

It is helpful for us to have records of any prior laboratory studies, x-rays, prior endoscopy reports, other test results, or hospitalizations. Having the child's growth record (obtained from their primary care clinician) is very helpful.
Clinic Contact Information Physicians: 734-763-9650 or M-Line 734-936-3856
Patients: 734-763-9650
Clinic Location Sites C.S. Mott Children’s Hospital
UM Consulting Physician Pediatric Gastroenterology Faculty
Revised on: 10/17/2012



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