Constipation

Constipation is one of a number of so-called functional gastrointestinal disorders that are common in infants and children of all ages worldwide.¹  Robin and colleagues ¹ presented data from a study of 1255 infants and children up to 18 years of age that showed that functional constipation was reported in about 12% of infants, about 18% in toddlers, and around 14% in children older than 4 years of age.  More recent data from Europe ²had a lower prevalence of functional constipation in infants at 3%, with the prevalence being about 10% in toddlers.

Interesting Australian data ³ were published in 2014, a report examining hospital admissions of children in Victoria with a primary diagnosis of constipation for a 7 year period from 2002/2003 to 2008/2009.  Constipation was recorded as a primary diagnosis in 8688 admissions, mean length of hospital stay was 4.4 days with an average treatment cost of A$4235.  Further interesting data were reported by Hinds and colleagues ⁴ that showed that in their survey of interactions between retail pharmacists and families of infants concerned about functional gastrointestinal disorders, conversations about constipation occurred at least once a week in 85% of those pharmacists surveyed.

Updated diagnostic criteria and guidelines relating to clinical evaluation and treatment for a number of functional gastrointestinal disorders in neonates and toddlers were published in 2016.⁵  In this publication, diagnostic criteria, clinical evaluation guidelines, and treatment recommendations are given separately for infant dyschezia and functional constipation.  For infant dyschezia, the publication states the child’s caregivers require effective reassurance to address their concerns that their child is in pain and that there is no pathologic disease process that requires intervention in their infant.  Parents usually accept the explanation that the child needs to learn to relax the pelvic floor at the same time as bearing down.  To encourage the infant’s defecation learning, the caregivers are advised to avoid rectal stimulation, which produces artificial sensory experiences that might be noxious, or that might condition the child to wait for stimulation before defecating. Laxatives are unnecessary.

For functional constipation, the authors point out that extensive recent evidence-based recommendations for the treatment of functional constipation have been made by the European Society of Pediatric Gastroenterology Hepatology and Nutrition/ NASPGHAN.⁶ These recommendations should read in detail however the authors point out that treatments that soften stools and assure painless defecation are an important part of the treatment.

Guidelines and recommendations that have been distilled from the international literature can also often be found via Royal Children’s Hospital websites.⁷

1. Robin SG et al, Prevalence of pediatric functional gastrointestinal disorders utilizing the Rome IV Criteria. J. Peds. 2018. N195. 134-139.
2. Steutel NF et al, Prevalence of functional gastrointestinal disorders in European infants in toddlers. J. Peds. 2020. 221. 107-114.
3. Ansari H et al, Factors relating to hospitalization and economic burden of paediatric constipation in the state of Victoria, Australia 2002-2009. J. Peds Child Health. 2014. 50. 993-999.
4. Hinds R et al, Functional gastrointestinal disorders in infants: Practice, knowledge and needs of Australian pharmacists. J. Peds. Child Health. 2020. 56. 1769-1773.
5. Benninga MA, Childhood functional gastrointestinal disorders: Neonate/toddler. Gastroenterology. 2016. 150. 1443-1445.
6. Tabbers MM et al, Evaluation and treatment of functional constipation in infants and children: evidence-based recommendations from ESPGHAN and NASPGHAN. J. Pediatr. Gastroenterol. Nutr. 2014. 58: 265-281.
7. https://www.rch.org.au/clinicalguide/guideline_index/Constipation/