Questionnaire/history: < 3 complete stools a week (unless exclusively breastfed, when stools may be infrequent)? Hard, large stool (may block the toilet in children older than 1 year of age)? 'Rabbit droppings' stools? Overflow soiling in children older than 1 year of age? Associated symptoms in a child at any age? Distress or pain on passing stool? Bleeding associated with hard stool? Straining? Associated symptoms in a child at any age? Poor appetite that improves with passage of large stool? Waxing and waning of abdominal pain with passage of stool? 'Retentive posturing' Anal pain? Past Questionnaire/history of constipation? Previous or current anal fissure? Dx of constipation if 2 or more of the above? Dx of faecal impaction if Questionnaire/history of severe symptoms of constipation? Presence of overflow soiling? Faecal mass palpable on abdominal examination? Red flags? Constipation from birth or during the first few weeks of life? Delay in passing meconium for more than 48 h after birth, in a full-term baby? Abdominal distention with vomiting? FH of Hirschsprung's disease? Ribbon stool pattern? Leg weakness or motor delay? Abnormal appearance of the anus? Abnormalities in the lumbosacral and gluteal regions? Amber flags? Faltering growth, developmental delay or concerns about wellbeing? Constipation triggered by the introduction of cows' milk? Concern of possible child maltreatment? Suggestive of idiopathic constipation? Dietary factors? - Changes to infant formula or weaning? - Poor diet? - Insufficient fluid intake? Acute illness? Anal fissure? Drugs? Psychosocial factors? Past medical history? Current medication? - Laxatives? Drug allergies? Examination: Generally well with normal development? Height and weight within normal limits? Normal gait, tone and power in lower limbs? Abdomen (eg soft and flat or distended)? Appearance of the anus and surrounding area? Management Reference(s): NICE CKS: Constipation in children Information for patient/carer(s): NHS Health A to Z: Constipation Patient: Constipation in Children