Constipation is a frequent reason for consulting a pediatrician. As a symptom, constipation can be due to various etiologies in terms of frequency, nature and seriousness. Constipation may be of medical or surgical origin or idiopathic. Surgical etiologies are mainly represented by Hirschsprung’s disease. It is the main differential diagnosis even if it is 50 times less frequent than idiopathic or functional constipation. A thorough history and physical examination, including anal examination, are the best way to reach a diagnosis. No other examination is required in most of the cases and all investigations have to be managed according to clinical considerations.

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