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Komeno Y, Kuchiki T, Onodera Y, Machida S. Defecation Habits in Preschoolers Are Associated with Physical Activity: A Cross-Sectional and Isotemporal Substitution Analysis. CHILDREN (BASEL, SWITZERLAND) 2023; 10:951. [PMID: 37371183 DOI: 10.3390/children10060951] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Revised: 05/23/2023] [Accepted: 05/23/2023] [Indexed: 06/29/2023]
Abstract
There is a lack of research on the relationship between defecation habits (DF) and physical activity (PA) in preschoolers. This study aimed to clarify the relationship between sedentary behaviour (SB), PA time, and DF in preschoolers and to estimate the effect of DF replacement in an isotemporal substitution (IS) model. The participants included 166 children (aged 4-6 years) attending childcare facilities. PA was measured using an accelerometer to calculate the daily activity and wearing time for SB, light-intensity physical activity (LPA), and moderate-to-vigorous-intensity physical activity (MVPA). DF were classified based on defecation frequency and timing. A multinomial logistic regression analysis was used for the IS model. One-way analysis of variance detected significant differences in MVPA between the DF groups (F(2) = 3.12, p < 0.05). According to the analysis results of the IS model, replacing 5 min of SB with MVPA resulted in improved DF (odds ratio [OR], 0.89; 95% confidence interval [CI], 0.81-0.97). Conversely, replacing 5 min of MVPA with SB worsened DF (OR, 1.13; 95% CI, 1.03-1.23). The findings suggest that PA is associated with DF among preschoolers. It also indicates that replacing SB with MVPA could help improve DF in children.
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Affiliation(s)
- Yoshinori Komeno
- Faculty of Health Science, Hyogo University, 2301 Hiraokacho Shinzaike, Kakogawa 675-0195, Hyogo, Japan
- Graduate School of Health and Sports Science, Juntendo University, 1-1 Hiraka-gakuendai, Inzai 270-1695, Chiba, Japan
| | - Tsutomu Kuchiki
- Faculty of Health Science, Hyogo University, 2301 Hiraokacho Shinzaike, Kakogawa 675-0195, Hyogo, Japan
| | - Yumiko Onodera
- Faculty of Sports Sciences, Tokyo Women's College of Physical Education, 4-30-1 Fujimidai, Kunitachi 186-8668, Tokyo, Japan
| | - Shuichi Machida
- Graduate School of Health and Sports Science, Juntendo University, 1-1 Hiraka-gakuendai, Inzai 270-1695, Chiba, Japan
- Institute of Health and Sports Science & Medicine, Juntendo University, 1-1 Hiraka-gakuendai, Inzai 270-1695, Chiba, Japan
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Xu Y, Xu H, Wang X, Wen H, Guan H, Gao F, Xu H, Jing W, Li J, Mei Y, Li W, Chen Q, Liu F, Cui H. Network-Based Elaboration of the Efficacy of the Dachangshu (BL25) and Tianshu (ST25) Points in the Treatment of Functional Constipation in Children through Inflammation, Adipocytokine, or Leptin Pathways. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE : ECAM 2022; 2022:5315927. [PMID: 36523422 PMCID: PMC9747304 DOI: 10.1155/2022/5315927] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Revised: 08/04/2022] [Accepted: 09/08/2022] [Indexed: 10/10/2023]
Abstract
Constipation commonly occurs during childhood, and more than 95% of cases are classified as functional constipation. If not effectively treated, 20% of patients with childhood constipation can continue to exhibit symptoms into adulthood, which seriously affects their mental health and quality of life. The main feature of acupuncture or acupoint stimulation, a special branch of traditional Chinese medicine, is the selection of different acupoints for different diseases, and many worthy guidelines have been established for matching acupoints. The back-shu and front-mu point combination adheres to an important acupoint compatibility law that has been used since its proposal 2,500 years ago but has not yet been verified by the modern evidence-based experiments. This study focused on the back-shu and front-mu point combination using the Dachangshu (BL25) and Tianshu (ST25) points as examples to explore possible research methods for network acupoint-based stimulation based on existing evidence and to elucidate the mechanisms induced by BL25 and ST25 in the treatment of functional constipation in children (FCC). The study found that BL25 and ST25 have 20 common targets, namely, AQP8, DRD2, VIP, TAC1, IL6R, TNF, FOS, KIT, CHAT, HTR3A, GAS8, SOD3, TRPV1, MPO, CALCA, IL1B, P2RX7, NPY2R, IL10RA, and TPH1, and these targets may provide a strategy for the combined usage of BL25 and ST25. In addition, BL25 and ST25 can affect FCC treatment through inflammation-relatedTh17-cell differentiation, the NF-kappa B signaling pathway, and the Toll-like receptor signaling pathway. Adipocytokines or leptin may also comprise the mechanism through which BL25 and ST25 regulate FCC. In addition, BL25 and ST25 regulate FCC through 13 core targets, namely, NFKBIA, RELA, TNF, IKBKB, IRAK1, TLR4, MYD88, TNFRSF1A, IL1R1, TLR2, IL1B, TRAF6, and TNFRSF1B. In short, this study provides new ideas and methods for studying the mechanism of acupuncture points.
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Affiliation(s)
- Yan Xu
- School of Pediatrics, Henan University of Chinese Medicine, Zhengzhou, Henan 450000, China
- The First Affiliated Hospital of Henan University of Chinese Medicine, Zhengzhou, Henan 450000, China
| | - Hanying Xu
- Changchun University of Chinese Medicine, Changchun, Jilin 130117, China
| | - Xinna Wang
- Changchun University of Chinese Medicine, Changchun, Jilin 130117, China
| | - Hongjuan Wen
- Changchun University of Chinese Medicine, Changchun, Jilin 130117, China
| | - Huifang Guan
- Changchun University of Chinese Medicine, Changchun, Jilin 130117, China
| | - Fa Gao
- Changchun University of Chinese Medicine, Changchun, Jilin 130117, China
| | - Hang Xu
- Changchun University of Chinese Medicine, Changchun, Jilin 130117, China
| | - Wei Jing
- Changchun University of Chinese Medicine, Changchun, Jilin 130117, China
| | - Jing Li
- Changchun University of Chinese Medicine, Changchun, Jilin 130117, China
| | - Yan Mei
- Chongqing Hospital Of Traditional Chinese Medicine, Chongqing 400021, China
| | - Weibin Li
- Chongqing Hospital Of Traditional Chinese Medicine, Chongqing 400021, China
| | - Qixiong Chen
- Chongqing Hospital Of Traditional Chinese Medicine, Chongqing 400021, China
| | - Fang Liu
- Chongqing Hospital Of Traditional Chinese Medicine, Chongqing 400021, China
| | - Hongtao Cui
- Chongqing Hospital Of Traditional Chinese Medicine, Chongqing 400021, China
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Niu Y, Liu T, Ran N, Li K, Sun Y, Wang X, Guo K, Yang X. Relationship between family-related factors and functional constipation among Chinese preschoolers: a case–control study. BMC Pediatr 2022; 22:460. [PMID: 35909122 PMCID: PMC9341050 DOI: 10.1186/s12887-022-03521-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Accepted: 07/26/2022] [Indexed: 11/30/2022] Open
Abstract
Background Constipation is one of the common symptoms in childhood. The prevalence of FC is about 0.5% to 32% and still on the rise according to global statistics. The aim of this study is to explore the associations between family-related factors (e.g., parental conflict, parenting style, and parent–child relationship) and functional constipation of preschool children based on family system theory. Methods The study is a case–control survey of preschoolers in China. In total, 108 preschoolers with functional constipation diagnosed with pediatric Rome IV criteria and 324 healthy examination preschoolers without functional constipation were enrolled in the study. Parents completed the following 5 instruments: General information questionnaire, the Parental Conflict Scale, the Parenting Style Questionnaire, the Child-parent Relationship Scale and the Children’s Emotional Adjustment Scale-Preschool Version. Results Nine categories of factors which significantly predicted functional constipation in preschoolers were retained in the final logistic regression model: Second child in birth order (OR = 0.456; 95% CI, 0.229 to 0.910), children picky eating (OR = 2.936; 95% CI, 1.133 to 7.611), bad bowel habits (OR = 2.896; 95% CI, 1.391 to 6.028), parental history of constipation (OR = 3.259; 95% CI, 1.600 to 6.639), parents blaming the child for having a bad bowel movement (OR = 3.788; 95% CI, 1.391 to 10.318), more than 3 h of fathers-child interaction time per day (OR = 0.137; 95% CI, 0.024 to 0.778), parental conflict (OR = 1.981; 95% CI, 0.950 to 3.831), doting or authoritarian parenting style (OR = 1.644; 95% CI, 1.067 to 2.534, OR = 2.481; 95% CI, 1.362 to 4.519), and anxiety control or temper control in children (OR = 0.492; 95% CI, 0.303 to 0.799, OR = 0.189; 95% CI, 0.103 to 0.348). Conclusions This study identified the significant associations between family-related factors and functional constipation in preschool children, which provide implications for healthcare professionals to address functional constipation in early childhood using a preventive lens. Supplementary Information The online version contains supplementary material available at 10.1186/s12887-022-03521-w.
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Classen M, Righini-Grunder F, Schumann S, von Gontard A, de Laffolie J. Constipation in Children and Adolescents. DEUTSCHES ARZTEBLATT INTERNATIONAL 2022; 119:697-708. [PMID: 36261928 PMCID: PMC9830679 DOI: 10.3238/arztebl.m2022.0309] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/24/2022] [Revised: 04/24/2022] [Accepted: 08/16/2022] [Indexed: 01/05/2023]
Abstract
BACKGROUND According to a population-based study, approximately 6.8% of children and adolescents in Germany suffer from acute or chronic constipation. It can be of organic or functional origin and may be associated with comorbid disturbances, particularly fecal incontinence. METHODS We selectively searched the PubMed and Google Scholar databases for articles with the keywords "constipation," "children and adolescents," and "incontinence". Recommendations are based on the AWMF guideline on constipation and fecal incontinence and on international guidelines and reviews. RESULTS More than 90% of cases of chronic constipation are of functional origin. Organic causes vary with age and call for targeted differential diagnosis. Invasive tests are only rarely necessary. Functional constipation may be associated with fecal and urinary incontinence, and the relative risk of urinary tract infections is 2.2 to 6.5. There may be associated psychological symptoms and mental disorders in 30-50% of cases. The cornerstone of treatment is patient and parent education, along with laxative medication and toilet training. Instructional programs have been found effective in otherwise refractory cases. CONCLUSION The treatment of constipation in childhood should begin as soon as the differential diagnostic evaluation is completed. The education of parents, follow-up at close intervals, and drug treatment and behavioral therapy that are adapted to the symptoms can improve quality of life.
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Affiliation(s)
| | | | | | - Alexander von Gontard
- Psychiatric Services Graubünden (PDGR), Outpatient Services for Child and Adolescent Psychiatry, Chur, Switzerland; Governor Kremers Centre, Department of Urology, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Jan de Laffolie
- Department of General Pediatrics and Neonatology, Justus Liebig University Giessen, Standort Giessen,*Kindergastroenterologie, Abt. Allgemeine Pädiatrie und Neonatologie Universitätsklinikum Giessen und Marburg, Standort Giessen Feulgenstr. 12, 35392 Giessen, Germany
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Hussong J, Greiner M, Schiedermaier U, Mattheus H, von Gontard A. Anxiety disorders, depression and incontinence in preschool children-A population-based study. Neurourol Urodyn 2022; 41:1800-1808. [PMID: 35979705 DOI: 10.1002/nau.25025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Revised: 08/01/2022] [Accepted: 08/03/2022] [Indexed: 11/09/2022]
Abstract
OBJECTIVE The aim was to examine associations of specific anxiety disorders, depressive symptoms, and incontinence in a representative, population-based sample of preschool children. METHODS All preschool children of a defined geographical area examined before school-entry were included. Parents completed a questionnaire including the Preschool Feelings Checklist (PFC), eight questions referring to nocturnal enuresis (NE), daytime urinary incontinence (DUI), fecal incontinence (FI) and constipation, and 30 items regarding Diagnostic and Statistical Manual of Mental Disorders-Fifth Edition (DSM-5) diagnostic criteria of separation anxiety disorder (SAD), social phobia (SOC), specific phobia (PHOB), and generalized anxiety disorder (GAD). Data of 1206 children (mean age = 5.7 years; 53.5% boys) are presented. RESULTS 34.6% of incontinent children had an anxiety disorder based on DSM-5 criteria and 13.3% had clinically relevant depressive symptoms (measured by the PFC). Rates of incontinence overall were 14.1% (11.9% NE, 3.1% DUI, and 1.8% FI) and 6.3% for constipation. Rates of SOC and PHOB were increased in NE (20.8% and 25.4%), DUI (39.3% and 34.5%) and FI (35.3% and 50.0%) compared to continent children (13.5% and 17.2%). Children with constipation had higher rates of SOC, PHOB, and GAD than those without. Compared to continent children (9.7%), depressive symptoms were more frequent in children with NE (26.8%), DUI (50.0%), and FI (61.9%). CONCLUSION Anxiety disorders and depressive symptoms are common in children with incontinence. The most specific DSM-5 disorders associated with incontinence are SOC and PHOB, which can be incapacitating and may require treatment. Due to the high rates of anxiety disorders, it is important to screen all children with incontinence, for example, with specific questionnaires.
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Affiliation(s)
- Justine Hussong
- Department of Child and Adolescent Psychiatry, Saarland University Hospital, Homburg, Germany
| | - Marion Greiner
- Institute for Community Health, Regionalverband Saarbrücken, Saarbrücken, Germany
| | - Ulrike Schiedermaier
- Institute for Community Health, Regionalverband Saarbrücken, Saarbrücken, Germany
| | - Hannah Mattheus
- Department of Child and Adolescent Psychiatry, Saarland University Hospital, Homburg, Germany
| | - Alexander von Gontard
- Governor Kremers Centre, Department of Urology, Maastricht University Medical Centre, Maastricht, The Netherlands.,Psychiatric Services Graubünden (PDGR), Outpatient Services for Child and Adolescent Psychiatry, Chur, Switzerland
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Chia LW, Nguyen TVH, Phan VN, Luu TTN, Nguyen GK, Tan SY, Rajindrajith S, Benninga MA. Prevalence and risk factors of functional gastrointestinal disorders in Vietnamese infants and young children. BMC Pediatr 2022; 22:315. [PMID: 35624448 PMCID: PMC9137065 DOI: 10.1186/s12887-022-03378-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Accepted: 05/20/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Functional gastrointestinal disorders (FGIDs) are common early in life. The prevalence of FGIDs varies among countries but is unknown in Vietnam. The aim of this study is to assess the prevalence of FGIDs in healthy Vietnamese infants and young children. METHODS This was a cross-sectional, observational study involving healthy infants and young children between 0 - 48 months old in Hanoi, Vietnam. A representative total of 1511 subjects completed the validated questionnaire on paediatric FGIDs. Rome IV criteria were used to define FGIDs. RESULTS For Vietnamese infants (0-6 months) and young children (7-48 months), the prevalence of having at least one FGID was 10.0% and only 0.6% was having more than one FGID. Infantile regurgitation (9.3%) was the most prevalent FGID among infants 0-6 months of age while all other FGIDs had a low prevalence between 0-2.5%. For young children between 7 - 48 months old, functional constipation was the most common disorder at the rate of 5.6%. Association analysis revealed that the risk of infant regurgitation was significantly lower among infants with exclusively breastfeeding at 2 - 3 months and 3 - 4 months, formula initiation at 0 - 1 months, and higher paternal education level. The prevalence of functional constipation was significantly higher in male subjects, children in families with annual household income between 273,000,000 - 546,999,999 VND (or estimate around 11,800 - 23,800 USD), families with one child only, and formula feeding initiation at 1 - 2 months. CONCLUSIONS The prevalence of FGIDs in Vietnamese infants and young children is relatively low compared to the published literature using Rome IV diagnostic criteria. Infantile regurgitation was the most common FGID in Vietnamese infants while functional constipation was most prevalent among Vietnamese young children. TRIAL REGISTRATION Netherlands Trial Registry Identifier: NL7286/NTR7495 .
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Affiliation(s)
- Loo Wee Chia
- FrieslandCampina, Amersfoort, The Netherlands. .,FrieslandCampina Development Centre AMEA,, 89 Science Park Drive, #02-05 The Rutherford B, Science Park 1, Singapore, 118261, Singapore.
| | | | - Van Nha Phan
- Department of Paediatrics, Hanoi Medical University, Hanoi, Vietnam
| | | | | | - Serene Yaling Tan
- FrieslandCampina, Amersfoort, The Netherlands.,FrieslandCampina Development Centre AMEA,, 89 Science Park Drive, #02-05 The Rutherford B, Science Park 1, Singapore, 118261, Singapore
| | - Shaman Rajindrajith
- Department of Paediatrics, Faculty of Medicine, University of Colombo, Colombo, Sri Lanka
| | - Marc Alexander Benninga
- Department of Paediatric Gastroenterology, Emma Children's Hospital, Amsterdam University Medical Centres, Amsterdam, 1105, AZ, The Netherlands
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Eom TH, Chae KH, Kim S, Kim KY. National population-based study of constipation in children in Korea, 2002-2013. Pediatr Int 2022; 64:e15211. [PMID: 35938583 DOI: 10.1111/ped.15211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Revised: 03/12/2022] [Accepted: 04/05/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND The purpose of this study is to estimate the overall prevalence and incidence of constipation in Korean children and adolescent based on health insurance claims data. METHODS This study is a retrospective cohort study using the Korean National Health Insurance Service - National Sample Cohort from 2002 to 2013. Patients age less than 19 years old were selected, and the prevalence and incidence of constipation were estimated. RESULTS The standardized incidence rate was 10.8 per 1,000 persons in 2004 to 14.3 per 1,000 persons in 2012. The standardized prevalence increased from 12.2 per persons in 2002 to 26.4 per persons in 2013. Females had a higher incidence rate and prevalence rate than males during the study period. The overall recurrence rates were 13.2%. The recurrence rates were 12.9% in males and 13.5% in females. The overall average constipation duration was 229 days. The duration was 222 days in males and 236 days in females. CONCLUSIONS This is the first study to conduct a population-based study of all children in Korea with constipation. These data reveal the increasing burden and impact of constipation on children and could enable effective public and clinical health strategies to be planned.
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Affiliation(s)
- Tae-Hoon Eom
- Department of Pediatrics, College of Medicine, Seoul Saint Mary's Hospital, The Catholic University of Korea, Seoul, Korea
| | - Kyung-Hee Chae
- Department of Preventive Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Sukil Kim
- Department of Preventive Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Kwang Yeon Kim
- Department of Pediatrics, College of Medicine, Eunpyeong Saint Mary's Hospital, The Catholic University of Korea, Seoul, Korea
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Koppen IJN, Benninga MA. Functional Constipation and Dyssynergic Defecation in Children. Front Pediatr 2022; 10:832877. [PMID: 35252068 PMCID: PMC8890489 DOI: 10.3389/fped.2022.832877] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2021] [Accepted: 01/06/2022] [Indexed: 12/22/2022] Open
Abstract
Defecation is a complex physiological process, which relies on intricate mechanisms involving the autonomic and somatic nervous system, the pelvic floor muscles, and the anal sphincter complex. Anorectal dysfunction may result in constipation, a bothersome defecation disorder that can severely affect daily lives of children and their families. In this review, we focus on different mechanisms underlying anorectal dysfunction and specific treatment options aimed at improving defecation dynamics in children with functional constipation.
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Affiliation(s)
- Ilan J N Koppen
- Department of Paediatric Gastroenterology and Nutrition, Emma Children's Hospital, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
| | - Marc A Benninga
- Department of Paediatric Gastroenterology and Nutrition, Emma Children's Hospital, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
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Affiliation(s)
| | - Robbie Foy
- Leeds Institute of Health Sciences, University of Leeds, Leeds
| | - Arnab K Seal
- Leeds Community Healthcare NHS Trust, Leeds
- University of Leeds, Leeds
| | - Jonathan C Darling
- Division of Women's and Children's Health, School of Medicine, University of Leeds, Leeds
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10
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Leung AK, Hon KL. Paediatrics: how to manage functional constipation. Drugs Context 2021; 10:dic-2020-11-2. [PMID: 33828605 PMCID: PMC8007206 DOI: 10.7573/dic.2020-11-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Accepted: 01/06/2021] [Indexed: 12/22/2022] Open
Abstract
Background Despite being a common problem in childhood, functional constipation is often difficult to manage. This article provides a narrative updated review on the evaluation, diagnosis and management of childhood functional constipation. Methods A PubMed search was performed with Clinical Queries using the key term ‘functional constipation’. The search strategy included clinical trials, meta-analyses, randomized controlled trials, observational studies and reviews. The search was restricted to the English literature and to the paediatric population. The information retrieved from the above search was used in the compilation of the present article. Results A detailed history and thorough physical examination are important in the evaluation of a child with constipation to establish the diagnosis of functional constipation as per the Rome IV criteria and to catch ‘red flags’ suggestive of organic causes of constipation. These ‘red flags’ include delayed passage of meconium, ribbon stool, rectal bleeding/blood in the stool unless attributable to an anal fissure, failure to thrive, severe abdominal distension, absent anal wink/cremasteric reflex, tight and empty rectum on digital examination and explosive expulsion of liquid stool and gas on withdrawal of the finger, hair tuft/dimple/lipoma/haemangioma in the lumbosacral area, and an anteriorly displaced anus. For functional constipation, pharmacological therapy consists of faecal disimpaction and maintenance therapy. This can be effectively accomplished with oral medications, rectal medications or a combination of both. The most commonly used and most effective laxative is polyethylene glycol. Non-pharmacological management consists of education, behavioural modification and dietary interventions. The combination of pharmacological therapy and non-pharmacological management increases the chance of success. Conclusion Polyethylene glycol is the medication of first choice for both disimpaction and maintenance therapy. If polyethylene glycol is not available or is poorly tolerated, lactulose is the preferred alternative. Other laxatives may be considered as second-line therapy if treatment with osmotic laxatives fails or is insufficient. Maintenance treatment should be continued for at least 2 months. Early treatment will result in a faster and shorter treatment course.
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Affiliation(s)
- Alexander Kc Leung
- Department of Pediatrics, University of Calgary, and Alberta Children's Hospital, Calgary, Alberta, Canada
| | - Kam Lun Hon
- Department of Paediatrics, The Chinese University of Hong Kong, Shatin, Hong Kong.,Department of Paediatrics and Adolescent Medicine, Hong Kong Children's Hospital, Hong Kong
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Huang Y, Tan SY, Parikh P, Buthmanaban V, Rajindrajith S, Benninga MA. Prevalence of functional gastrointestinal disorders in infants and young children in China. BMC Pediatr 2021; 21:131. [PMID: 33731059 PMCID: PMC7968152 DOI: 10.1186/s12887-021-02610-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2020] [Accepted: 03/11/2021] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND The prevalence of functional gastrointestinal disorders (FGIDs) in children, particularly from Asia, is largely unknown. There are not many studies done in Asia especially using the Rome IV criteria. The aim of this study is to assess the prevalence of FGIDs in infants and young children in a representative sample in China. METHODS A prospective, cross-sectional, community-based survey was conducted among healthy infants and young children between the ages of 0-4 years in Jinhua and Shanghai, China. A total of 2604 subjects (1300 subjects from Jinhua and 1304 subjects from Shanghai) completed a validated questionnaire on pediatric gastrointestinal symptoms. FGIDs in infants and young children were diagnosed using the Rome IV criteria. RESULTS According to the Rome IV criteria, the prevalence of having a FGID in Chinese infants and young children is 27.3%. Infant regurgitation (33.9%) was the most common FGID among the 0-6 months old while functional constipation (7.0%) was the most common among the 1-4 years old. Risk factor analysis revealed that prevalence of infantile colic was higher with better maternal education and low birth weight. Prevalence of infantile regurgitation was significantly greater in males, living in a rural area, being exclusively breast fed at least up to 4 months and starting formula feeds within the first month. The risk of functional constipation was lower for infants who were delivered vaginally. CONCLUSIONS Infantile regurgitation was the most common FGID in Chinese infants while functional constipation was most prevalent among young Chinese children. TRIAL REGISTRATION Netherlands Trial Registry Identifier: NL6973/NTR7161 .
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Affiliation(s)
- Ying Huang
- Department of Gastroenterology, Children's Hospital of Fudan University, Shanghai, P.R. China
| | - Serene Yaling Tan
- FrieslandCampina, Amersfoort, The Netherlands.
- FrieslandCampina Development Centre AMEA, 89 Science Park Drive, #02-05/06/08 The Rutherford B, Science Park 1, Singapore, 118261, Singapore.
| | | | | | - Shaman Rajindrajith
- Department of Pediatrics, Faculty of Medicine, University of Colombo, Colombo, Sri Lanka
| | - Marc Alexander Benninga
- Department of Pediatric Gastroenterology, Emma Children's Hospital, Amsterdam UMC, Academic Medical Center, Amsterdam, 1105, AZ, The Netherlands
- Academic Medical Center, Amsterdam, 1105, AZ, The Netherlands
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12
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Deffaa OJ, Gosemann JH, Lacher M, Wagner R. Increased Incidence of Functional Constipation in Children with a History of Perianal Abscess-A Single-Center Retrospective Cohort Study. Eur J Pediatr Surg 2021; 31:76-79. [PMID: 32950031 DOI: 10.1055/s-0040-1716881] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
INTRODUCTION Functional constipation (FC) is a common gastrointestinal disorder affecting up to 30 % of children. Voluntary stool withholding (e.g., after painful defecation) with consecutive harder and larger stools can result in avoidance patterns. Perianal abscesses (PA) are associated with anal pain and painful stooling. We hypothesized that patients with PA have a higher incidence of subsequent FC compared with children without PA. MATERIALS AND METHODS Between January 2010 and December 2016, we retrospectively analyzed all infants (< 365 days of life) presenting at our institution with PA or unilateral inguinal hernia repair (IH; control group). We screened the clinical charts of these patients for outpatient or inpatient visits due to FC according to ROME IV criteria between 01/2010 and 10/2019. Statistical analysis was done using chi-squared test. RESULTS We included a total of 37 infants with PA and 118 with IH repair (controls). Mean age at presentation for PA was 3.7 ± 0.5 months compared with 4.2 ± 0.3 months at surgery for IH. In the PA group, 6/37 (16%) developed FC compared with 1/118 (1%) in the control group (p-value < 0.01). Patients with PA presented with FC at a mean age of 22.3 ± 4.6 months. Twenty-three of thirty-seven (62%) of PA patients underwent surgery. The development of FC in the PA group was independent of conservative versus surgical treatment (14 vs. 17%, p >0.05). CONCLUSION Our study suggests that PA is associated with an increased risk of FC during the further course. Prophylactic stool softening in patients with PA may be considered to prevent subsequent FC.
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Affiliation(s)
| | | | - Martin Lacher
- Department of Pediatric Surgery, Universitätsklinikum Leipzig, Leipzig, Germany
| | - Richard Wagner
- Department of Pediatric Surgery, Universitätsklinikum Leipzig, Leipzig, Germany
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13
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Van Aggelpoel T, De Wachter S, Neels H, Vermandel A. Observing postprandial bowel movements in diaper-dependent toddlers. J Child Health Care 2020; 24:629-636. [PMID: 31630536 DOI: 10.1177/1367493519882846] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The gastrocolic reflex is a response of the colon to the presence of food in the stomach. Our goal was to observe bowel movements in healthy infants and toddlers not yet toilet trained, in response to a meal. Stool behavior of 40 toddlers, aged 18-27 months, was monitored. We observed a bowel movement within the first hour after a meal in 75% of the children. This occurred 15, 30 or 60 minutes after a meal in, respectively, 25%, 48% and 66% of the observations. If we limit to the ones that actually defecated, 37% would defecate within 15 minutes and 72% within half an hour. Fifty-nine percent of all children defecated in the morning, 54% at noon and 28% in the evening. In conclusion, we believe the gastrocolic reflex can be used as a facilitating factor to help a child to defecate on the potty, 15-30 minutes after a meal. In 50% of the cases, a child will have a bowel movement on the potty and learn to defecate on it much easier.
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Affiliation(s)
- Tinne Van Aggelpoel
- Faculty of Medicine and Health Sciences, Antwerp University, Antwerpen, Belgium.,Department of Urology, University Hospital Antwerp, Edegem, Belgium
| | - Stefan De Wachter
- Faculty of Medicine and Health Sciences, Antwerp University, Antwerpen, Belgium.,Department of Urology, University Hospital Antwerp, Edegem, Belgium
| | - Hedwig Neels
- Faculty of Medicine and Health Sciences, Antwerp University, Antwerpen, Belgium.,Department of Urology, University Hospital Antwerp, Edegem, Belgium
| | - Alexandra Vermandel
- Faculty of Medicine and Health Sciences, Antwerp University, Antwerpen, Belgium.,Department of Urology, University Hospital Antwerp, Edegem, Belgium
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14
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Epidemiology of Functional Abdominal Pain Disorders and Functional Defecation Disorders in Adolescents in Curacao. J Pediatr Gastroenterol Nutr 2020; 70:e71-e76. [PMID: 32213782 DOI: 10.1097/mpg.0000000000002623] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
OBJECTIVES Functional abdominal pain disorders (FAPDs) and functional defecation disorders (FDDs) are common in children and adolescents, but prevalence rates from the Caribbean are lacking. Therefore, our aim was to determine the prevalence of FAPDs and FDDs in adolescents in Curacao and to assess the influence of psychosocial factors on the prevalence of FAPDs and FDDs. METHODS The prevalence of FAPDs and FDDs in children and adolescents living in Curacao, ages 11 to 18 years, was assessed using the Rome IV Questionnaire on Pediatric Gastrointestinal Disorders (RIV-QPGD). FAPDs and FDDs were diagnosed according to the Rome IV criteria. Sociodemographic characteristics, somatic symptoms, early adverse life events, stressful life events, and physical and emotional abuse were evaluated as associated factors. RESULTS Out of 946 questionnaires distributed, 783 were included for further analysis. The mean age of adolescents was 14.7 years (±1.6) with 61.7% being girls. A total of 266 adolescents (34%, 95% confidence interval [CI] 30.7-37.5) met Rome IV criteria for at least 1 FAPD or FDD. Twenty-nine adolescents (3.7%) qualified for 2 functional gastrointestinal disorders. Functional constipation (18.6%) and irritable bowel syndrome (12.3%) were the most prevalent disorders. After multivariate logistic regression analyses, dizziness (odds ratio [OR] 1.84, 95% CI 1.28-2.64) was significantly associated with having a FAPD or FDD. CONCLUSIONS FAPDs and FDDs are common in adolescents in Curacao. Dizziness is associated with the presence of a FAPD or FDD.
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Vriesman MH, Koppen IJN, Camilleri M, Di Lorenzo C, Benninga MA. Management of functional constipation in children and adults. Nat Rev Gastroenterol Hepatol 2020; 17:21-39. [PMID: 31690829 DOI: 10.1038/s41575-019-0222-y] [Citation(s) in RCA: 181] [Impact Index Per Article: 45.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/26/2019] [Indexed: 02/06/2023]
Abstract
Functional constipation is common in children and adults worldwide. Functional constipation shows similarities in children and adults, but important differences also exist regarding epidemiology, symptomatology, pathophysiology, diagnostic workup and therapeutic management. In children, the approach focuses on the behavioural nature of the disorder and the initial therapeutic steps involve toilet training and laxatives. In adults, management focuses on excluding an underlying cause and differentiating between different subtypes of functional constipation - normal transit, slow transit or an evacuation disorder - which has important therapeutic consequences. Treatment of adult functional constipation involves lifestyle interventions, pelvic floor interventions (in the presence of a rectal evacuation disorder) and pharmacological therapy. When conventional treatments fail, children and adults are considered to have intractable functional constipation, a troublesome and distressing condition. Intractable constipation is managed with a stepwise approach and in rare cases requires surgical interventions such as antegrade continence enemas in children or colectomy procedures for adults. New drugs, including prokinetic and prosecretory agents, and surgical strategies, such as sacral nerve stimulation, have the potential to improve the management of children and adults with intractable functional constipation.
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Affiliation(s)
- Mana H Vriesman
- Department of Pediatric Gastroenterology and Nutrition, Emma Children's Hospital, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands.
| | - Ilan J N Koppen
- Department of Pediatric Gastroenterology and Nutrition, Emma Children's Hospital, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
| | - Michael Camilleri
- C.E.N.T.E.R. Program, Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN, USA
| | - Carlo Di Lorenzo
- Division of Gastroenterology, Hepatology and Nutrition, Nationwide Children's Hospital, Columbus, OH, USA
| | - Marc A Benninga
- Department of Pediatric Gastroenterology and Nutrition, Emma Children's Hospital, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
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16
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Santucci NR, Rein LE, van Tilburg MA, Karpinski A, Rosenberg A, Amado-Feeley A, Stoops E, Herdes RE, Hyman PE. Self-Efficacy in Children with Functional Constipation Is Associated with Treatment Success. J Pediatr 2020; 216:19-24. [PMID: 31679634 DOI: 10.1016/j.jpeds.2019.08.062] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2019] [Revised: 08/27/2019] [Accepted: 08/30/2019] [Indexed: 12/15/2022]
Abstract
OBJECTIVES To assess the relationship between self-efficacy, the belief that an individual can succeed at a goal, and short-term treatment outcome in children with functional constipation. STUDY DESIGN Patients with functional constipation age 8-16 years completed the Self-Efficacy for Functional Constipation Questionnaire (SEFCQ), consisting of 14 statements about performing tasks needed for defecation. Patients completed SEFCQ before, immediately after, and 3 weeks after their clinic visit. Treatment success was defined as ≥3 bowel movements into the toilet and no fecal incontinence in the third week. RESULTS 75% of patients had a successful outcome. Scores were higher in the group that was successful than in those that failed before, immediately after the visit, and 3 weeks later (P < .001). Self-efficacy improved at all time points in the group that was successful (P < .001). In the group that failed, scores improved immediately after clinic visit (P < .01) but were unchanged at follow-up (P > .05). CONCLUSIONS Improved self-efficacy is associated with successful outcomes in children with functional constipation, thus, it may be beneficial to enhance self-efficacy for defecation during treatment.
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Affiliation(s)
- Neha R Santucci
- Pediatric Gastroenterology, Cincinnati Children's Hospital Medical Center and Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH
| | - Lauren E Rein
- Pediatric Gastroenterology, Louisiana State University Health Sciences Center, New Orleans, LA
| | | | - Aryn Karpinski
- Department of Administration, Kent State University, Kent, OH
| | - Allan Rosenberg
- Pediatric Gastroenterology, Louisiana State University Health Sciences Center, New Orleans, LA
| | - Amir Amado-Feeley
- Pediatric Gastroenterology, Louisiana State University Health Sciences Center, New Orleans, LA
| | - Eva Stoops
- Pediatric Gastroenterology, Louisiana State University Health Sciences Center, New Orleans, LA
| | - Rachel E Herdes
- Pediatric Gastroenterology, Louisiana State University Health Sciences Center, New Orleans, LA
| | - Paul E Hyman
- Pediatric Gastroenterology, Louisiana State University Health Sciences Center, New Orleans, LA
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17
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Játiva‐Mariño E, Rivera‐Valenzuela MG, Velasco‐Benitez CA, Saps M. The prevalence of functional constipation in children was unchanged after the Rome IV criteria halved the diagnosis period in Rome III. Acta Paediatr 2019; 108:2274-2277. [PMID: 31140192 DOI: 10.1111/apa.14880] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2018] [Revised: 03/26/2019] [Accepted: 05/27/2019] [Indexed: 12/19/2022]
Abstract
AIM The Rome IV criteria for the diagnosis of functional constipation are one month, compared with two months in the Rome III criteria. Our aim was to see whether this altered the prevalence in Ecuador by surveying school children and comparing the results to our previous study. METHODS A cross-sectional study was conducted in Quito, Ecuador, in 2013 two randomly selected schools: one private and one public. Children aged 8-15 completed the Spanish version of the Questionnaire of Paediatric Gastrointestinal Symptoms based on the Rome IV criteria. We compared our findings with our previous 2013 study based on the Rome III criteria. RESULTS A total of 951 children (61% male) completed the Rome IV questionnaire from June to July 2017 at a mean age of 11.2 ± 1.8 years, and 417 children (52% male) completed the Rome III questionnaire in June 2013 at a mean age of 12.0 ± 1.8 years. We found that 14.4% met the Rome IV criteria for functional constipation compared with 11.8% for the Rome III criteria (p = 0.11). CONCLUSION Modifying the time required for a diagnosis functional constipation from two months to one month did not result in a significant difference in the prevalence.
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Affiliation(s)
- Edgar Játiva‐Mariño
- Faculty of Medicine Universidad Central del Ecuador Quito Ecuador
- Medical Sciences PhD program Universidad de La Frontera Temuco Chile
| | | | | | - Miguel Saps
- Division of Pediatric Gastroenterology, Hepatology & Nutrition, Department of Pediatrics, Miller School of Medicine University of Miami Miami FL USA
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Walter AW, Hovenkamp A, Devanarayana NM, Solanga R, Rajindrajith S, Benninga MA. Functional constipation in infancy and early childhood: epidemiology, risk factors, and healthcare consultation. BMC Pediatr 2019; 19:285. [PMID: 31416431 PMCID: PMC6694472 DOI: 10.1186/s12887-019-1652-y] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2018] [Accepted: 07/31/2019] [Indexed: 02/08/2023] Open
Abstract
Background Functional constipation (FC) is a pediatric problem that is seen frequently. However, its prevalence in Asia remains undetermined. In this study we attempted to determine the prevalence, risk factors and therapeutic modalities of FC in infants and toddlers in Sri Lanka. Methods Children aged 6.5 months to 4 years were selected from 14 well-baby and vaccination clinics in the Gampaha District of Sri Lanka. A questionnaire with questions regarding the socio-demographic characteristics, child’s bowel habits, psycho-social risk factors and treatment modalities were filled by the mothers. FC was diagnosed according to ROME III criteria. Results A total of 1113 children were analyzed [(female n = 560 (50.3%) with a mean age of 20.7 months, standard deviation [SD] 11.2 months. FC was found in 89 (8.0%). FC was significantly and independently associated with underweight (14.3% vs 7.2%, p = 0.008. [OR and 95% CI: 2,3 (CI; 1.3–4.2)] and residence in an urban area (9.6% vs 5.6%, p = 0.013). [OR and 95% CI: 0.592 (CI; 0.396–0.95)]. Children subjected to violence showed a significantly higher prevalence of FC (20.0 vs 7.8%, p = 0.046). Children being overweight and children living with mothers subjected to violence showed a higher, though not statistically significant, tendency to develop FC. Children with FC visited healthcare clinics more frequently when compared to controls (19.6% vs 6.0%, p < 0.0001). However, only 24% of infants and toddlers with FC were treated specifically for the condition by a doctor. Conclusions FC occurred in 8% of this cohort of Sri Lankan infants and toddlers. It is significantly associated with underweight and living in an urban area. Only a quarter of them received medical attention for their constipation. Trial registration SLCP/ERC/2014/12, December 2014. Electronic supplementary material The online version of this article (10.1186/s12887-019-1652-y) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Anne Willemijn Walter
- Department of Pediatrics, University of Amsterdam, Academic Medical Center, H7-248, Meibergdreef 9, 1105, AZ, Amsterdam, The Netherlands.
| | - Anne Hovenkamp
- Department of Pediatrics, University of Amsterdam, Academic Medical Center, H7-248, Meibergdreef 9, 1105, AZ, Amsterdam, The Netherlands
| | - Niranga Manjuri Devanarayana
- Senior Lecturer in Physiology, Department of Physiology, Faculty of Medicine, University of Kelaniya, Thalagolla Road, Ragama, 11010, Sri Lanka
| | | | - Shaman Rajindrajith
- Senior lecturer in Paediatrics, Department of Paediatrics, Faculty of Medicine, University of Kelaniya, Thalagolla Road, Ragama, 11010, Sri Lanka
| | - Marc Alexander Benninga
- Department of Paediatric Gastroenterology and Nutrition, Emma Children's Hospital, Academic Medical Center, Amsterdam, The Netherlands
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Joinson C, Grzeda MT, von Gontard A, Heron J. Psychosocial risks for constipation and soiling in primary school children. Eur Child Adolesc Psychiatry 2019; 28:203-210. [PMID: 29748737 PMCID: PMC7019639 DOI: 10.1007/s00787-018-1162-8] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2017] [Accepted: 04/27/2018] [Indexed: 11/06/2022]
Abstract
To examine prospective associations between psychosocial problems and childhood constipation and soiling. We used latent classes of constipation and soiling ('constipation alone', 'soiling alone', 'constipation with soiling') extracted from longitudinal maternally reported data on constipation (4-10 years) and soiling (4-9 years) from 8435 children (4353 males, 4082 females) from the ALSPAC cohort. We examined the association between maternally reported psychosocial problems at 2-3 years (difficult temperament, behaviour/emotional problems, temper tantrums, behavioural sleep problems and stressful events) and the latent classes using multinomial logistic regression adjusted for a range of confounders relating to the child and family (reference category = normative latent class with very low probability of constipation/soiling). Difficult temperament and emotional/behaviour problems were associated with increased odds of constipation and soiling. Associations were generally strongest for 'constipation with soiling', e.g. difficult mood: 1.42 (1.23-1.64); behaviour problems: 1.48 (1.28-1.71); temper tantrums: 1.89 (1.34-2.65); lack of a regular sleep routine 2.09 (1.35-3.25). Stressful life events were associated with constipation alone [1.23 (1.12-1.36)] and constipation with soiling [1.32 (1.14-1.52)], but not soiling alone. Additional comparisons of the non-normative latent classes provided evidence for differential associations with the risk factors, e.g. frequent temper tantrums were associated with a greater than twofold increase in the odds of constipation with soiling versus constipation alone. Psychosocial problems in early childhood are risk factors for constipation and soiling at school age. An increased understanding of early risk factors for constipation and soiling could aid the identification of children who require treatment.
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Affiliation(s)
- Carol Joinson
- Population Health Sciences, Bristol Medical School, University of Bristol, Oakfield House, Oakfield Grove, Clifton, Bristol, BS8 2BN, UK.
| | - Mariusz T Grzeda
- Population Health Sciences, Bristol Medical School, University of Bristol, Oakfield House, Oakfield Grove, Clifton, Bristol, BS8 2BN, UK
| | - Alexander von Gontard
- Department of Child and Adolescent Psychiatry, Saarland University Hospital, Homburg, Germany
| | - Jon Heron
- Population Health Sciences, Bristol Medical School, University of Bristol, Oakfield House, Oakfield Grove, Clifton, Bristol, BS8 2BN, UK
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Russo M, Strisciuglio C, Scarpato E, Bruzzese D, Casertano M, Staiano A. Functional Chronic Constipation: Rome III Criteria Versus Rome IV Criteria. J Neurogastroenterol Motil 2019; 25:123-128. [PMID: 30646483 PMCID: PMC6326211 DOI: 10.5056/jnm18035] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2018] [Revised: 06/25/2018] [Accepted: 10/09/2018] [Indexed: 12/12/2022] Open
Abstract
Background/Aims Functional constipation (FC) is aa frequent functional gastrointestinal disorder, diagnosed according to the Rome criteria. In this study, we compared Rome III and Rome IV criteria for the diagnosis of FC, and determined the prevalence of FC according to these criteria. Methods Consecutive children between infancy and 17 years old were recruited for the study, excluding those with a known organic gastrointestinal disease. A prospective longitudinal design has beenused. For the diagnosis of FC, questionnaires on Pediatric Gastrointestinal Symptoms (QPGS) based on the Rome III and Rome IV criteria (QPGS-RIII and QPGS-RIV) were used. The agreement between these 2 questionnaires was measured by Cohen’s kappa coefficient. Results Two hundred fourteen children (mean age, 77.4 ± 59.5 months; 103 males) were screened. There was no statistically significant difference in the prevalence of FC evaluated using the QPGS-Rome IV vs the QPGS-Rome III in the overall sample (39/214 [18.2%] vs 37/214 [17.3.0%]; P = 0.831) as well as in any of the groups. The Cohen’s kappa test showed a good agreement between the 2 criteria (κ = 0.65; 95% CI, 0.51 to 0.78). Conclusion Our study demonstrates that the new Rome IV criteria have a good agreement with the Rome III criteria for the diagnosis of FC, without an increase in the number of potential diagnoses, despite the reduction in the duration of the symptoms. This conclusion is important in the management of childhood FC, since a late diagnosis negatively affects the prognosis.
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Affiliation(s)
- Marina Russo
- Department of Translational Medical Science, Section of Pediatrics, University of Naples "Federico II", Naples, Italy
| | - Caterina Strisciuglio
- Department of Women, Child and Specialist Surgery, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Elena Scarpato
- Department of Translational Medical Science, Section of Pediatrics, University of Naples "Federico II", Naples, Italy
| | - Dario Bruzzese
- Department of Public Health, University of Naples "Federico II", Naples, Italy
| | - Marianna Casertano
- Department of Women, Child and Specialist Surgery, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Annamaria Staiano
- Department of Translational Medical Science, Section of Pediatrics, University of Naples "Federico II", Naples, Italy
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Maffei HVL, Morais MBD. PROPOSALS TO APPROXIMATE THE PEDIATRIC ROME CONSTIPATION CRITERIA TO EVERYDAY PRACTICE. ARQUIVOS DE GASTROENTEROLOGIA 2018; 55Suppl 1:56-60. [PMID: 30184022 DOI: 10.1590/s0004-2803.201800000-44] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/23/2018] [Accepted: 03/27/2018] [Indexed: 12/27/2022]
Abstract
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.
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Affiliation(s)
- Helga Verena Leoni Maffei
- Universidade Estadual Paulista (UNESP), Faculdade de Medicina de Botucatu, Departamento de Pediatria, Botucatu,SP, Brasil
| | - Mauro Batista de Morais
- Universidade Federal de São Paulo (UNIFESP), Escola Paulista de Medicina, Divisão de Gastroenterologia Pediátrica, São Paulo, SP, Brasil
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Prevalence of Functional Defecation Disorders in Children: A Systematic Review and Meta-Analysis. J Pediatr 2018; 198:121-130.e6. [PMID: 29656863 DOI: 10.1016/j.jpeds.2018.02.029] [Citation(s) in RCA: 143] [Impact Index Per Article: 23.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2017] [Revised: 01/19/2018] [Accepted: 02/13/2018] [Indexed: 12/11/2022]
Abstract
OBJECTIVE To systematically review the literature regarding the epidemiology of functional constipation and functional nonretentive fecal incontinence (FNRFI) in children. Secondary objectives were to assess the geographical, age, and sex distribution of functional constipation and FNRFI and to evaluate associated factors. STUDY DESIGN The Cochrane Library, PubMed, and Embase databases were searched from 2006 until September 2017. The following inclusion criteria were applied: (1) prospective studies of population-based samples; (2) reporting on the prevalence of functional constipation or FNRFI according to the Rome III/IV criteria; (3) in children aged 0-18 years; and (4) published in full manuscript form. A quality assessment of included studies was conducted. Random effect meta-analyses with meta-regression analyses of study characteristics were performed. RESULTS Thirty-seven studies were included, of which 35 reported on the prevalence of functional constipation and 15 of FNRFI. The reported prevalence of functional constipation ranged from 0.5% to 32.2%, with a pooled prevalence of 9.5% (95% CI 7.5-12.1). The prevalence of FRNFI ranged from 0.0% to 1.8%, with a pooled prevalence of 0.4% (95% CI 0.2-0.7). The prevalence of functional constipation was 8.6% in boys compared with 8.9% in girls (OR 0.99, 95% CI 0.9-1.4). Geographical location, dietary habits, and exposure to stressful life events were reported to be associated with the prevalence of functional constipation. Data on FNRFI were scarce and no associated factors were identified. CONCLUSION Functional constipation is common in childhood and is associated with geographical location, lifestyle factors, and stressful life events. FNRFI is rare, and no associated factors were identified.
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Santucci NR, Hyman PE, Karpinski A, Rosenberg A, Garguilo D, Rein LE, Amado-Feeley A, Stoops E, Herdes RE, van Tilburg MAL. Development and validation of a childhood self-efficacy for functional constipation questionnaire. Neurogastroenterol Motil 2018; 30. [PMID: 28980378 DOI: 10.1111/nmo.13222] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2017] [Accepted: 09/07/2017] [Indexed: 02/08/2023]
Abstract
BACKGROUND Children with functional constipation fear painful bowel movements leading to stool withholding behavior. Self-efficacy is the belief that an individual can accomplish a given goal. If children with constipation avoid defecation because they think that they are unable defecate comfortably, this low self-efficacy may prevent treatment success. The aim of the current study was to develop and validate a constipation specific self-efficacy scale. METHODS The self-efficacy for functional constipation questionnaire (SEFCQ) was developed by the authors and evaluated by 10 children and seven experts. Ninety-nine healthy children and 122 children with functional constipation completed the SEFCQ and three other questionnaires measuring related constructs. KEY RESULTS Minor changes were made in wording based on feedback from experts and children. Factor analysis showed two scales, a 7 item Action scale (Cronbach's α = 0.88) and a 7 item Emotion scale (Cronbach α = 0.86). The SEFCQ total scale correlated positively with general self-efficacy (r = .32, P < .001) and quality of life (r = .20; P < .01) and negatively with anxiety (r = -.15; P < .05). Scores on the SEFCQ were higher in children without functional constipation compared to those with functional constipation (53.33 + 3.38 vs 39.34 + 7.19, P < .001). CONCLUSIONS & INFERENCES We developed a constipation specific self-efficacy questionnaire with good initial internal reliability, excellent face validity and adequate content validity. A low self-efficacy for defecation, may make the child resist their physical urge to defecate and hence, the need for further studies to assess its effect on treatment outcomes.
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Affiliation(s)
- N R Santucci
- Pediatric Gastroenterology, Louisiana State University Health Sciences Center, New Orleans, LA, USA
| | - P E Hyman
- Pediatric Gastroenterology, Louisiana State University Health Sciences Center, New Orleans, LA, USA
| | - A Karpinski
- School of Administration, Kent State University, Kent, OH, USA
| | - A Rosenberg
- Pediatric Gastroenterology, Louisiana State University Health Sciences Center, New Orleans, LA, USA
| | - D Garguilo
- Department of Pediatric Orthopedic Surgery, Louisiana State University Health Sciences Center, New Orleans, LA, USA
| | - L E Rein
- Pediatric Gastroenterology, Louisiana State University Health Sciences Center, New Orleans, LA, USA
| | - A Amado-Feeley
- Pediatric Gastroenterology, Louisiana State University Health Sciences Center, New Orleans, LA, USA
| | - E Stoops
- Pediatric Gastroenterology, Louisiana State University Health Sciences Center, New Orleans, LA, USA
| | - R E Herdes
- Pediatric Gastroenterology, Louisiana State University Health Sciences Center, New Orleans, LA, USA
| | - M A L van Tilburg
- College of Pharmacy & Health Sciences, Campbell University, Buies Creek, NC, USA.,Department of Medicine, University of North Carolina, Chapel Hill, NC, USA.,School of Social Work, University of Washington, Seattle, WA, USA
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Zeevenhooven J, Koppen IJ, Benninga MA. The New Rome IV Criteria for Functional Gastrointestinal Disorders in Infants and Toddlers. Pediatr Gastroenterol Hepatol Nutr 2017; 20:1-13. [PMID: 28401050 PMCID: PMC5385301 DOI: 10.5223/pghn.2017.20.1.1] [Citation(s) in RCA: 152] [Impact Index Per Article: 21.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2017] [Accepted: 02/05/2017] [Indexed: 12/13/2022] Open
Abstract
Functional gastrointestinal disorders (FGIDs) are common worldwide and cover a wide range of disorders attributable to the gastrointestinal tract that cannot be explained by structural or biochemical abnormalities. The diagnosis of these disorders relies on the symptom-based Rome criteria. In 2016 the Rome criteria were revised for infants/toddlers and for children and adolescents. In this review, we discuss the novel Rome IV criteria for infants and toddlers. The criteria for infant colic were drastically changed, whereas only minor changes were made for regurgitation, cyclic vomiting syndrome, functional diarrhea, infant dyschezia and functional constipation. In addition to this, the new Rome IV discusses underlying mechanisms of pain in infants and toddlers, including the neuro-development of nociceptive and pain pathways, the various factors that are involved in pain experience, and methods of pain assessment in infants and toddlers is essential for the clinician who encounters functional pain in this age group. Overall, the Rome IV criteria have become more distinctive for all disorders in order to improve the process of diagnosing pediatric FGIDs.
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Affiliation(s)
- Judith Zeevenhooven
- Department of Pediatric Gastroenterology and Nutrition, Emma Children's Hospital/Academic Medical Center, Amsterdam, The Netherlands
| | - Ilan J.N. Koppen
- Department of Pediatric Gastroenterology and Nutrition, Emma Children's Hospital/Academic Medical Center, Amsterdam, The Netherlands
| | - Marc A. Benninga
- Department of Pediatric Gastroenterology and Nutrition, Emma Children's Hospital/Academic Medical Center, Amsterdam, The Netherlands
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Beaudry-Bellefeuille I, Booth D, Lane SJ. Defecation-Specific Behavior in Children with Functional Defecation Issues: A Systematic Review. Perm J 2017; 21:17-047. [PMID: 29035187 PMCID: PMC5638627 DOI: 10.7812/tpp/17-047] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
CONTEXT Atypical defecation habits are common and distressing for children and families and can have a major impact on quality of life. Often, no underlying factor can be identified, and the defecation disorder is considered functional. Current interventions are not successful for up to 50% of children. We suggest this high failure rate may be caused by lack of consistency in descriptors of behavioral indicators for functional defecation problems. Most investigations and descriptors focus on general behavior. There are fewer reports concerning defecation-specific behaviors. OBJECTIVE To develop a thorough inventory of defecation-specific behaviors, providing a more informed foundation for assessment and intervention. DESIGN A systematic review of six common databases was performed following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses recommendations. Reference lists of retained articles were screened for additional studies. MAIN OUTCOME MEASURES Content analysis was used to classify defecation-specific behaviors into 17 categories. RESULTS Our search yielded 2677 articles; 98 peer-reviewed publications were retained for full-text review, and 67 articles were included in the final qualitative synthesis. Although there is inconsistency in reported diagnostic criteria, stool withholding and manifesting pain on defecation are the most commonly reported defecation-specific behaviors. In the studies that included children with autism or attention-deficit/hyperactivity disorder, the defecation-specific behaviors were not unique to the diagnostic group. CONCLUSION Consistent use of established diagnostic criteria, along with use of behaviors identified through this review, lay a foundation for more effective interventions.
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Affiliation(s)
| | - Debbie Booth
- Senior Librarian at the University of Newcastle in Callaghan, New South Wales, Australia.
| | - Shelly J Lane
- Professor of Occupational Therapy at the University of Newcastle School of Health Sciences in Callaghan, New South Wales, Australia.
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Koppen IJN, Velasco-Benitez CA, Benninga MA, Di Lorenzo C, Saps M. Using the Bristol Stool Scale and Parental Report of Stool Consistency as Part of the Rome III Criteria for Functional Constipation in Infants and Toddlers. J Pediatr 2016; 177:44-48.e1. [PMID: 27453373 DOI: 10.1016/j.jpeds.2016.06.055] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2016] [Revised: 05/06/2016] [Accepted: 06/15/2016] [Indexed: 02/07/2023]
Abstract
OBJECTIVES To evaluate among parents of infants and toddlers the agreement between parental report and the Bristol Stool Scale (BSS) in assessing stool consistency and the effect of both methods on determining the prevalence of functional constipation (FC) according to the Rome III criteria. STUDY DESIGN Parents of children ≤48 months of age who were seen for a well-child visit completed a questionnaire about their child's bowel habits during the previous month. Cohen kappa coefficient (κ) was used to measure intrarater agreement between parental report of stool consistency ("hard," "normal," "soft/mucous/liquid") and the BSS (types 1-2, hard; types 3-5, normal; types 6-7, loose/liquid). The prevalence of FC was assessed based on the questionnaire according to the Rome III criteria, comparing both methods of stool consistency assessment. RESULTS Parents of 1095 children (median age, 15 months; range, 1-48) were included. Only fair agreement existed between the 2 methods of stool consistency assessment (κ = 0.335; P < .001). According to the Rome III criteria, using parental report the prevalence of FC was 20.5% and using the BSS the prevalence was 20.9% (P = .87). The agreement between these 2 methods for assessing the prevalence of FC was excellent (κ = 0.95; P < .001). CONCLUSIONS Only fair agreement exists between the BSS and parental report of stool consistency among parents of infants and toddlers. Different methods of stool consistency assessment did not result in a difference in the prevalence of FC.
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Affiliation(s)
- Ilan J N Koppen
- Division of Pediatric Gastroenterology, Hepatology, and Nutrition, Department of Pediatrics, Nationwide Children's Hospital, Columbus, OH; Department of Pediatric Gastroenterology and Nutrition, Emma Children's Hospital/Academic Medical Center, Amsterdam, The Netherlands.
| | | | - Marc A Benninga
- Department of Pediatric Gastroenterology and Nutrition, Emma Children's Hospital/Academic Medical Center, Amsterdam, The Netherlands
| | - Carlo Di Lorenzo
- Division of Pediatric Gastroenterology, Hepatology, and Nutrition, Department of Pediatrics, Nationwide Children's Hospital, Columbus, OH
| | - Miguel Saps
- Division of Pediatric Gastroenterology, Hepatology, and Nutrition, Department of Pediatrics, Nationwide Children's Hospital, Columbus, OH
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