Constipation in the Critically Ill Child: Frequency and Related Factors

J Pediatr. 2015 Oct;167(4):857-861.e1. doi: 10.1016/j.jpeds.2015.06.046. Epub 2015 Aug 5.


Objective: To analyze the incidence and factors associated with constipation in critically ill children.

Study design: We performed a prospective observational study that included children admitted to the pediatric intensive care unit for more than 3 days. Constipation was defined as more than 3 days without a bowel movement. Relationships between constipation and demographic data; clinical severity score; use of mechanical ventilation, use of vasoconstrictors, sedatives, and muscle relaxants; nutritional data; electrolyte disturbances; and clinical course were analyzed.

Results: Constipation developed in 46.7% of the 150 patients studied (mean age, 34.3 ± 7.1 months). It was most common in postoperative, older, and higher-body-weight patients, and in those with fecal continence (P < .01). Compared with patients without constipation, patients with constipation had higher severity scores and more frequently received midazolam, fentanyl, muscle relaxants, and inotropic support (P < .05). Patients with constipation also started nutrition later and with a lower volume of nutrition (P < .01). There were no between-group differences in mortality or length of pediatric intensive care unit stay. In multivariate analysis, independent factors associated with constipation were body weight (OR, 1.08; 95% CI, 1.03-1.13), Pediatric Index of Mortality 2 score (OR, 1.05; 95% CI, 1.02-1.09), admission after surgery (OR, 7.64; 95% CI, 2.56-22.81), and treatment with vasoconstrictors (OR, 10.28; 95% CI, 3.53-29.93).

Conclusion: Constipation is common in critically ill children. Body weight, Pediatric Index of Mortality 2 clinical severity score, admission after surgery, and the need for vasoconstrictor therapy are major independent risk factors associated with constipation.

Publication types

  • Observational Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Body Weight
  • Child
  • Child, Preschool
  • Constipation / etiology*
  • Critical Illness
  • Electrolytes
  • Female
  • Hospitalization
  • Humans
  • Hypnotics and Sedatives / adverse effects
  • Infant
  • Intensive Care Units, Pediatric
  • Male
  • Muscle Relaxants, Central / adverse effects
  • Prospective Studies
  • Regression Analysis
  • Respiration, Artificial / adverse effects
  • Risk Factors
  • Vasoconstrictor Agents / adverse effects


  • Electrolytes
  • Hypnotics and Sedatives
  • Muscle Relaxants, Central
  • Vasoconstrictor Agents