A 3-Year-Old Child with Constipation Is Brought to the Office

A 3-year-old child with constipation is brought to the office by his parents. Before, the boy had one to two soft stools each day. His bowel motions have, however, diminished over the past three months to one every three to four days, with severe straining and the formation of firm stool balls. The boy's general appetite has not been influenced by his sporadic diffuse stomach pain and increasing agitation. A maternal aunt who has celiac disease and a paternal grandma who has "thyroid difficulties" are significant family members. The youngster and his parents moved into a home that has belonged to their family for many generations four months ago, and now the boy's parents are concerned that the stress of the move may be a factor in his symptoms. Which of the following is the most appropriate diagnostic test for this patient?

A) Anorectal manometry
B) Blood lead level
C) Serum electrolytes
D) Serum thyroid-stimulating hormone
E) Serum tissue transglutaminase

Correct Answer:

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