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Evaluating the role of the Bristol stool chart in diagnosing functional constipation in pediatric populations

Kriangsak Ounboontham1, Thitima Ngoenmak2

  • 1Department of Pediatrics, Faculty of Medicine, Naresuan University, Mueang 65000, Phitsanulok, Thailand.

World Journal of Clinical Pediatrics
|June 1, 2026
PubMed

Insights

The Bristol Stool Chart (BSC) shows high specificity but low sensitivity for diagnosing functional constipation (FC) in young children. Stool types 1-2 on the BSC can help confirm FC when used with Rome IV criteria.

Area of Science:

  • Pediatrics
  • Gastroenterology
  • Diagnostic Accuracy

Background:

  • Functional constipation (FC) is prevalent in children globally.
  • Rome IV criteria are standard but challenging for infants and toddlers.
  • Bristol Stool Chart (BSC) accuracy in this age group is uncertain.

Purpose of the Study:

  • Compare diagnostic performance of BSC and Rome IV criteria.
  • Evaluate BSC and Rome IV criteria in children under four years.

Main Methods:

  • Prospective cross-sectional study (June-October 2025).
  • Participants: 275 children (6 months-4 years).
  • Validated Thai Rome IV questionnaire and BSC completed by parents; FC diagnosed via Rome IV criteria.

Main Results:

  • 15.6% of children met Rome IV criteria for FC.
  • FC group had higher mean age (30.1 vs 21.2 months).
  • BSC (stool types 1-2) showed 48.8% sensitivity, 98.3% specificity, 84.0% PPV, 91.2% NPV versus Rome IV criteria.

Conclusions:

  • BSC demonstrates high specificity but low sensitivity for FC in young children.
  • Stool types 1-2 on BSC support FC diagnosis.
  • BSC is best used to confirm FC alongside Rome IV criteria.
Abstract

Keywords:
Bristol stool chartChildrenFunctional constipationPediatricPrevalence

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