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Published on: July 5, 2024
Practice patterns of pediatricians and trainees for the management of functional constipation compared with 2006
Christine H Yang1, Jaya Punati
1Children's Hospital Los Angeles, Los Angeles, CA.
Insights
Pediatricians often lack familiarity with functional constipation guidelines, leading to varied treatment approaches. Education on medication use and guideline adherence is crucial for effective pediatric constipation management.
Area of Science:
- Pediatric Gastroenterology
- Clinical Practice Guidelines
- Medical Education
Background:
- The North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition (NASPGHAN) established guidelines for managing functional constipation.
- No studies have assessed pediatrician adherence to the revised 2006 NASPGHAN constipation guidelines.
- Understanding current pediatrician practices is essential for improving pediatric constipation care.
Purpose of the Study:
- To evaluate how pediatricians approach functional constipation management.
- To determine the extent of adherence to established pediatric constipation guidelines.
Main Methods:
- An anonymous multiple-choice questionnaire was developed by pediatric gastroenterologists and general pediatricians.
- The survey was distributed to pediatricians and residents across 7 academic institutions and the AAP mailing list.
- 1202 responses were collected from trainees and attending physicians.
Main Results:
- A significant majority (84.3%) of respondents were unfamiliar or only slightly familiar with the guidelines.
- Common initial interventions included fluids, fiber, and behavioral changes, with variations based on fecal incontinence.
- Osmotic laxatives were widely used, but concerns about stimulant laxative safety were prevalent.
Conclusions:
- There is a clear need for enhanced education on functional constipation management for pediatricians.
- Key areas for education include medication efficacy, the importance of disimpaction, and addressing misconceptions about laxative side effects.
- Improving guideline awareness and application can optimize treatment outcomes for children with functional constipation.
Objectives:
The North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition has formulated guidelines for managing functional constipation. There have been no studies that have investigated how pediatricians apply the constipation guideline since it was revised in 2006. The purpose of this study was to examine how pediatricians approach functional constipation and how closely their approaches adhere to the guidelines.
Methods:
An anonymous multiple-choice questionnaire was developed by general pediatricians and pediatric gastroenterologists. This was distributed to pediatricians and pediatric residents at 7 academic institutions, and to the American Academy of Pediatrics section on medical students, residents, and fellowship trainees mailing list.
Results:
A total of 1202 responses were received (952 trainees, 250 attendings). Of these, 84.3% reported being unfamiliar/slightly familiar with the guidelines. The most common initial interventions for constipation without fecal incontinence included fluids (92.1%), fiber (89.5%), juice (77.7%), behavioral interventions (71.2%), follow-up (53.4%), and reducing constipating foods (50.1%). The most common initial interventions for constipation with fecal incontinence included bowel cleanout (73.4%), maintenance medication (70.0%), fluids (67.9%), behavioral interventions (67.6%), fiber (66.1%), and follow-up (57.8%). Osmotics were the most commonly prescribed as needed (83.0%) and maintenance medications (96.8%), with stimulants prescribed PRN by 35.6% and as maintenance by 16.8%. Some individuals (39.7%) reported concern that osmotics could result in dependence, addiction, or electrolyte imbalances, compared with 73.0% for stimulants.
Conclusions:
Our results show that more education regarding medication in functional constipation is necessary, including the use of medication reducing time to remission, the necessity of disimpaction, and misconceptions regarding adverse effects.
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