Functional constipation in children: challenges and solutions

PROPOSALS TO APPROXIMATE THE PEDIATRIC ROME CONSTIPATION CRITERIA TO EVERYDAY PRACTICE

BACKGROUND

Acceptance of the prevailing pediatric Rome constipation criteria, by primary care physician, is still low. Even for research purposes they have not been universally adopted. Thus, it has been indicated that some re-evaluation of these criteria would be welcome.

OBJECTIVE

The authors aimed to look at the timing of diagnosis and the dietary treatment recommendations in the criteria, to make proposals trying to approximate them to everyday practice.

METHODS

The literature cited in the Rome criteria was reviewed and the publications pertinent to the subject, searched by Medline up to January 2018, were included.

RESULTS

An early diagnosis is fundamental to avoid evolution to bothersome complications and possibly to 'intractable' constipation, but the inclusion of two items of the criteria might hamper it. Thus, one constipation sign/symptom should suffice, usually the easily observable 'painful or hard bowel movements'. Details about dietary fiber recommendations are missing in the criteria, although its increase is usually the first approach in primary care, and overall the data about dietary fiber supplements point to beneficial effects.

CONCLUSION

For diagnosis and treatment of pediatric constipation in primary care, one constipation sign/symptom should suffice. The recommended daily dietary fiber intake, according to the American Health Foundation, should be detailed as a treatment measure, and also for prevention, from weaning on.

Constipation Management in Pediatric Primary Care

Constipation is a common and often difficult to manage problem encountered in outpatient primary care. Although we give our patients many different modalities to treat constipation (eg, diet changes, behavior modification, probiotics, medication), there is little evidence to support any of these modalities. We also tend to order unnecessary tests during the diagnostic process. This article tries to clarify the diagnostic process and provide a clear treatment path to be used for functional constipation. [Pediatr Ann. 2018;47(5):e180-e184.].