Background Constipation is common in childhood with UK prevalence ranging between 5–30%. Consequently, inpatient data statistics showed that 79% of children with constipation are admitted through emergency admission. Functional constipation is a clinical diagnosis using history and clinical examination. The national institute for health and care excellence (NICE) and our local trust guidelines clearly state that abdominal x-rays (AXR) should not be used in the diagnosis of constipation unless by specialist services.

Objectives To assess the number of children with constipation presenting to the Paediatric Emergency department(PED) who had Abdominal X-ray(AXR) against recommended guidelines, time spent by these patients in paediatric emergency department, patient flow, the cost of having the AXR and the amount of radiation exposure.

Methods A retrospective review of electronic notes of patients under the age of 16 who had a diagnosis of constipation was conducted over a 3 month period from 1 September 2019 to 30 November 2019.

Results 67 cases were identified.

28% (19) of the 67 children had AXR. Only 1 of the 19 patients who had imaging was admitted. The rest were discharged with no change in management.

The average time spent in the Emergency Department for those who had AXR was 3.92 hours compared to 2.62 hours (P Value 0.008) in children who had no imaging.

The estimated avoidable cost for the AXR was £2000 over a 3 month period (£100/AXR) with a total avoidable radiation of 0.03–0.11 mSv/AXR.

Conclusions Abdominal X-rays are still performed in children presenting to our PED with constipation despite our guideline recommendations against doing so. Performing X-rays in these children led to longer time spent in the department, increased cost and unnecessary radiation exposure without influencing change in management plan or need for admission. We recommend adhering to the national and local guidelines and avoid AXR where necessary.