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Diagnosis and management of functional constipation in children over 6 months of age.

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eMediNexus    19 July 2018

A new study published in the World Journal of Clinical Pediatrics assessed the knowledge of general pediatricians about the diagnosis and treatment of childhood constipation. This study entailed distribution of a comprehensive questionnaire among 100 general pediatricians practicing in hospitals of 20 cities in Indonesia. The results of the survey was summarized as follows: a child should be evaluated for the presence of constipation when he or she is over 6 months of age and presents with a decreased frequency of bowel movements with a mean of one bowel movement per 3.59 ± 1.0 d, hard stools, blood in the stools, fecal incontinence, and/or difficulty in defecating. A majority of pediatricians prefer nonpharmacological treatment as the first-line approach in the management of childhood constipation. Among the participants, 96% preferred a high-fiber diet, 90% advised increased fluid intake, 74% recommended appropriate toilet training, and 49% prescribed abdominal massage. Usually, the duration of non-pharmacological treatment was limited to 1-2 weeks. However, only 15% of pediatricians who recommended toilet training could explain its techniques completely and correctly. Meanwhile, only 51% of the participants prescribed rectal treatment for fecal impaction. Sixty-nine percent of these pediatricians expected a positive response during the first week; most of them would treat during one month or even less and treatment was often discontinued once the frequency and/or consistency of the stools become normal. Thus, it was stated that the existing guidelines should be reinforced among general pediatricians.

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