Evaluation And Treatment Of Functional Constipation In Infants And Children

Publication Date: November 13, 2013
Last Updated: March 14, 2022

Recommendations

Diagnosis

The Rome III criteria are recommended for the definition of functional constipation for all age groups.
6731
The diagnosis of functional constipation is based on history and physical examination.
6731
We recommend using alarm signs and symptoms and diagnostic clues to identify an underlying disease responsible for the constipation.
6731
If only 1 of the Rome III criteria is present and the diagnosis of functional constipation is uncertain, a digital examination of the anorectum is recommended.
6731
In the presence of alarm signs or symptoms or in children with intractable constipation, a digital examination of the anorectum is recommended to exclude underlying medical conditions.
6731
The routine use of an abdominal radiograph has no role to diagnose functional constipation.
6731
A plain abdominal radiography may be used in a child in whom fecal impaction is suspected but in whom physical examination is unreliable/not possible.
6731
Colonic transit studies are not recommended to diagnose functional constipation.
6731
A colonic transit study may be useful to discriminate between functional constipation and functional nonretentive fecal incontinence and in situations in which the diagnosis is not clear.
6731
Rectal ultrasound is not recommended to diagnose functional constipation.
6731
Routine allergy testing to diagnose cow’s-milk allergy is not recommended in children with constipation in the absence of alarm symptoms.
6731
Based on expert opinion, a 2- to 4-week trial of avoidance of CMP may be indicated in the child with intractable constipation.
6731
Routine laboratory testing to screen for hypothyroidism, celiac disease, and hypercalcemia is not recommended in children with constipation in the absence of alarm symptoms.
6731
Based on expert opinion, the main indication to perform ARM in the evaluation of intractable constipation is to assess the presence of the RAIR.
6731
Rectal biopsy is the gold standard for diagnosing HD.
6731
We do not recommend performing barium enema as an initial diagnostic tool for the evaluation of children with constipation.
6731
Colonic manometry may be indicated in patients with intractable constipation before considering surgical intervention.
6731
The routine use of MRI of the spine is not recommended in patients with intractable constipation without other neurologic abnormalities.
6731
We do not recommend obtaining full-thickness colonic biopsies to diagnose colonic neuromuscular disorders in children with intractable constipation.
6731
We do not recommend the routine use of colonic scintigraphy studies in children with intractable constipation.
6731

Treatment

A normal fiber intake is recommended.
6731
We recommend a normal physical activity in children with constipation.
6731
The routine use of prebiotics is not recommended in the treatment of childhood constipation.
6731
The routine use of probiotics is not recommended in the treatment of childhood constipation.
6731
The routine use of an intensive behavioral protocolized therapy program in addition to conventional treatment is not recommended in childhood constipation.
6731
Based on expert opinion, we recommend demystification, explanation, and guidance for toilet training (in children with a developmental age of at least 4 years) in the treatment of childhood constipation.
6731
The use of biofeedback as additional treatment is not recommended in childhood constipation.
6731
We do not recommend the routine use of multidisciplinary treatment in childhood constipation.
6731
We do not recommend the use of alternative treatments in childhood constipation.
6731
PEG with or without electrolytes orally 1 to 1.5 g/kg/day for 3 to 6 days is recommended as the first-line treatment for children presenting with fecal impaction.
6731
An enema once per day for 3 to 6 days is recommended for children with fecal impaction, if PEG is not available.
6731
PEG with or without electrolytes is recommended as the first-line maintenance treatment. A starting dose of 0.4 g/kg/day is recommended, and the dose should be adjusted according to the clinical response.
6731
Addition of enemas to the chronic use of PEG is not recommended.
6731
Lactulose is recommended as the first-line maintenance treatment, if PEG is not available.
6731
Based on expert opinion, the use of milk of magnesia, mineral oil, and stimulant laxatives may be considered as an additional or second-line treatment.
6731
Maintenance treatment should continue for at least 2 months. All symptoms of constipation symptoms should be resolved for at least 1 month before discontinuation of treatment. Treatment should be decreased gradually.
6731
In the developmental stage of toilet training, medication should only be stopped once toilet training is achieved.
6731
The routine use of lubiprostone, linaclotide, and prucalopride in children with intractable constipation is not recommended.
6731
Antegrade enemas are recommended in the treatment of selected children with intractable constipation.
6731
The routine use of TNS is not recommended in children with intractable constipation.
6731
ARM, anorectal manometry; CMP, cow’s-milk protein; HD, Hirschsprung disease; PEG, polyethylene glycol; RAIR, rectoanal-inhibitory reflex; TNS, transcutaneous nerve stimulation.

Recommendation Grading

Overview

Title

Evaluation And Treatment Of Functional Constipation In Infants And Children

Authoring Organization

Consensus and Physician Experts

Publication Month/Year

November 13, 2013

Last Updated Month/Year

June 26, 2023

Supplemental Implementation Tools

Document Type

Consensus

External Publication Status

Published

Country of Publication

US

Inclusion Criteria

Female, Male, Child, Infant

Health Care Settings

Ambulatory

Intended Users

Nurse, nurse practitioner, physician, physician assistant

Scope

Assessment and screening, Management, Treatment

Diseases/Conditions (MeSH)

D003248 - Constipation

Keywords

children, evidence-based medicine, constipation, laxative, guideline, fecal incontinence, encopresis, enema, fecal soiling, functional constipation, infants