Constipation is a common childhood condition that health professionals will encounter in many different settings. The majority of these cases of childhood constipation are idiopathic in nature. It is considered to exhibit the 'tip of the iceberg' phenomenon as a large number of cases remain undetected due to under-recognition by families, embarrassment regarding the condition, fear of receiving a negative response from health professionals, or parental belief there is actually something more seriously wrong and failure to accept the diagnosis. Prompt evaluation and management is likely to be associated with better outcomes. To ensure this, fast recognition of symptoms, with care taken to exclude any 'red flag' symptoms that could indicate an organic cause and subsequently a different treatment pathway, is essential. Nurses, given their regular contact with families in different settings, are suitably placed to detect these symptoms early and can play a vital role in successful management of the condition. Laxatives are the first line in management of constipation. Polyethylene glycol 3350 is the laxative that evidence-based guidelines from the National Institute for Health and Care Excellence (2010) recommend as the initial pharmacological management. Advice should also be given about supportive measures, including diet and lifestyle changes.

Key Points: 1. Efforts to combat the large global burden of ear and hearing disorders are hampered by poor availability of expert diagnosis 2. We report the first study to directly compare prediction model, non-expert and tele-diagnosis of middle and external ear disorders. 3. A prediction model based upon a novel automated otological symptom questionnaire performed poorly, but absence of otorrhoea was found to reliably exclude a diagnosis of chronic suppurative otitis media. 4. Both on-site non-expert and expert tele-diagnosis had high diagnostic specificity, but low sensitivity. 5. Future work could explore how the validity of these diagnostic methods may be improved. Key Points: 1. Efforts to combat the large global burden of ear and hearing disorders are hampered by poor availability of expert diagnosis 2. We report the first study to directly compare prediction model, non-expert and tele-diagnosis of middle and external ear disorders. 3. A prediction model based upon a novel automated otological symptom questionnaire performed poorly, but absence of otorrhoea was found to reliably exclude a diagnosis of chronic suppurative otitis media. 4. Both on-site non-expert and expert tele-diagnosis had high diagnostic specificity, but low sensitivity. 5. Future work could explore how the validity of these diagnostic methods may be improved.

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