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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.
Insights
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.
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.
Abstract:
This review intends to update what is known about and what is still a challenge in functional constipation (FC) in children regarding epidemiology, pathophysiology, diagnosis, and management. Although FC is a common childhood problem, its global burden remains unknown as data from parts of the world are missing. Another problem is that there is a large variation in prevalence due to differences in study methods and defining age groups. The pathophysiology of FC remains unclear to date but is probably multifactorial. Withholding behavior is likely to be the most important factor in toddlers and young children. Genetics may also play a role since many patients have positive family history, but mutations in genes associated with FC have not been found. Over the past years, different diagnostic criteria for FC in infants and children have been proposed. This year, Rome IV criteria have been released. Compared to Rome III, it eliminates two diagnostic criteria in children under the age of 4 who still wear diapers. Physical examination and taking a thorough medical history are recommended, but other investigations such as abdominal radiography, transabdominal recto-ultrasonography, colonic transit time, rectal biopsies, and colon manometry are not routinely recommended. Regarding treatment, guidelines recommend disimpaction and maintenance therapy with polyethylene glycol (PEG) with or without electrolytes. But experience shows that acceptability, adherence, and tolerance to PEG are still a challenge. Counseling of parents and children about causes of FC is often neglected. Recent studies suggest that behavior therapy added to laxative therapy improves the relief of symptoms. Further homogeneous studies, better-defined outcomes, and studies conducted in primary care are needed.
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