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Evaluation and treatment of functional constipation in infants and children: evidence-based recommendations from
M M Tabbers1, C DiLorenzo, M Y Berger
1Emma Children's Hospital/Academic Medical Center, Amsterdam, The Netherlands.
Insights
This study provides evidence-based guidelines for evaluating and managing pediatric functional constipation. It offers standardized recommendations and algorithms for infants and children to improve care quality.
Area of Science:
- Pediatric Gastroenterology
- Evidence-Based Medicine
Background:
- Functional constipation is a common pediatric issue requiring standardized management.
- The North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition (NASPGHAN) and the European Society for Pediatric Gastroenterology, Hepatology, and Nutrition (ESPGHAN) developed evidence-based guidelines.
Purpose of the Study:
- To create uniform, evidence-based guidelines for the evaluation and management of functional constipation in children.
- To standardize and improve the quality of care for pediatric patients with constipation.
Main Methods:
- Formulated nine clinical questions covering diagnosis, treatment, and prognosis.
- Conducted a systematic literature search (inception-October 2011) across multiple databases (Embase, MEDLINE, Cochrane, PsychInfo).
- Applied the Grading of Recommendations Assessment, Development and Evaluation (GRADE) system and Oxford Centre for Evidence-Based Medicine criteria to assess evidence quality; recommendations finalized through consensus meetings and voting.
Main Results:
- Developed evidence-based recommendations for evaluating and treating pediatric functional constipation.
- Created two distinct algorithms: one for infants under 6 months and another for older infants and children.
Conclusions:
- The guidelines aim to standardize daily practice and serve as a foundation for future research in pediatric constipation.
- Highlights the need for large, well-designed clinical trials for diagnostic evaluation and treatment strategies.
Background:
Constipation is a pediatric problem commonly encountered by many health care workers in primary, secondary, and tertiary care. To assist medical care providers in the evaluation and management of children with functional constipation, the North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition and the European Society for Pediatric Gastroenterology, Hepatology, and Nutrition were charged with the task of developing a uniform document of evidence-based guidelines.
Methods:
Nine clinical questions addressing diagnostic, therapeutic, and prognostic topics were formulated. A systematic literature search was performed from inception to October 2011 using Embase, MEDLINE, the Cochrane Database of Systematic Reviews and Cochrane Central Register of Controlled Clinical Trials, and PsychInfo databases. The approach of the Grading of Recommendations Assessment, Development and Evaluation was applied to evaluate outcomes. For therapeutic questions, quality of evidence was assessed using the Grading of Recommendations, Assessment, Development, and Evaluation system. Grading the quality of evidence for the other questions was performed according to the classification system of the Oxford Centre for Evidence-Based Medicine. During 3 consensus meetings, all recommendations were discussed and finalized. The group members voted on each recommendation, using the nominal voting technique. Expert opinion was used where no randomized controlled trials were available to support the recommendation.
Results:
This evidence-based guideline provides recommendations for the evaluation and treatment of children with functional constipation to standardize and improve their quality of care. In addition, 2 algorithms were developed, one for the infants <6 months of age and the other for older infants and children.
Conclusions:
This document is intended to be used in daily practice and as a basis for further clinical research. Large well-designed clinical trials are necessary with regard to diagnostic evaluation and treatment.
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