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Functional constipation in children: challenges and solutions.

Elvira Ingrid Levy1, Roel Lemmens1, Yvan Vandenplas1

  • 1Kidz Health Castle, UZ Brussel, Vrije Universiteit Brussel, Brussels, Belgium.

Pediatric Health, Medicine and Therapeutics
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Summary

Functional constipation (FC) in children presents challenges in understanding its global prevalence and multifactorial causes. While new diagnostic criteria exist, effective management requires addressing adherence issues and integrating behavioral therapies alongside laxatives.

Keywords:
childrendiagnosticsepidemiologyfunctional constipationpathophysiologyrecurrent abdominal paintreatment

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Area of Science:

  • Pediatric Gastroenterology
  • Clinical Pediatrics
  • Digestive Health

Background:

  • Functional constipation (FC) is a prevalent pediatric condition with an incompletely understood global burden and variable prevalence rates.
  • The pathophysiology of pediatric FC is likely multifactorial, with withholding behavior and potential genetic factors implicated.
  • Existing diagnostic criteria, including the newly released Rome IV criteria, continue to evolve for infants and children.

Purpose of the Study:

  • To provide an updated review of functional constipation in children, covering epidemiology, pathophysiology, diagnosis, and management.
  • To highlight current challenges and knowledge gaps in the field of pediatric functional constipation.
  • To discuss recent advancements and future research directions for FC in pediatric populations.

Main Methods:

  • Systematic review of current literature on pediatric functional constipation.
  • Analysis of epidemiological data, diagnostic criteria (Rome IV), and pathophysiological factors.
  • Evaluation of current management strategies, including disimpaction, laxative therapy (polyethylene glycol), and behavioral interventions.

Main Results:

  • Global prevalence data for pediatric FC are incomplete, with significant variations reported.
  • Rome IV criteria offer updated diagnostic guidelines for children, particularly those under four.
  • Polyethylene glycol (PEG) is recommended for maintenance therapy, but adherence and tolerance remain challenges; behavior therapy shows promise when combined with laxatives.

Conclusions:

  • Despite advances, significant challenges persist in the epidemiology, pathophysiology, and management of pediatric functional constipation.
  • Improved diagnostic consistency, better understanding of multifactorial causes, and enhanced treatment adherence are crucial.
  • Further research, including homogeneous studies in primary care settings, is needed to refine management strategies and improve patient outcomes.