Functional constipation in children: challenges and solutions.


eMediNexus    04 July 2018

A new article published in Pediatric Health, Medicine and Therapeutics was based on a review which intended to update what is known about the challenges in functional constipation (FC) in children, with regard to epidemiology, pathophysiology, diagnosis, and management. The authors discussed, despite being a common childhood problem the global burden of FC remains unknown. While there is a large variation in its prevalence due to differences in study methods and defining age groups. The pathophysiology of FC remains unclear, but is said to be multifactorial. It was stated that withholding behavior may be the most important factor in toddlers and young children. In addition, genetics may play a role since many patients have positive family history. It was reported that over the past years, different diagnostic criteria for FC in infants and children have been proposed. When compared to the Rome III criteria, the Rome IV criteria eliminates two diagnostic features in children under the age of 4 years who still wear diapers. For children with FC, physical examination and taking a thorough medical history are recommended in routine practice, rather than investigations, such as abdominal radiography, transabdominal recto-ultrasonography, colonic transit time, rectal biopsies, and colon manometry. Treatment, guidelines recommend disimpaction and maintenance therapy with polyethylene glycol (PEG) with or without electrolytes. It was stated that behavior therapy added to laxative therapy improves the relief of symptoms. However, counseling of parents and children about causes of FC is often neglected.

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