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The frequency of constipation in children with nocturnal enuresis: a comparison with parental reporting
Kathleen H McGrath1, Patrina H Y Caldwell, Michael P Jones
1Graduate Medical Program, University of Sydney, The Children's Hospital at Westmead Clinical School, Westmead, New South Wales, Australia.
Insights
Constipation is common in children with nocturnal enuresis, with clinicians identifying it more often than parents. This difference in recognition may affect diagnosis and treatment.
Area of Science:
- Pediatric Gastroenterology
- Urology
- Child Health
Background:
- Nocturnal enuresis (bedwetting) is a common pediatric condition.
- Constipation is a potential contributing factor to nocturnal enuresis.
- Accurate identification of constipation is crucial for effective management.
Purpose of the Study:
- To determine the prevalence of constipation in children with nocturnal enuresis.
- To evaluate the accuracy of parental and clinician recognition of constipation in this population.
Main Methods:
- Prospective cross-sectional study of 277 children with nocturnal enuresis.
- Data collected via parental questionnaires and pediatrician assessments.
- Constipation assessed by parents and clinicians using standardized criteria.
Main Results:
- Clinicians identified constipation in 36.1% of children, while parents reported it in only 14.1%.
- Agreement between parent and clinician assessment was low for constipation (Kappa = 0.155).
- Parental reporting was influenced by bowel movement frequency and soiling, with less emphasis on stool consistency.
Conclusions:
- Constipation is highly prevalent in children with nocturnal enuresis.
- There is a significant under-recognition of constipation by parents compared to clinicians.
- Improved parental and clinician awareness is needed for optimal diagnosis and management of nocturnal enuresis.
Aims:
To identify the prevalence of constipation in children with nocturnal enuresis presenting to a tertiary paediatric outpatient service and to assess parental and clinician recognition of constipation.
Methods:
A prospective cross-sectional study of children with nocturnal enuresis at presentation to a continence service. Data relating to the child's bowel habits, pattern of enuresis and other history items were obtained from parental questionnaires and paediatrician assessments. Presence and severity of constipation was assessed independently by parents and clinicians. Kappa was used to compare agreement between parental reporting and clinician assessment of constipation.
Results:
Of the 277 participants aged 4.8-17.5 years (median 8.6 years), 36.1% (n = 95) were identified as constipated by the clinician-based scoring method ('Constipation Score') compared with 14.1% from parental reporting (Kappa = 0.155, P = 0.003). Despite the poor overall recognition of constipation by parents, parental and clinician assessment of frequency of bowel motions (Kappa = 0.804) and soiling (Kappa = 0.384) were similar. Major factors influencing parental reporting of constipation were frequency of bowel motions and soiling with less emphasis on straining and stool consistency.
Conclusions:
Prevalence of constipation was high among children with nocturnal enuresis as assessed by clinicians despite poor identification by parents. This may limit optimal diagnosis and management.
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