Quality statement 1: Assessment

Quality statement

Children and young people with constipation receive a full assessment before a diagnosis of idiopathic constipation is made.

Rationale

Children and young people with constipation can present to different types of healthcare professionals in primary, community and secondary care. Once constipation in children and young people has been recognised it is important to ensure that underlying causes of constipation and 'red flag' symptoms are excluded. A diagnosis of idiopathic constipation, in which the constipation cannot be explained by anatomical or physiological abnormalities, can only be made through a full assessment, including detailed history-taking and a physical examination by a healthcare professional.

Quality measures

Structure

Evidence of local arrangements to ensure that children and young people with constipation receive a full assessment before a diagnosis of idiopathic constipation is made.

Data source: Local data collection.

Process

Proportion of children and young people with constipation who receive a full assessment.

Numerator – the number in the denominator who receive a full assessment.

Denominator – the number of children and young people with constipation.

Data source: Local data collection. NICE Constipation in children and young people: audit support tool, criteria 1, 2, 5 and 7.

What the quality statement means for service providers, healthcare professionals and commissioners

Service providers ensure that staff are trained to perform a full assessment (including detailed history-taking and physical examination to exclude 'red flag' symptoms) for children and young people with constipation before making a diagnosis of idiopathic constipation.

Healthcare professionals perform a full assessment for children and young people with constipation (including detailed history-taking and physical examination to exclude 'red flag' symptoms) before making a diagnosis of idiopathic constipation.

Commissioners ensure that they commission services from providers whose staff perform a full assessment (including detailed history-taking and physical examination to exclude 'red flag' symptoms) for children and young people with constipation before making a diagnosis of idiopathic constipation.

What the quality statement means for patients, service users and carers

Children and young people with constipation have a detailed assessment, which includes asking about their symptoms and other problems, and a physical examination. This will help to check that the constipation is not caused by anything serious.

Source guidance

  • Constipation in children and young people (NICE clinical guideline 99), recommendation 1.1.2 (key priority for implementation) and 1.1.3 (key priority for implementation).

Definitions of terms used in this quality statement

Full assessment

A combination of history-taking and physical examination should be used to diagnose idiopathic constipation. Key components of assessment can be found in tables 1–3 in NICE clinical guideline 99.

A positive diagnosis of idiopathic constipation can be established by excluding underlying causes. If a child or young person has any 'red flag' symptoms identified from history-taking or physical examination, do not treat them for constipation. Instead, refer them urgently to a healthcare professional with experience in the area of concern.

'Red flag' findings and diagnostic clues that indicate an underlying disorder or condition (not idiopathic constipation) are detailed in full in table 2 of NICE clinical guideline 99 for history-taking and in table 3 for physical examination.

Assessment can be undertaken by healthcare professionals such as GPs, school nurses, health visitors, practice nurses, continence advisors and paediatricians. [NICE clinical guideline 99 and expert opinion]

Idiopathic constipation

Constipation that cannot (currently) be explained by any anatomical, physiological, radiological or histological abnormalities. [NICE clinical guideline 99, Introduction]

Equality and diversity considerations

Certain groups of children and young people are more prone to idiopathic constipation than others, such as those with Down's syndrome or autism, and some children and young people with physical disabilities, such as cerebral palsy. There is also a higher prevalence of idiopathic constipation in children and young people in local authority care. These children and young people may have additional needs that should be considered when assessing them for idiopathic constipation.