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Chronic childhood constipation: a review of the literature and the introduction of a protocolized behavioral
Marieke van Dijk1, Marc A Benninga, Martha A Grootenhuis
1Psychosocial Department, Emma Children's Hospital, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands. m.vandijk@amc.uva.nl
Insights
This study introduces a new behavioral intervention program for children aged 4-18 with chronic constipation. The program is based on literature and provides a theoretical framework for evaluating treatment effectiveness.
Area of Science:
- Pediatric Gastroenterology
- Child Psychology
- Behavioral Medicine
Background:
- Chronic constipation is a common issue in children, impacting their quality of life.
- Existing treatment approaches often lack a standardized, theory-based behavioral component.
- A need exists for a structured intervention addressing the psychological and behavioral aspects of childhood constipation.
Purpose of the Study:
- To present a newly protocolized behavioral intervention program for children (aged 4-18) suffering from chronic constipation.
- To ground the intervention techniques in established theoretical frameworks from existing literature.
- To offer a transparent description of the program for clinical and research application.
Main Methods:
- A comprehensive literature search was conducted using Medline, PsychInfo, and Picarta databases up to July 2006.
- Keywords included terms related to constipation, encopresis, behavioral interventions, and psychosocial factors in children.
- Seventy-one relevant articles were critically reviewed to extract key constructs for the intervention program.
Main Results:
- A detailed protocol for a behavioral intervention program for chronic childhood constipation is described.
- The program integrates theoretical underpinnings with practical treatment techniques.
- The review categorized 71 articles covering epidemiology, etiology, treatment, and outcomes of childhood constipation.
Conclusions:
- This work presents the first comprehensive and transparent description of a behavioral intervention program for childhood constipation, supported by a theoretical framework.
- The program and framework can guide clinical practice and serve as a paradigm for evaluating intervention effectiveness through RCTs and qualitative research.
- This initiative aims to improve the implementation of effective treatments for chronic constipation in children.
Objective:
To release a newly protocolized behavioral intervention program for children with chronic constipation aged 4-18 years with guidance from literature about underlying theories from which the treatment techniques follow.
Methods:
Articles until July 2006 were identified through electronic searches in Medline, PsychInfo and Picarta. There was no limit placed on the time periods searched. Following keywords were used: constipation, encopresis, fecal incontinence, psychotherapy, emotions, randomized controlled trials, parent-child relations, parents, family, psychology, behavioral, behavioral problems, psychopathology, toilet, social, psychosocial, pain, retentive posturing, stool withholding, stool toileting refusal, shame, stress, anxiety. A filter was used to select literature referring to children 0-18 years old. Key constructs and content of sessions for a protocolized behavioral intervention program are derived from literature.
Results:
Seventy-one articles on chronic childhood constipation are critically reviewed and categorized into sections on epidemiology, symptomatology, etiology and consequences, treatment and effectivity, and follow-up on chronic childhood constipation. This is followed by an extensive description of our protocolized behavioral intervention program.
Conclusion:
This is the first article on childhood constipation presenting a full and transparent description of a behavioral intervention program embedded in literature. In addition, a theoretical framework is provided that can serve as a trial paradigm to evaluate intervention effectiveness.
Practice Implications:
This article can serve as an extensive guideline in routine practice to treat chronically constipated children. By releasing our protocolized behavioral intervention program and by offering a theoretical framework we expect to provide a good opportunity to evaluate clinical effectivity by both randomized controlled trials and qualitative research methods. Findings will contribute to the implementation of an effective treatment for chronic constipation in childhood.
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