Approach to constipation (pediatrics) Quiz: Ace Your Exams
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A 3-year-old boy presents to the pediatrician accompanied by his parents for evaluation of ongoing issues with stooling. Parents report the patient has had difficulty passing stool for the past two months and appears to be straining while having bowel movements. They report, on average, less than two bowel movements per week. When the patient does pass stool, it is “large in diameter” and hurts. He is toilet trained but is refusing to sit on the toilet due to pain with stooling. There are no complaints of abdominal pain and no systemic symptoms. The patient is otherwise healthy and does not take any medications daily. The patient first stooled at 36 hours of life. Vaccinations are up-to-date, and he has received all appropriate pediatric well-childcare. Dietary changes have been implemented, but no other intervention has been tried. Vital signs are within normal limits. Growth and development are appropriate for age. Physical examination demonstrates a well-appearing boy in no acute distress. Abdomen is soft and nontender, there are normoactive bowel sounds, and stool is palpated in the left lower quadrant. Rectal examination does not demonstrate evidence of fissures, hemorrhoids, masses, or fecal impaction. Which of the following is the best next step in management?
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