Approach to constipation (pediatrics) Quiz: Ace Your Exams

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A 16-year-old boy presents to the pediatrician with his parents for evaluation of several months of worsening constipation and fatigue. The patient has tried limiting dairy and increasing fruit and fiber in his diet. Over-the-counter laxatives were also tried with minimal improvement in symptoms. The patient reports intermittent abdominal pain and vomiting. Vaccinations are up-to-date, and he has received all age-appropriate well-childcare. Weight is 8^th percentile and height is 12^th percentile. Vital signs are within normal limits. 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. There is an itchy papular vesicular rash on the extensor surfaces of the patient’s knees. Which of the following would likely be present on further questioning?

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Family history of neurologic disease

Exposure to a home built in 1956 in the United States

Cold intolerance

History of delayed passage of meconium

Sensitivity to gluten