Regarding red flags that suggest an organic cause of constipation, the following are TRUE:

• A. True
• B. False: Onset between 1 and 5 years with withholding behaviour is the characteristic pattern of functional constipation, not a red flag for organic disease.
• C. False: A hairy patch over the spine is a red flag, not reassuring.
• D. True
• E. True

Red flags for an organic cause

Red flags identify the minority of children who need investigation for an organic cause.

The red flags

• Delayed meconium (or onset from birth) - Hirschsprung's.
• Ribbon stools.
• Leg weakness or locomotor delay; abnormal anal appearance or absent anal wink.
• Abdominal distension with vomiting; faltering growth.
• Sacral signs: agenesis, hairy patch, naevi, gluteal asymmetry, scoliosis.

Not a red flag

• Onset between 1 and 5 years with withholding is the typical pattern of functional constipation, not an organic red flag.

Statement-by-statement verdict

Why A is true

Delayed meconium is a red flag.

Why B is false

Onset at 1-5 years with withholding is the typical functional pattern, not an organic red flag.

Why C is false

A hairy patch over the spine is a red flag for a spinal cause, not reassuring.

Why D is true

Ribbon stools are a red flag.

Why E is true

Leg weakness/locomotor delay is a red flag.