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Srinivas S, Trimble C, Driesbach S, Zahora P, Gasior A, Wood RJ, Halaweish I. Laxative Weaning Protocol for Patients With Functional Constipation: A Pilot Study. J Pediatr Surg 2024; 59:1633-1637. [PMID: 38760307 DOI: 10.1016/j.jpedsurg.2024.04.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2024] [Accepted: 04/12/2024] [Indexed: 05/19/2024]
Abstract
BACKGROUND Children with functional constipation require prolonged laxative administration for proper emptying. Whether these laxatives can be weaned after better functioning is achieved is unknown. We aim to describe a standardized protocol for stimulant laxative weaning and its early outcomes. METHODS Patients were candidates for weaning if they had been on a stable laxative dose for six months, defined as one bowel movement per day with no soiling, impaction, or enemas. Laxative dose was decreased by 10-25% with re-evaluation every two weeks. If patients remained well without constipation, dose was weaned further by 10-25%. If there were worsening of symptoms, lower dose was maintained for 3-6 months until re-evaluation. RESULTS There were a total of sixteen patients evaluated. Median age was 12.7 years [IQR: 11.7-15.3] with laxative duration of 8.0 years [IQR: 5.4-10.7]. All patients were on senna; some were on fiber. Median starting senna dose was 71.3 mg [IQR: 54.3-75.0] and median fiber dose was 5.5 g [IQR: 4.0-6.0]. As of most recent follow up, nine patients (56.3%) had weaned off laxatives in 3.7 months [IQR: 1.3-11.6]. For those still on laxatives, median reduction in dose was 41.4 mg [30.0-75.0], and over half weaned their dose by >50%. Almost all (90.9%) of those on high doses were able to wean. CONCLUSION A standardized laxative weaning process can be successful in patients with functional constipation, especially on high doses. Further prospective studies will be necessary to confirm the success of this protocol. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Shruthi Srinivas
- Department of Colorectal and Pelvic Reconstructive Surgery, Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH 43205, USA
| | - Casey Trimble
- Department of Colorectal and Pelvic Reconstructive Surgery, Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH 43205, USA
| | - Sarah Driesbach
- Department of Colorectal and Pelvic Reconstructive Surgery, Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH 43205, USA
| | - Pooja Zahora
- Department of Colorectal and Pelvic Reconstructive Surgery, Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH 43205, USA
| | - Alessandra Gasior
- Department of Colorectal and Pelvic Reconstructive Surgery, Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH 43205, USA
| | - Richard J Wood
- Department of Colorectal and Pelvic Reconstructive Surgery, Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH 43205, USA
| | - Ihab Halaweish
- Department of Colorectal and Pelvic Reconstructive Surgery, Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH 43205, USA.
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Melkonian V, Wehrli L, Bischoff A, Cooper EH, Ketzer J, Judd-Glossy L, de la Torre L. Transanal proximal rectosigmoidectomy: a single-center experience in surgically treated severe medically refractory idiopathic constipation. Pediatr Surg Int 2024; 40:169. [PMID: 38954056 DOI: 10.1007/s00383-024-05764-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/27/2024] [Indexed: 07/04/2024]
Abstract
PURPOSE To present the functional results after a transanal proximal rectosigmoidectomy in patients with severe idiopathic constipation in which medical treatment has failed. METHODS Patients with severe idiopathic constipation who underwent transanal proximal rectosigmoidectomy (TPRS) at Children's Hospital Colorado between June 2019 and March 2024 were included in the study. We compared multiple pre- and post-operative outcome measures and the patient's bowel regimen before and after resection. RESULTS Fourteen patients underwent TPRS, 10 of whom were male. The average age at the time of surgery was 10.1 years (range 5-19). Seven patients have moderate to severe autism. Constipation-related clinic visits, family calls, procedural intervention, emergency room visits, and hospitalizations notably decreased frequency after TPRS. Laxative dosages and enema volume requirements were also reduced after surgery. Before surgery, all the patients suffered from daily fecal accidents, while post-operatively, all were completely free of stool accidents. CONCLUSION In our experience, for patients who suffer from severe medically refractory idiopathic constipation, TPRS has provided improvement in their symptoms and decreased the complications inherent to this chronic disease. Parents and patients attest to a profound positive transformation in their quality of life after surgery.
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Affiliation(s)
- Vatche Melkonian
- International Center for Colorectal and Urogenital Care, Children's Hospital Colorado, Aurora, CO, USA.
| | - Lea Wehrli
- International Center for Colorectal and Urogenital Care, Children's Hospital Colorado, Aurora, CO, USA
| | - Andrea Bischoff
- International Center for Colorectal and Urogenital Care, Children's Hospital Colorado, Aurora, CO, USA
| | - Emily H Cooper
- Research Outcomes in Children's Surgery, Center for Children's Surgery, Children's Hospital Colorado, University of Colorado School of Medicine, Aurora, CO, USA
| | - Jill Ketzer
- International Center for Colorectal and Urogenital Care, Children's Hospital Colorado, Aurora, CO, USA
| | - Laura Judd-Glossy
- International Center for Colorectal and Urogenital Care, Children's Hospital Colorado, Aurora, CO, USA
| | - Luis de la Torre
- International Center for Colorectal and Urogenital Care, Children's Hospital Colorado, Aurora, CO, USA
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Osmanlı CÇ, Şahin B. Stool-toileting refusal in preschool age children: A follow-up study. J Pediatr Nurs 2024; 77:e426-e433. [PMID: 38762424 DOI: 10.1016/j.pedn.2024.05.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2024] [Revised: 04/29/2024] [Accepted: 05/02/2024] [Indexed: 05/20/2024]
Abstract
BACKGROUND Stool-toileting refusal in preschool-aged children is a significant issue that strongly impacts both the child and the family, signaling a challenging period. We investigated the relationships between temperament, traumatic life events, parental sociodemographic characteristics, and psychological burdens and these behaviors. Our goal was to identify factors that may contribute to the chronicity of this stool-toileting refusal behavior. METHODS Conducted as a single-center, prospective, controlled design, the research involved children exhibiting stool-toileting refusal for at least one month, alongside healthy individuals of similar age and sex. Evaluation covered sociodemographic characteristics, parental psychopathologies, children's temperament features, and life events. Follow-up questionnaires, administered one year later, assessed stool-toileting refusal behavior. FINDINGS An evaluation at the end of one year revealed that stool-toileting refusal behavior persisted in 11 of the 31 children. A family history of constipation, comorbid enuresis in the child, maternal psychiatric disorders, and rhythmic temperament features were significantly higher than in the healthy group. Children with persistent stool-toileting refusal behavior exhibited notably lower activity levels. DISCUSSION The study's results indicated associations between the TSC rhythmicity score, comorbid constipation and enuresis, and maternal psychiatric illness in preschool-aged children with stool-toileting refusal behavior. A notable association was identified between the continuation of stool-toileting refusal behavior and a low TSC activity score. Advanced statistical methods did not reveal significant differences, highlighting the need for larger sample studies. IMPLICATIONS TO PRACTICE Applying the study's findings to clinical practice involves considering factors such as a family history of constipation, comorbid enuresis in the child, maternal psychiatric disorders, and rhythmic temperament features as potential indicators of persistent stool-toileting refusal in preschool-aged children, guiding healthcare professionals in tailored assessments and interventions.
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Affiliation(s)
- Cansu Çobanoğlu Osmanlı
- Department of Child and Adolescent Psychiatry, Giresun University Faculty of Medicine, Giresun, Turkey.
| | - Berkan Şahin
- Department of Child and Adolescent Psychiatry, Giresun University Faculty of Medicine, Giresun, Turkey
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Pearlstein H, Wang L, Thompson BP, Wood RJ, Levitt MA, Bali N, Vaz K, Yacob D, Di Lorenzo C, Lu PL. Significance of retrograde flow with antegrade continence enemas in children with fecal incontinence and constipation. J Pediatr Gastroenterol Nutr 2024. [PMID: 38937991 DOI: 10.1002/jpn3.12297] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Revised: 04/11/2024] [Accepted: 05/14/2024] [Indexed: 06/29/2024]
Abstract
BACKGROUND For children with constipation and fecal incontinence treated with antegrade continence enemas (ACE), a fluoroscopic study with contrast administered via appendicostomy/cecostomy can define the anatomy of the colon and simulate the flush to investigate associated symptoms or inadequate response. These studies can at times show retrograde flow into the small intestine. Our objective was to investigate the significance of this finding. METHODS We reviewed studies at our institution with contrast administered via appendicostomy/cecostomy in children treated with ACE, identifying those demonstrating retrograde flow of contrast. We recorded demographics, medical history, interventions, and outcomes. RESULTS We identified 162 studies (52% male, median age 10.7 years) with contrast via appendicostomy (76%) or cecostomy (24%). Diagnoses included anorectal malformation (38%), spinal cord anomaly (26%), functional constipation (24%), colonic dysmotility (18%), and Hirschsprung disease (12%). Fifty-nine (36%) studies showed retrograde flow: 28/59 children (48%) were not responding adequately and 21/59 (36%) had symptoms with ACE. Children with retrograde flow were more likely to have symptoms with ACE than those without (36% vs. 15%, p < 0.01). Fourteen children underwent interventions for this finding, including administering flushes more distally (4/8 responded), changing positioning of the child during flush administration, (1/2 responded), and slowing administration (1/1 responded). Retrograde flow was associated with younger age (p < 0.01), not sex or underlying diagnosis. CONCLUSION Identifying retrograde flow during studies with contrast administered via appendicostomy/cecostomy can be useful for children with a poor response or symptoms associated with ACE, as adjustments to the mechanics of the flush can alleviate those symptoms. LEVEL OF EVIDENCE Prognostic study, Level III.
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Affiliation(s)
- Haley Pearlstein
- Division of Gastroenterology, Hepatology, and Nutrition, Department of Pediatrics, Nationwide Children's Hospital, Columbus, Ohio, USA
- Division of Pediatric Gastroenterology, Hepatology and Nutrition, Nemours Children's Hospital, Delaware, Wilmington, Delaware, USA
| | - Lyon Wang
- Division of Gastroenterology, Hepatology, and Nutrition, Department of Pediatrics, Nationwide Children's Hospital, Columbus, Ohio, USA
- The Ohio State University College of Medicine, Columbus, Ohio, USA
| | - Benjamin P Thompson
- Division of Pediatric Radiology, Nationwide Children's Hospital, The Ohio State University, Columbus, Ohio, USA
| | - Richard J Wood
- Center for Colorectal and Pelvic Reconstruction, Nationwide Children's Hospital, Columbus, Ohio, USA
| | - Marc A Levitt
- Center for Colorectal and Pelvic Reconstruction, Nationwide Children's Hospital, Columbus, Ohio, USA
| | - Neetu Bali
- Division of Gastroenterology, Hepatology, and Nutrition, Department of Pediatrics, Nationwide Children's Hospital, Columbus, Ohio, USA
| | - Karla Vaz
- Division of Gastroenterology, Hepatology, and Nutrition, Department of Pediatrics, Nationwide Children's Hospital, Columbus, Ohio, USA
| | - Desale Yacob
- Division of Gastroenterology, Hepatology, and Nutrition, Department of Pediatrics, Nationwide Children's Hospital, Columbus, Ohio, USA
| | - Carlo Di Lorenzo
- Division of Gastroenterology, Hepatology, and Nutrition, Department of Pediatrics, Nationwide Children's Hospital, Columbus, Ohio, USA
| | - Peter L Lu
- Division of Gastroenterology, Hepatology, and Nutrition, Department of Pediatrics, Nationwide Children's Hospital, Columbus, Ohio, USA
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El Mouzan M, Kambal M, Alabdulkarim H, Alshammari NR, Alanazi R, Al Sarkhy A, Alhamid N, Assiri AM, Alzahrani A, Shaik SA, Alasmi M. Clinical profile of functional constipation in Saudi children. Ann Saudi Med 2024; 44:111-115. [PMID: 38615181 PMCID: PMC11016151 DOI: 10.5144/0256-4947.2024.111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Accepted: 01/01/2024] [Indexed: 04/15/2024] Open
Abstract
BACKGROUND Functional constipation (FC) is a common condition in children, and information on the clinical characteristics of FC in Saudi children is scarce. OBJECTIVE Describe the clinical profile of FC in Saudi children. DESIGN Retrospective. SETTING Hospital that provides primary, intermediate and tertiary care. PATIENTS AND METHODS All children diagnosed with FC according to the Rome IV criteria were included and had at least one follow-up clinic visit. Demographic and clinical data collected from medical records included the age at onset, duration of constipation, clinical features, treatment modalities, and factors associated with clinical response. Descriptive statistics and Pearson's chi-squared test were used in the statistical analysis to see how categorical study variables were linked to clinical response. A P value of ≤.05 was used to report statistical significance. MAIN OUTCOME MEASURE Compliance and clinical response to polyethylene glycol (PEG) compared with lactulose. SAMPLE SIZE 370 children from 0.1 to 13 years of age. RESULTS The median (IQR) age of onset was 4 (5) years and less than one year in 14%. The median (IQR) duration of constipation was 4 months (11) and less than two months in 93/370 (25%). Abdominal pain was the most commonly associated feature (44%). Screening for celiac disease and hypothyroidism was negative. A Fleet enema was the most common disimpaction method (54%) and PEG was the most common maintenance medication (63.4%). PEG was significantly better tolerated (P=.0008) and more effective than lactulose (P<.0001). Compliance was the only variable significantly associated with clinical response. CONCLUSIONS PEG was better tolerated and more effective than lactulose in our study, a finding in agreement with the literature. Therefore, PEG should be the drug of choice in the initial management of FC in Saudi children. Prospective studies on the causes of noncompliance are needed to improve the response to treatment. LIMITATIONS The limitations of retrospective design are missing data, recall bias, and hospital-based limitation, such as missing milder cases treated at the outpatient level. However, the sample size of 370 may have minimized these limitations.
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Affiliation(s)
- Mohammad El Mouzan
- From the Department of Pediatrics, King Saud University, Riyadh, Saudi Arabia
| | - Mohammed Kambal
- From the Department of Pediatrics, King Saud University, Riyadh, Saudi Arabia
| | - Hayfa Alabdulkarim
- From the Department of Pediatrics, King Saud University, Riyadh, Saudi Arabia
| | | | - Rehab Alanazi
- From the Department of Pediatrics, King Saud University, Riyadh, Saudi Arabia
| | - Ahmed Al Sarkhy
- From the Department of Pediatrics, King Saud University, Riyadh, Saudi Arabia
| | - Nouf Alhamid
- From the Department of Pediatrics, King Saud University, Riyadh, Saudi Arabia
| | | | - Alhanouf Alzahrani
- From the Department of Pediatrics, King Saud University, Riyadh, Saudi Arabia
| | - Shaffi Ahamed Shaik
- From the Department of Pediatrics, King Saud University, Riyadh, Saudi Arabia
| | - Mona Alasmi
- From the Department of Pediatrics, King Saud University, Riyadh, Saudi Arabia
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Todhunter-Brown A, Booth L, Campbell P, Cheer B, Cowie J, Elders A, Hagen S, Jankulak K, Mason H, Millington C, Ogden M, Paterson C, Richardson D, Smith D, Sutcliffe J, Thomson K, Torrens C, McClurg D. Strategies used for childhood chronic functional constipation: the SUCCESS evidence synthesis. Health Technol Assess 2024; 28:1-266. [PMID: 38343084 PMCID: PMC11017632 DOI: 10.3310/pltr9622] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/15/2024] Open
Abstract
Background Up to 30% of children have constipation at some stage in their life. Although often short-lived, in one-third of children it progresses to chronic functional constipation, potentially with overflow incontinence. Optimal management strategies remain unclear. Objective To determine the most effective interventions, and combinations and sequences of interventions, for childhood chronic functional constipation, and understand how they can best be implemented. Methods Key stakeholders, comprising two parents of children with chronic functional constipation, two adults who experienced childhood chronic functional constipation and four health professional/continence experts, contributed throughout the research. We conducted pragmatic mixed-method reviews. For all reviews, included studies focused on any interventions/strategies, delivered in any setting, to improve any outcomes in children (0-18 years) with a clinical diagnosis of chronic functional constipation (excluding studies of diagnosis/assessment) included. Dual reviewers applied inclusion criteria and assessed risk of bias. One reviewer extracted data, checked by a second reviewer. Scoping review: We systematically searched electronic databases (including Medical Literature Analysis and Retrieval System Online, Excerpta Medica Database, Cumulative Index to Nursing and Allied Health Literature) (January 2011 to March 2020) and grey literature, including studies (any design) reporting any intervention/strategy. Data were coded, tabulated and mapped. Research quality was not evaluated. Systematic reviews of the evidence of effectiveness: For each different intervention, we included existing systematic reviews judged to be low risk of bias (using the Risk of Bias Assessment Tool for Systematic Reviews), updating any meta-analyses with new randomised controlled trials. Where there was no existing low risk of bias systematic reviews, we included randomised controlled trials and other primary studies. The risk of bias was judged using design-specific tools. Evidence was synthesised narratively, and a process of considered judgement was used to judge certainty in the evidence as high, moderate, low, very low or insufficient evidence. Economic synthesis: Included studies (any design, English-language) detailed intervention-related costs. Studies were categorised as cost-consequence, cost-effectiveness, cost-utility or cost-benefit, and reporting quality evaluated using the consensus health economic criteria checklist. Systematic review of implementation factors: Included studies reported data relating to implementation barriers or facilitators. Using a best-fit framework synthesis approach, factors were synthesised around the consolidated framework for implementation research domains. Results Stakeholders prioritised outcomes, developed a model which informed evidence synthesis and identified evidence gaps. Scoping review 651 studies, including 190 randomised controlled trials and 236 primary studies, conservatively reported 48 interventions/intervention combinations. Effectiveness systematic reviews studies explored service delivery models (n = 15); interventions delivered by families/carers (n = 32), wider children's workforce (n = 21), continence teams (n = 31) and specialist consultant-led teams (n = 42); complementary therapies (n = 15); and psychosocial interventions (n = 4). One intervention (probiotics) had moderate-quality evidence; all others had low to very-low-quality evidence. Thirty-one studies reported evidence relating to cost or resource use; data were insufficient to support generalisable conclusions. One hundred and six studies described implementation barriers and facilitators. Conclusions Management of childhood chronic functional constipation is complex. The available evidence remains limited, with small, poorly conducted and reported studies. Many evidence gaps were identified. Treatment recommendations within current clinical guidelines remain largely unchanged, but there is a need for research to move away from considering effectiveness of single interventions. Clinical care and future studies must consider the individual characteristics of children. Study registration This study is registered as PROSPERO CRD42019159008. Funding This award was funded by the National Institute for Health and Care Research (NIHR) Health Technology Assessment programme (NIHR award ref: 128470) and is published in full in Health Technology Assessment; Vol. 28, No. 5. See the NIHR Funding and Awards website for further award information.
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Affiliation(s)
- Alex Todhunter-Brown
- Nursing, Midwifery and Allied Health Professions (NMAHP) Research Unit, Glasgow Caledonian University, Glasgow, UK
| | - Lorna Booth
- Nursing, Midwifery and Allied Health Professions (NMAHP) Research Unit, Glasgow Caledonian University, Glasgow, UK
| | - Pauline Campbell
- Nursing, Midwifery and Allied Health Professions (NMAHP) Research Unit, Glasgow Caledonian University, Glasgow, UK
| | - Brenda Cheer
- ERIC, The Children's Bowel and Bladder Charity, Bristol, UK
| | - Julie Cowie
- Nursing, Midwifery and Allied Health Professions (NMAHP) Research Unit, Glasgow Caledonian University, Glasgow, UK
| | - Andrew Elders
- Nursing, Midwifery and Allied Health Professions (NMAHP) Research Unit, Glasgow Caledonian University, Glasgow, UK
| | - Suzanne Hagen
- Nursing, Midwifery and Allied Health Professions (NMAHP) Research Unit, Glasgow Caledonian University, Glasgow, UK
| | | | - Helen Mason
- Yunus Centre for Social Business and Health, Glasgow Caledonian University, Glasgow, UK
| | | | | | - Charlotte Paterson
- Nursing, Midwifery and Allied Health Professions (NMAHP) Research Unit, University of Stirling, Stirling, UK
| | | | | | | | - Katie Thomson
- Nursing, Midwifery and Allied Health Professions (NMAHP) Research Unit, Glasgow Caledonian University, Glasgow, UK
- Department of Occupational Therapy, Human Nutrition and Dietetics, Glasgow Caledonian University, Glasgow, UK
| | - Claire Torrens
- Nursing, Midwifery and Allied Health Professions (NMAHP) Research Unit, University of Stirling, Stirling, UK
| | - Doreen McClurg
- Nursing, Midwifery and Allied Health Professions (NMAHP) Research Unit, Glasgow Caledonian University, Glasgow, UK
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Bautista-Casasnovas A, Argüelles-Martín F, Martín-Martínez B, Domínguez-Otero MJ, Tavares M, Amil-Dias J. Multicentre Study Into the Use of Polyethylene Glycol With Electrolytes Over at Least 6 Months to Treat Constipation in Paediatric Populations. JPGN REPORTS 2023; 4:e353. [PMID: 38034437 PMCID: PMC10684192 DOI: 10.1097/pg9.0000000000000353] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Accepted: 07/28/2023] [Indexed: 12/02/2023]
Abstract
Background Constipation is a common clinical problem in children, for which the first-line therapeutic options are osmotic laxatives, mainly polyethylene glycol (PEG). These treatments are often prescribed for short or limited periods, with progressive treatment withdrawal often resulting in relapses. However, there are a few studies into the long-term use (≥6 months) of PEG 3350 with electrolytes (PEG+E) in terms of the patients' clinical evolution. Objectives To assess bowel movement and other relevant symptoms in children with constipation receiving PEG+E (≥6 months), as well as parent/caregiver satisfaction with this treatment. Methods A retrospective, observational, descriptive, longitudinal, and multicentre study was carried out on 74 children diagnosed with functional constipation (ROME IV criteria) who had received PEG+E (≥6 months). Bowel control was assessed using the Bristol stool scale, and the parent's/caregiver's perception of the treatment was also evaluated employing a nonvalidated questionnaire. Results Children with an average duration of constipation >1 year experienced a significant improvement in bowel movements and stool consistency when using PEG+E. The mean duration of use was 18.6 (±13.4) months, without the need to adjust the dose for weight. All clinical symptoms improved significantly except bloating, and all the parents/caregivers confirmed these clinical improvements. Conclusions Children treated with PEG+E (≥6 months) normalised their bowel movements, improving the clinical symptoms related to constipation in the absence of serious advert events or the need for dosage adjustments due to weight gain. Parents/caregivers reported good satisfaction with PEG+E treatment.
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Affiliation(s)
| | | | | | | | - Marta Tavares
- Pediatric Gastroenterology Unit, Centro Infantil do Norte, Oporto
| | - Jorge Amil-Dias
- Pediatric Gastroenterology Department, Hospital Sao Joao, Oporto
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Verkuijl SJ, Trzpis M, Broens PM. The Prevalence of Bowel and Bladder Function During Early Childhood: A Population-Based Study. J Pediatr Gastroenterol Nutr 2023; 77:47-54. [PMID: 37098114 PMCID: PMC10259211 DOI: 10.1097/mpg.0000000000003804] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Accepted: 03/11/2023] [Indexed: 04/27/2023]
Abstract
OBJECTIVES Our primary aim was to determine bowel and bladder function in children aged 1 month to 7 years in the general Dutch population. Second, we aimed to identify demographic factors associated with the presence of bowel and bladder dysfunction, and their coexistence. METHODS For this cross-sectional, population-based study, parents/caregivers of children aged from 1 month to 7 years were asked to complete the Early Pediatric Groningen Defecation and Fecal Continence questionnaire. Different parameters of bowel and bladder function were assessed using validated scoring systems such as the Rome IV criteria. RESULTS The mean age of the study population (N = 791) was 3.9 ± 2.2 years. The mean age at which parents/caregivers considered their child fully toilet-trained was 5.1 ± 1.5 years. Prevalence of fecal incontinence among toilet-trained children was 12%. Overall prevalence of constipation was 14%, with a constant probability and severity at all ages. We found significant associations between fecal incontinence and constipation [odds ratio (OR) = 3.88, 95% CI: 2.06-7.30], fecal incontinence and urinary incontinence (OR = 5.26, 95% CI: 2.78-9.98), and constipation and urinary incontinence (OR = 2.06, 95% CI: 1.24-3.42). CONCLUSIONS Even though most children are fully toilet-trained at 5 years, fecal incontinence is common. Constipation appears to be common in infants, toddlers, and older children. Fecal incontinence and constipation frequently coexist and are often accompanied by urinary incontinence. Increased awareness of bowel and bladder dysfunction in infants, toddlers, and young children is required to prevent these problems from continuing at older ages.
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Affiliation(s)
- Sanne J. Verkuijl
- From the Department of Surgery, Division of Pediatric Surgery, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
- the Department of Surgery, Anorectal Physiology Laboratory, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Monika Trzpis
- the Department of Surgery, Anorectal Physiology Laboratory, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Paul M.A. Broens
- From the Department of Surgery, Division of Pediatric Surgery, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
- the Department of Surgery, Anorectal Physiology Laboratory, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
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9
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de Geus A, Koppen IJN, Flint RB, Benninga MA, Tabbers MM. An Update of Pharmacological Management in Children with Functional Constipation. Paediatr Drugs 2023; 25:343-358. [PMID: 36941393 PMCID: PMC10097737 DOI: 10.1007/s40272-023-00563-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/19/2023] [Indexed: 03/23/2023]
Abstract
Functional constipation is a common problem in childhood worldwide and has a great impact on social, physical, and emotional functioning of affected children and their caregivers. It is a clinical diagnosis based on the Rome IV criteria. Non-pharmacological treatment involves education, demystification, lifestyle advice, and toilet training. Pharmacological treatment consists of disimpaction, maintenance treatment, and eventually weaning if possible. Polyethylene glycol is considered as the first choice of laxative for both disimpaction and maintenance treatment. Different osmotic laxatives, stimulant laxatives, lubricants, and enemas are available as alternative pharmacological treatment options. Novel drugs are emerging but evidence to support the widespread application of these drugs in the pediatric population is often lacking and more high-quality research is needed in this field. If children remain symptomatic despite optimal pharmacological treatment, botulinum toxin injections in the anal sphincter can be considered as an alternative, more invasive treatment option. This review provides an update on currently available literature concerning the pharmacologic treatment of functional constipation in children.
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Affiliation(s)
- Anna de Geus
- Department of Pediatric Gastroenterology and Nutrition, Emma Children's Hospital/Academic Medical Center, Meibergdreef 9, 1105, Amsterdam, AZ, The Netherlands
| | - Ilan J N Koppen
- Department of Pediatric Gastroenterology and Nutrition, Emma Children's Hospital/Academic Medical Center, Meibergdreef 9, 1105, Amsterdam, AZ, The Netherlands
| | - Robert B Flint
- Department of Clinical Pharmacy, Erasmus MC University Medical Center, Rotterdam, The Netherlands
- Division of Neonatology, Department of Paediatrics, Erasmus University Medical Center-Sophia Children's Hospital, Rotterdam, The Netherlands
| | - Marc A Benninga
- Department of Pediatric Gastroenterology and Nutrition, Emma Children's Hospital/Academic Medical Center, Meibergdreef 9, 1105, Amsterdam, AZ, The Netherlands
| | - Merit M Tabbers
- Department of Pediatric Gastroenterology and Nutrition, Emma Children's Hospital/Academic Medical Center, Meibergdreef 9, 1105, Amsterdam, AZ, The Netherlands.
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Rajindrajith S, Devanarayana NM, Thapar N, Benninga MA. Myths and misconceptions about childhood constipation. Eur J Pediatr 2023; 182:1447-1458. [PMID: 36689003 DOI: 10.1007/s00431-023-04821-8] [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: 11/02/2022] [Revised: 01/09/2023] [Accepted: 01/13/2023] [Indexed: 01/24/2023]
Abstract
Many widely held beliefs and assumptions concerning childhood constipation continue to interfere with rational management of childhood constipation. Although many still believe that constipation is not a common disease, about 9.5% of the world's children suffer from chronic constipation. Most of these children live in non-Western countries. There are major misconceptions about the etiology of constipation as a significant proportion of clinicians still believe that constipation is caused by some form an organic pathology, whereas in reality, the majority have functional constipation. Contrary to a commonly held belief that children outgrow constipation without long-term problems, there is evidence that constipation leads to significant bowel and psychological consequences and has a major impact on the quality of life which detrimentally affects future health and education. Finally, ineffective management strategies such as increasing fiber and water in the diet, and short duration of treatment owing to the fear that long-term laxative treatment leads to colonic dysfunction, interfere with effective therapeutic strategies. Conclusions: It is apparent that myths and misconception often lead to wrong assumptions regarding the distribution of the disease, its etiology, pathophysiology, and management leading to ordering incorrect investigations and ineffective therapeutic strategies while spending large sums of public funds unnecessarily. Poorly treated constipation leads to deleterious psychological consequences predisposing children to develop significant psychological damage and bowel dysfunctions. This review aims to challenge these myths about various elements of constipation by exploring the existing literature and encouraging clinicians to have a fresh look at old concepts that could interfere with the well-being of children with constipation. What is Known: • Childhood constipation is a growing problem in the world leading to significant suffering and high healthcare expenditure • Myths and misconceptions lead to poor management strategies causing psychological and bowel damage What is New: • Organic, systemic, and bowel disorders leading to constipation are uncommon, and in the majority, it arises due to deliberate fecal withholding and most investigations ordered by clinicians are not very helpful in the management • Most non-pharmacological interventions are not effective in the day-to-day management of childhood constipation. The use of laxatives is considered to be the first-line management strategy.
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Affiliation(s)
- Shaman Rajindrajith
- Department of Pediatrics, Faculty of Medicine, University of Colombo, Colombo, 00800, Sri Lanka.
| | | | - Nikhil Thapar
- Department of Gastroenterology, Hepatology and Liver Transplant, Queensland Children's Hospital, Brisbane, Australia
| | - Marc Alexander Benninga
- Department of Pediatric Gastroenterology and Nutrition, Emma Children's Hospital, Amsterdam University Medical Center, University, of Amsterdam, Amsterdam, The Netherlands
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11
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Reppucci ML, Nolan MM, Cooper E, Wehrli LA, Schletker J, Ketzer J, Peña A, Bischoff A, De la Torre L. The success rate of antegrade enemas for the management of idiopathic constipation. Pediatr Surg Int 2022; 38:1729-1736. [PMID: 36107238 DOI: 10.1007/s00383-022-05214-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/02/2022] [Indexed: 11/29/2022]
Abstract
PURPOSE Most patients with idiopathic constipation achieve daily voluntary bowel movements with stimulant laxatives after a "Structured Bowel Management Program" (BMP). A small percentage require rectal enemas. One week in a BMP to find the right enema recipe results in a success rate great than 95%. Once the enema is radiologically and clinically effective, antegrade continent enema procedures (ACE) can afford patients an alternative route of enema administration. This study summarized the outcomes of children with idiopathic constipation who receive antegrade enemas (AE) with or without a prior BMP. METHODS This was a single institution, retrospective cohort study of children with idiopathic constipation who underwent ACE procedures indicated by different providers from 2015-2020. We categorized the outcomes with AE after the ACE procedure as: "successful outcome" when the AE produced a daily bowel movement, no involuntary bowel movements, and no more fecal impactions, "unsuccessful outcome" was defined when the patient continued having involuntary bowel movements or fecal impaction requiring cleanouts despite a daily AE, and "unnecessary outcome" was defined when the patient was no longer doing AE, but had daily bowel movements, and no involuntary bowel movements or fecal impactions. RESULTS Thirty-eight children with idiopathic constipation had an ACE. The most frequent indication for ACE was a failure of medical treatment. The most common medical treatment was polyethylene glycol. Before ACE, 34 (89%) patients did not have a BMP; 18 patients were on rectal enemas and 16 on laxatives. All four with BMP (100%) had a successful rectal enema. After ACE, 12 (31%) patients had successful antegrade enemas, including the four with previous successful BMP with rectal enemas. Twenty patients (52%) had unsuccessful antegrade enemas, and in 6 (15%), the ACE was unnecessary (Fig. 1). CONCLUSION Using antegrade enemas without a previously successful formula for rectal enemas has resulted in a high rate of unsuccessful and unnecessary procedures. BMP for children with idiopathic constipation who needs rectal enemas offers a high possibility to find the proper rectal enema recipe and ensures higher rates of successful AE.
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Affiliation(s)
- Marina L Reppucci
- International Center for Colorectal and Urogenital Care, Children's Hospital Colorado, Aurora, CO, USA
| | - Margo M Nolan
- International Center for Colorectal and Urogenital Care, Children's Hospital Colorado, Aurora, CO, USA
| | - Emily Cooper
- Research in Outcomes in Children's Surgery, Children's Hospital Colorado, Aurora, CO, USA
| | - Lea A Wehrli
- International Center for Colorectal and Urogenital Care, Children's Hospital Colorado, Aurora, CO, USA
| | - Julie Schletker
- International Center for Colorectal and Urogenital Care, Children's Hospital Colorado, Aurora, CO, USA
| | - Jill Ketzer
- International Center for Colorectal and Urogenital Care, Children's Hospital Colorado, Aurora, CO, USA
| | - Alberto Peña
- International Center for Colorectal and Urogenital Care, Children's Hospital Colorado, Aurora, CO, USA
| | - Andrea Bischoff
- International Center for Colorectal and Urogenital Care, Children's Hospital Colorado, Aurora, CO, USA
| | - Luis De la Torre
- International Center for Colorectal and Urogenital Care, Children's Hospital Colorado, Aurora, CO, USA. .,Division of Pediatric Surgery, Children's Hospital Colorado, 13213 E 16th Ave, Anschutz Medical Campus, Box 323, Aurora, CO, 80045, USA.
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12
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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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13
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Rajindrajith S, Devanarayana NM, Benninga MA. Childhood constipation: Current status, challenges, and future perspectives. World J Clin Pediatr 2022; 11:385-404. [PMID: 36185096 PMCID: PMC9516492 DOI: 10.5409/wjcp.v11.i5.385] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2021] [Revised: 12/23/2021] [Accepted: 07/06/2022] [Indexed: 02/05/2023] Open
Abstract
Constipation in children is a major health issue around the world, with a global prevalence of 9.5%. They present to clinicians with a myriad of clinical signs. The Rome IV symptom-based criteria are used to diagnose functional constipation. Functional constipation is also a huge financial burden for healthcare system and has a detrimental impact on health-related quality of life of children. There are various risk factors identified globally, including centrally connected factors such as child abuse, emotional and behavioral issues, and psychological stress. Constipation is also precipitated by a low-fiber diet, physical inactivity, and an altered intestinal microbiome. The main pathophysiological mechanism is stool withholding, while altered rectal function, anal sphincter, pelvic floor, and colonic dysfunction also play important roles. Clinical evaluation is critical in making a diagnosis, and most investigations are only required in refractory patients. In the treatment of childhood constipation, both nonpharmacological (education and de-mystification, dietary changes, toilet training, behavioral interventions, biofeedback, and pelvic floor physiotherapy), and pharmacological (osmotic and stimulant laxatives and novel drugs like prucalopride and lubiprostone) interventions are used. For children with refractory constipation, transanal irrigation, botulinum toxin, neuromodulation, and surgical treatments are reserved. While frequent use of probiotics is still in the experimental stage, healthy dietary habits, living a healthy lifestyle and limiting exposure to stressful events, are all beneficial preventive measures.
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Affiliation(s)
- Shaman Rajindrajith
- Department of Paediatrics, Faculty of Medicine, University of Colombo, Colombo 00800, Sri Lanka
- University Paediatric Unit, Lady Ridgeway Hospital for Children, Colombo 00800, Sri Lanka
| | | | - Marc A Benninga
- Department of Pediatric Gastroenterology and Nutrition, Emma Children Hospital, Amsterdam University Medical Center, Amsterdam 1105AZ, The Netherlands
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14
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de Campos GRC, Sandy NS, Lomazi EA, Bellomo-Brandao MA. Management of children with functional constipation referred to tertiary care. J Pediatr (Rio J) 2022; 98:289-295. [PMID: 34506747 PMCID: PMC9432125 DOI: 10.1016/j.jped.2021.06.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Revised: 06/03/2021] [Accepted: 06/19/2021] [Indexed: 02/07/2023] Open
Abstract
OBJECTIVES To describe the management, to compare treatment at initial referral vs. during specialized follow-up, and to describe outcomes of children with functional constipation (FC) referred to a Brazilian tertiary care center. METHODS Retrospective study, including children (4-18 years) with FC followed at a single center from 2006 to 2019. Demographics, treatments, time of follow-up, and outcomes were analyzed. The management of FC followed an institutional protocol. RESULTS 104 patients were identified, 79 were eligible and included in the analysis: 59% male, mean age at referral was 6.4 years, and mean duration of symptoms was 4.4 years. There were significant changes in the therapy(ies) used at the time of referral compared to during follow-up, with a noticeable increase in the frequency of the use of polyethylene glycol, enemas, magnesium hydroxide, and bisacodyl; 5.1% received trans-anal irrigation, and 3.8% underwent surgery. Outcomes were favorable in more than half of the cases: 31% improved; 19.5% had complete resolution and 2.5% were transferred back to primary care. Symptoms remained unchanged in 30.4%, and no patients experienced worsening of symptoms. The mean duration of follow-up was 2.8 years. When comparing patients with favorable vs. unfavorable outcomes, the authors did not identify significant differences in gender, age, therapies used, duration of symptoms, or length of follow-up. CONCLUSIONS Children with FC are often referred to specialized care not receiving optimal therapy. Many patients whose FC was labeled "refractory" may be treated successfully with a well-established plan of care, and do not truly present intractable constipation.
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Affiliation(s)
| | - Natascha Silva Sandy
- Hospital for Sick Children, University of Toronto, Division of Gastroenterology, Hepatology and Nutrition - Department of Pediatrics, Toronto, Canada
| | - Elizete Aparecida Lomazi
- Universidade Estadual de Campinas (UNICAMP), Faculdade de Ciências Médicas, Departamento de Pediatria, Campinas, SP, Brazil
| | - Maria Angela Bellomo-Brandao
- Universidade Estadual de Campinas (UNICAMP), Faculdade de Ciências Médicas, Departamento de Pediatria, Campinas, SP, Brazil.
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15
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Kaisyakuji Y, Ogawa K, Etoh T, Matsumoto H, Kono Y, Akagi T, Ninomiya S, Ueda Y, Tojigamori M, Shiroshita H, Ohno Y, Inomata M. A case of laparoscopic rectopexy for chronic organic constipation due to insufficient fixation of the rectum to the sacrum in a 14-year-old boy. JOURNAL OF PEDIATRIC SURGERY CASE REPORTS 2022. [DOI: 10.1016/j.epsc.2021.102150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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16
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Di Chio T, Sokollik C, Peroni DG, Hart L, Simonetti G, Righini-Grunder F, Borrelli O. Nutritional Aspects of Pediatric Gastrointestinal Diseases. Nutrients 2021; 13:nu13062109. [PMID: 34205445 PMCID: PMC8235230 DOI: 10.3390/nu13062109] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Revised: 06/09/2021] [Accepted: 06/15/2021] [Indexed: 12/16/2022] Open
Abstract
In the last decade, the role of nutritional management in pediatric gastrointestinal diseases has gained increasing popularity. Disease-specific diets have been introduced as conventional treatments by international guidelines. Patients tend to more willingly accept food-based therapies than drugs because of their relatively “harmless” nature. Apart from a diet’s therapeutic role, nutritional support is crucial in maintaining growth and improving clinical outcomes in pediatric patients. Despite the absence of classical “side effects”, however, it should be emphasized that any dietary modification might have negative consequences on children’s growth and development. Hence, expert supervision is always advised, in order to support adequate nutritional requirements. Unfortunately, the media provide an inaccurate perception of the role of diet for gastrointestinal diseases, leading to misconceptions by patients or their caregivers that tends to overestimate the beneficial role of diets and underestimate the potential adverse effects. Moreover, not only patients, but also healthcare professionals, have a number of misconceptions about the nutritional benefits of diet modification on gastrointestinal diseases. The aim of this review is to highlight the role of diet in pediatric gastrointestinal diseases, to detect misconceptions and to give a practical guide for physicians on the basis of current scientific evidence.
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Affiliation(s)
- Teresa Di Chio
- Pediatric Institute of Southern Switzerland, Ospedale Regionale di Bellinzona e Valli, Via Ospedale 12, 6500 Bellinzona, Switzerland;
- Correspondence: (T.D.C.); (C.S.); (F.R.-G.); (O.B.)
| | - Christiane Sokollik
- Division of Pediatric Gastroenterology, Hepatology and Nutrition, Children’s Hospital, Inselspital, University of Bern, 3010 Bern, Switzerland
- Correspondence: (T.D.C.); (C.S.); (F.R.-G.); (O.B.)
| | - Diego G. Peroni
- Department of Clinical and Experimental Medicine, Section of Pediatrics, University of Pisa, 56126 Pisa, Italy;
| | - Lara Hart
- Division of Pediatric Gastroenterology, Hepatology and Nutrition, McMaster University, Hamilton, ON L8N 3Z5, Canada;
| | - Giacomo Simonetti
- Pediatric Institute of Southern Switzerland, Ospedale Regionale di Bellinzona e Valli, Via Ospedale 12, 6500 Bellinzona, Switzerland;
- Università della Svizzera Italiana, 6900 Lugano, Switzerland
| | - Franziska Righini-Grunder
- Division of Pediatric Gastroenterology, Hepatology and Nutrition, Lucerne Children’s Hospital, Cantonal Hospital Lucerne, 6000 Lucerne, Switzerland
- Correspondence: (T.D.C.); (C.S.); (F.R.-G.); (O.B.)
| | - Osvaldo Borrelli
- Division of Neurogastroenterology and Motility, Department of Pediatric Gastroenterology, University College London (UCL) Institute of Child Health and Great Ormond Street, London WC1N 3JH, UK
- Correspondence: (T.D.C.); (C.S.); (F.R.-G.); (O.B.)
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17
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Baaleman DF, Malamisura M, Benninga MA, Bali N, Vaz KH, Yacob D, Di Lorenzo C, Lu PL. The not-so-rare absent RAIR: Internal anal sphincter achalasia in a review of 1072 children with constipation undergoing high-resolution anorectal manometry. Neurogastroenterol Motil 2021; 33:e14028. [PMID: 33301220 PMCID: PMC8047870 DOI: 10.1111/nmo.14028] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Revised: 09/21/2020] [Accepted: 10/16/2020] [Indexed: 01/01/2023]
Abstract
BACKGROUND Our objective is to describe the prevalence of patients with internal anal sphincter achalasia (IASA) without Hirschsprung disease (HD) among children undergoing anorectal manometry (ARM) and their clinical characteristics. METHODS We performed a retrospective review of high-resolution ARM studies performed at our institution and identified patients with an absent rectoanal inhibitory reflex (RAIR). Clinical presentation, medical history, treatment outcomes, and results of ARM and other diagnostic tests were collected. We compared data between IASA patients, HD patients, and a matched control group of patients with functional constipation (FC). KEY RESULTS We reviewed 1,072 ARMs and identified 109 patients with an absent RAIR, of whom 28 were diagnosed with IASA. Compared to patients with FC, patients with IASA had an earlier onset of symptoms and were more likely to have abnormal contrast enema studies. Compared to patients with HD, patients with IASA were more likely to have had a normal timing of meconium passage, a later onset of symptoms, and were diagnosed at an older age. At the latest follow-up, the majority of patients diagnosed with IASA (54%) were only using oral laxatives. Over half of patients with IASA had been treated with anal sphincter botulinum toxin injection, and 55% reported a positive response. CONCLUSIONS AND INFERENCES Patients diagnosed with IASA may represent a more severe patient population compared to patients with FC, but have a later onset of symptoms compared to patients with HD. They may require different treatments for their constipation and deserve further study.
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Affiliation(s)
- Desiree F. Baaleman
- Division of Pediatric Gastroenterology, Hepatology, and NutritionDepartment of PediatricsNationwide Children’s HospitalColumbusOHUSA
- Department of Pediatric Gastroenterology and NutritionEmma Children’s Hospital, Amsterdam UMCUniversity of Amsterdam & VU UniversityAmsterdamthe Netherlands
- Amsterdam UMCUniversity of Amsterdam, Gastroenterology and HepatologyAmsterdam Gastroenterology Endocrinology MetabolismAmsterdamthe Netherlands
| | - Monica Malamisura
- Division of Pediatric Gastroenterology, Hepatology, and NutritionDepartment of PediatricsNationwide Children’s HospitalColumbusOHUSA
- Digestive endoscopy and surgery UnitBambino Gesù Children’s Hospital IRCCSRomeItaly
| | - Marc A. Benninga
- Department of Pediatric Gastroenterology and NutritionEmma Children’s Hospital, Amsterdam UMCUniversity of Amsterdam & VU UniversityAmsterdamthe Netherlands
| | - Neetu Bali
- Division of Pediatric Gastroenterology, Hepatology, and NutritionDepartment of PediatricsNationwide Children’s HospitalColumbusOHUSA
| | - Karla H. Vaz
- Division of Pediatric Gastroenterology, Hepatology, and NutritionDepartment of PediatricsNationwide Children’s HospitalColumbusOHUSA
| | - Desale Yacob
- Division of Pediatric Gastroenterology, Hepatology, and NutritionDepartment of PediatricsNationwide Children’s HospitalColumbusOHUSA
| | - Carlo Di Lorenzo
- Division of Pediatric Gastroenterology, Hepatology, and NutritionDepartment of PediatricsNationwide Children’s HospitalColumbusOHUSA
| | - Peter L. Lu
- Division of Pediatric Gastroenterology, Hepatology, and NutritionDepartment of PediatricsNationwide Children’s HospitalColumbusOHUSA
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18
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Yamada M, Sekine M, Tatsuse T, Fujimura Y. Lifestyle, psychological stress, and incidence of adolescent constipation: results from the Toyama birth cohort study. BMC Public Health 2021; 21:47. [PMID: 33407297 PMCID: PMC7789557 DOI: 10.1186/s12889-020-10044-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Accepted: 12/10/2020] [Indexed: 12/28/2022] Open
Abstract
Background We aimed to clarify the predisposing factors for adolescent constipation in a longitudinal study, because while factors associated with childhood constipation have been reported, prospective studies on the incidence of constipation are lacking. Methods We enrolled 5540 adolescents aged 12 to 13 years from the Toyama Birth Cohort Study—a community-based prospective study examining children’s health. The incidence of constipation, defined as bowel movement frequency of less than once every 2 days, was surveyed during the three-year period from baseline (grade 4) to follow-up (grade 7). Multivariate logistic regression analyses were performed to explore the association between the incidence of adolescent constipation and their lifestyle variables. Results A total of 261 adolescents (4.7%) developed constipation during the three-year period. Female sex (odds ratio [OR] = 2.62,) overweight (OR = 0.60), and infrequent intake of fruits (OR = 1.50) at baseline were associated with the incidence of constipation. Furthermore, factors related to lifestyle changes and psychological status such as skipping breakfast (OR = 1.73), becoming physically inactive (OR = 1.55), and being persistently irritated (OR = 1.80) were significantly associated with the incidence of constipation. Conclusion Our prospective study demonstrated that female sex, insufficient fruit intake, and deteriorating lifestyles such as skipping breakfast and becoming inactive during the 3-year period were associated with the incidence of adolescent constipation. Beyond anecdotal, maintaining a healthy lifestyle is recommended to reduce the incidence of adolescent constipation. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-020-10044-5.
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Affiliation(s)
- Masaaki Yamada
- Department of Epidemiology and Health Policy, School of Medicine, University of Toyama, Toyama, Japan. 2630 Sugitani, Toyama, 930-0194, Japan.
| | - Michikazu Sekine
- Department of Epidemiology and Health Policy, School of Medicine, University of Toyama, Toyama, Japan. 2630 Sugitani, Toyama, 930-0194, Japan
| | - Takashi Tatsuse
- Department of Epidemiology and Health Policy, School of Medicine, University of Toyama, Toyama, Japan. 2630 Sugitani, Toyama, 930-0194, Japan
| | - Yuko Fujimura
- Department of Community Medicine and Health Promotion, University of Toyama, Toyama, Japan. 2630 Sugitani, Toyama, 930-0194, Japan
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19
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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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20
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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: 200] [Impact Index Per Article: 50.0] [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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21
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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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Randomized, Double-Blind, Placebo-Controlled Parallel Clinical Trial Assessing the Effect of Fructooligosaccharides in Infants with Constipation. Nutrients 2018; 10:nu10111602. [PMID: 30388751 PMCID: PMC6266108 DOI: 10.3390/nu10111602] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2018] [Revised: 10/25/2018] [Accepted: 10/26/2018] [Indexed: 01/29/2023] Open
Abstract
Constipation often begins in the first year of life. The aim of this study was to assess the effect of fructooligosaccharides (FOS) in the treatment of infants with constipation. This randomized, double-blind, placebo-controlled clinical trial included infants with constipation who were randomly assigned to one of two parallel groups: FOS or placebo. Either the FOS supplement or the placebo was added to the infant formula. Thirty-six infants completed the 4-week intervention. Therapeutic success occurred in 83.3% of the FOS group infants and in 55.6% of the control group infants (p = 0.073; one-tailed test). Compared with the control group, the FOS group exhibited a higher frequency of softer stools (p = 0.035) and fewer episodes of straining and/or difficulty passing stools (p = 0.041). At the end of the intervention, the mouth-to-anus transit time was shorter (22.4 and 24.5 h, p = 0.035), and the Bifidobacterium sp. count was higher (p = 0.006) in the FOS group. In conclusion, the use of FOS in infants with constipation was associated with significant improvement in symptoms, but the results showed no statistical significance regarding the success of the therapy compared with the control group. FOS was associated with reduced bowel transit time and higher counts of the genus Bifidobacterium in the stool.
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Gulati R, Komuravelly A, Leb S, Mhanna MJ, Ghori A, Leon J, Needlman R. Usefulness of Assessment of Stool Form by the Modified Bristol Stool Form Scale in Primary Care Pediatrics. Pediatr Gastroenterol Hepatol Nutr 2018; 21:93-100. [PMID: 29713606 PMCID: PMC5915696 DOI: 10.5223/pghn.2018.21.2.93] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2017] [Revised: 12/10/2017] [Accepted: 12/20/2017] [Indexed: 12/12/2022] Open
Abstract
PURPOSE Rome criteria are considered the gold standard for diagnosing functional constipation. The modified Bristol stool form scale (m-BSFS) was validated to measure stool form in children. However, neither the potential use of the m-BSFS as a tool to facilitate the diagnosis of potential constipation, nor the agreement between m-BSFS and stool consistency by Rome has been studied. Our objective is to determine if m-BSFS is a reliable tool to facilitat detection of constipation; and the agreement between stool form by m-BSFS and hard stool criteria in Rome. METHODS A survey tool with the Rome III criteria and the m-BSFS was developed. A Likert-scale addressed frequency of each stool form on the m-BSFS. Responses to Rome III and m-BSFS were compared. RESULTS The sensitivity and specificity of the m-BSFS was 79.2% and 66.0% respectively; and in children <4 years. improved to 81.2% and 75.0% respectively. There was poor agreement between hard stools by m-BSFS and the painful or hard bowel movement question of Rome Criteria. CONCLUSION The potential utility of m-BSFS as a reasonably good tool to facilitate the diagnosis of potential constipation in children is shown. The poor agreement between painful or hard stool question in Rome III, and ratings for hard stool on the m-BSFS illustrates that one's perception may differ between a question and a picture. A useful pictorial tool to appraise stool form may, thus, be a favorable complement in the process of enquiry about bowel habits in well-child care.
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Affiliation(s)
- Reema Gulati
- Department of Pediatrics, Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Arpitha Komuravelly
- Department of Pediatrics, Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Stephen Leb
- Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Maroun J Mhanna
- Department of Pediatrics, Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Abdullah Ghori
- Department of Pediatrics, Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Janeen Leon
- Department of Pediatrics, Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Robert Needlman
- Department of Pediatrics, Case Western Reserve University School of Medicine, Cleveland, OH, USA
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Prevalence of Functional Constipation and Relationship with Dietary Habits in 3- to 8-Year-Old Children in Japan. Gastroenterol Res Pract 2018; 2018:3108021. [PMID: 29681930 PMCID: PMC5848140 DOI: 10.1155/2018/3108021] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2017] [Revised: 08/24/2017] [Accepted: 12/31/2017] [Indexed: 12/27/2022] Open
Abstract
Objectives To determine the prevalence and effect of dietary habits on functional constipation in preschool and early elementary school children in Japan. Study Design A total of 3595 children aged 3 to 8 years from 28 nursery schools and 22 elementary schools in Yokohama City, Kanagawa Prefecture, Japan, were evaluated. The subjects were divided into a functional constipation group and a nonfunctional constipation group according to the Rome III criteria. Dietary intake data were collected using a brief-type, self-administered, diet-history questionnaire validated for Japanese preschool-aged children. Results Of the 3595 subjects evaluated, 718 (20.0%) had functional constipation. The association between functional constipation and gender was not statistically significant (p = 0.617). A decrease in bowel frequency was observed in 15.9% of those with functional constipation. There was no significant difference in the proportion of participants in the constipation group by age (p = 0.112). Binomial logistic regression analysis indicated that only fat per 100 kcal positively correlated with functional constipation [odds ratio = 1.216, 95% confidence interval: 1.0476–1.412]. Conclusions Functional constipation is common among children in preschool and early elementary school in urban areas of Japan. Parents should pay attention to constipation-related symptoms other than defecation frequency. A high-fat diet should be avoided to prevent functional constipation.
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Investigation of Demographic and Clinical Characteristics of Children with Constipation Referring to the Pediatric Gastrointestinal Clinic, Shiraz in 2014 - 2016. ACTA ACUST UNITED AC 2018. [DOI: 10.5812/semj.13669] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
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Heron J, Grzeda M, Tappin D, von Gontard A, Joinson C. Early childhood risk factors for constipation and soiling at school age: an observational cohort study. BMJ Paediatr Open 2018; 2:e000230. [PMID: 29637194 PMCID: PMC5843013 DOI: 10.1136/bmjpo-2017-000230] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2017] [Revised: 01/04/2018] [Accepted: 01/06/2018] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVE Constipation and soiling are common in childhood. This study examines the comorbidity between childhood constipation and soiling and early childhood risk factors for these problems. DESIGN The sample comprised 8435 participants from the Avon Longitudinal Study of Parents and Children with maternally reported measures of constipation (six time points between 4 and 10 years) and soiling (five time points between 4 and 9 years). We used latent class analysis to extract longitudinal patterns of constipation and soiling. We examined whether the latent classes are differentially associated with maternally reported risk factors in early childhood (stool consistency, breast feeding, socioeconomic background, gestation, birth weight, developmental level and age at initiation of toilet training) using multinomial logistic regression models. RESULTS We extracted four latent classes: 'normative' (74.5%: very low probability of constipation or soiling), 'constipation alone' (13.2%), 'soiling alone' (7.5%) and 'constipation with soiling' (4.8%). Hard stools at 2½ years were associated with increased odds of constipation alone. Developmental delay at 18 months was associated soiling alone and constipation with soiling, but not constipation alone. We found limited evidence of associations with socioeconomic background and no evidence of associations with age at initiation of toilet training, breast feeding, gestational age or birth weight. CONCLUSION Constipation alone was the most prevalent pattern in this cohort. Treatment for hard stools in early childhood is needed to prevent chronic constipation at school age. Constipation with soiling was less common than soiling alone. Further research is needed into the causes of non-retentive soiling.
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Affiliation(s)
- Jon Heron
- Department of Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Mariusz Grzeda
- Department of Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - David Tappin
- Department of Child Health, School of Medicine, Scottish Cot Death Trust, University of Glasgow, Glasgow, UK
| | - Alexander von Gontard
- Department of Child and Adolescent Psychiatry, Saarland University Hospital, Homburg, Germany
| | - Carol Joinson
- Department of Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
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Abstract
PURPOSE There is a scarcity of literature, and prevalent misconceptions about constipation in India. METHODS A literature search in PubMed was conducted with regard to epidemiology, clinical features, and management of constipation. Special emphasis was paid to functional constipation and refractory constipation. English language studies available full text over the last 25 years were considered and relevant information was extracted. CONCLUSIONS Estimated prevalence of constipation is 3% among toddlers and pre-school children worldwide and 95%, of them are considered functional. A careful history and thorough physical examination is all that is required to diagnose functional constipation. Management includes disimpaction followed by maintenance therapy with oral laxative, dietary modification and toilet training. A close and regular follow-up is necessary for successful treatment. In most of the cases laxative needs to be continued for several months and sometimes years. Early withdrawal of laxative is the commonest cause of recurrence. Refractory constipation is less common in primary care set up. Radiological colon transit study is useful in picking up Slow transit constipation. Antegrade continence enema plays an important role in the management of slow transit constipation.
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Abstract
BACKGROUND Obesity and functional constipation seem to share a common biopsychosocial model of causation. Though chronic constipation can significantly affect the quality of life of an overweight child, this association has not been highlighted in the literature. The purpose of this study was to compare the proportion of overweight children among children with chronic constipation with a control group of children with normal bowel habits. METHODS Retrospective chart review with a control population. One hundred one consecutive children 5-18 years of age referred to the Subspecialty Clinic for functional constipation were the study group. The control group consisted of 100 consecutive children from the general pediatric practice seen for physicals and minor illnesses. Children with a body mass index (BMI) of >85 percentile from the National Institutes of Health (NIH) 2000 chart were classified as overweight. RESULTS The control and study groups were statistically comparable in mean age (10.97 +/- 3.83 years and 8.07 +/- 2.56 years, respectively) and gender ratio (58 males in each group). Thirty children in the control group and 44 in the study population were overweight (p < .05). Among children with chronic constipation, the group of overweight children was male predominant (70.45% vs 47.36%, p < .05), had increased incidence of psychological/behavioral problems (45.45% vs 22.8%, p < .05), and was more likely to fail treatment (40.9% vs 21.05%, p < .05). There was no significant difference in the clinical profile of constipation, such as mean duration of constipation before presentation, sex ratio, incidence of painful defecation, and soiling and frequency of defecation between these 2 groups. CONCLUSIONS There appears to be an association between chronic severe constipation and being overweight. Children with constipation are more likely to be overweight when compared with controls. Among children with chronic constipation, overweight individuals seem to constitute a distinct clinical group. This group is male predominant, has increased incidence of psychological/behavioral disorders, and is more likely to fail treatment.
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Affiliation(s)
- Sudipta Misra
- Division of Pediatric Gastroenterology, Hepatology and Nutrition, Department of Pediatrics, UIC College of Medicine at Peoria, 320 E. Armstrong, Peoria, IL, USA.
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Chronic Functional Constipation and Encopresis in Children in Relationship with the Psychosocial Environment. Gastroenterol Res Pract 2016; 2016:7828576. [PMID: 27990158 PMCID: PMC5136637 DOI: 10.1155/2016/7828576] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2016] [Accepted: 09/25/2016] [Indexed: 01/17/2023] Open
Abstract
Functional constipation is an issue for both the patient and his/her family, affecting the patient's psychoemotional balance, social relations, and their harmonious integration in the school environment. We aimed to highlight the connection between chronic constipation and encopresis and the patient's psychosocial and family-related situation. Material and Method. 57 patients with ages spanning from 6 to 15 were assessed within the pediatric gastroenterology ward. Sociodemographic, medical, and psychological data was recorded. The collected data was processed using the SPSS 20 software. Results. The study group consisted of 57 children diagnosed with encopresis (43 boys (75.44%) and 14 girls (24.56%)), M = 10.82 years. It was determined that most of the children came from urban families with a poor socioeducational status. We identified a level of studies of 11.23 ± 5.56 years in mothers, while fathers had an average number of 9.35 ± 4.53 years of study. We also found a complex relationship between encopretic episodes and school performances (F = 7.968, p = 0.001, 95% Cl). Children with encopresis were found to have more anxiety/depression symptoms, greater social problems, more disruptive behavior, and poorer school performance. Conclusions. The study highlights the importance of the family environment and socioeconomic factors in manifestations of chronic constipation and encopresis.
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Ulusoy E, Arslan N, Küme T, Ülgenalp A, Çirali C, Bozkaya Ö, Ercal D. Serum motilin levels and motilin gene polymorphisms in children with functional constipation. Minerva Pediatr (Torino) 2016; 73:420-425. [PMID: 27706119 DOI: 10.23736/s2724-5276.16.04369-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND Functional constipation is an important clinical problem among chidren all over the world. Its main cause is not completely understood. Motilin is a gastrointestinal hormone that increases intestinal motility. In this study, we aimed to investigate the serum motilin levels and its relationship with stool consistency and motilin gene polymorphisms in constipated children. METHODS In this study we investigated 91 constipated patients (mean age 6.84±3.55 years) and 100 healthy controls (mean age 7.78±4.25 years). Serum motilin levels were assessed by sandwich enzyme-linked immunosorbent assay. rs2281820 (c.44 C>T) and rs2281818 (c.66 C>T) mutations were evaluated for motilin gene polymorphisms. RESULTS Serum motilin levels were significantly lower in constipated children than healthy controls (6.20±7.86 vs. 11.54±17.89 pg/mL, respectively, P=0.008). Serum motilin levels were significantly correlated with Bristol stool scale rate (r=0.193, P=0.011) in whole study group, but in the constipation group there was no significant correlation (r=-0.072, P=0.528). There were no differences in terms of presence or distribution of the polymorphisms of rs2281820 (c.44 C>T) and rs2281818 (c.66 C>T) in both groups. There was not a significant difference between different polymorphism groups regarding serum motilin concentrations in whole study group and also in both of the study groups. CONCLUSIONS This study indicated for the first time that serum motilin levels decreased in constipated children. Further studies are needed to clarify whether motilin or motilin gene polymorphisms has a role in pathogenesis of functional constipation.
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Affiliation(s)
- Emel Ulusoy
- Division of Pediatric Emergency Care, Department of Pediatrics, Dokuz Eylül University, School of Medicine, Izmir, Turkey
| | - Nur Arslan
- Division of Pediatric Gastroenterology, Nutrition and Metabolism, Department of Pediatrics, Dokuz Eylül University, School of Medicine, Izmir, Turkey -
| | - Tuncay Küme
- Department of Biochemistry, Dokuz Eylül University, School of Medicine, Izmir, Turkey
| | - Ayfer Ülgenalp
- Division of Genetics, Department of Pediatrics, Dokuz Eylül University, School of Medicine, Izmir, Turkey
| | - Ceren Çirali
- Department of Pediatrics, Dokuz Eylül University, School of Medicine, Izmir, Turkey
| | - Özlem Bozkaya
- Division of Genetics, Department of Pediatrics, Dokuz Eylül University, School of Medicine, Izmir, Turkey
| | - Derya Ercal
- Division of Genetics, Department of Pediatrics, Dokuz Eylül University, School of Medicine, Izmir, Turkey
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Abstract
In the United States, the Best Pharmaceuticals for Children Act and the Pediatric Research Equity Act continue to promote clinical trials in pediatric populations across all age ranges. In 2014 and 2015, over 70 changes were made to drug labels with updates on information regarding pediatric populations. Additionally, multiple new therapies have received first-approvals for the treatment of pediatric indications ranging form rare genetic metabolic diseases to oncology. In the European Union, there have been more than 30 new authorizations for medicines used in children and 130 approved pediatric investigation plans. Despite the progress that has been made over the last two years, much work remains to further the development of safe and effective therapies for pediatric patients.
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Affiliation(s)
- Laura A Wang
- Duke Clinical Research Institute, Duke University Medical Center, 2400 Pratt Street, Durham, NC 27705, USA
| | - Michael Cohen-Wolkowiez
- Duke Clinical Research Institute, Duke University Medical Center, 2400 Pratt Street, Durham, NC 27705, USA; Department of Pediatrics, Children's Health Center, College of Medicine, Duke University, T901, Durham, NC 27705, USA.
| | - Daniel Gonzalez
- Division of Pharmacotherapy and Experimental Therapeutics, UNC Eshelman School of Pharmacy, University of North Carolina at Chapel Hill, 301 Pharmacy Lane, CB #7569, Chapel Hill, NC 27599, USA
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Mantegazzi LS, Seliner B, Imhof L. Constipation prophylaxis in children undergoing orthopedic surgery: A quasi-experimental study. J SPEC PEDIATR NURS 2016; 21:109-18. [PMID: 27221041 DOI: 10.1111/jspn.12145] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2015] [Revised: 03/18/2016] [Accepted: 03/20/2016] [Indexed: 12/21/2022]
Abstract
PURPOSE This study evaluated the effectiveness of constipation prophylaxis administered with the support of an advanced practice nurse. DESIGN A quasi-experimental study with a historical control group of 112 pediatric (age 1-18) orthopedic patients and an intervention group of 59 patients was conducted in a surgical ward in Switzerland. RESULTS The implementation of a standardized constipation prophylaxis led to an absolute risk reduction (27%) of constipation. Fisher's exact test showed a significant difference in the prevalence of constipation in the two samples, p = .001. PRACTICE IMPLICATIONS Constipation prophylaxis is a necessity in pediatric orthopedics.
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Affiliation(s)
| | - Brigitte Seliner
- APN in Continence and Rehabilitation Care, University Children's Hospital Zurich, Zurich, Switzerland
| | - Lorenz Imhof
- Professor and Head of Research and Development, Institute of Nursing, Zurich University of Applied Sciences, and Institute of Nursing, School of Health Professions, Zurich University of Applied Sciences, Winterthur, Switzerland
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Abstract
Pediatricians and other child care providers manage a large number of children with constipation, a recurrent medical problem that is frustrating to patients, their care givers, and the health care providers themselves. Most often the constipation in children is functional in nature, and only a very small percentage of patients have an organic cause for it. In this review, we discuss the epidemiology, causes, evaluation, and management of children with functional constipation. [Pediatr Ann. 2016;45(5):e189-e196.].
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Abstract
OBJECTIVES The aim of the study was to review published evidence and the opinion of practising clinicians on the prevalence and long-term health consequences of functional gastrointestinal symptoms in infants younger than 12 months. METHODS PubMed was searched from inception to November 2014 to find articles reporting the prevalence and long-term health outcomes of infantile colic, regurgitation, functional constipation, functional diarrhoea, and dyschezia in infants younger than <12 months. A questionnaire was sent to practising clinicians worldwide, and a group of 15 international experts met to discuss the likely frequency and longer-term consequences of these symptoms. RESULTS The literature search identified 30 studies reporting the prevalence of infantile colic (2%-73%), 13 that of regurgitation (3%-87%), 8 that of functional constipation (0.05%-39.3%), 2 that of functional diarrhoea (2%-4.1%), and 3 that of dyschezia (0.9%-5.6%). The studies varied in design, populations investigated, and definition of the symptoms. Questionnaires were received from 369 respondents. The experts agreed that the likely prevalences for colic, regurgitation, and functional constipation were 20%, 30%, and 15%, respectively. The limited data in the literature for functional diarrhoea and dyschezia suggest prevalences <10%. Infantile colic may be associated with future health problems in a subset of infants. CONCLUSIONS Functional gastrointestinal symptoms appear to occur in a significant proportion of infants younger than 12 months and may have an impact on future health outcomes. Prospective collection of data according to agreed criteria is needed to obtain more accurate estimates of the prevalence and consequences of these symptoms.
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Kovacic K, Sood MR, Mugie S, Di Lorenzo C, Nurko S, Heinz N, Ponnambalam A, Beesley C, Sanghavi R, Silverman AH. A multicenter study on childhood constipation and fecal incontinence: effects on quality of life. J Pediatr 2015; 166:1482-7.e1. [PMID: 26008173 DOI: 10.1016/j.jpeds.2015.03.016] [Citation(s) in RCA: 56] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2014] [Revised: 01/16/2015] [Accepted: 03/09/2015] [Indexed: 12/13/2022]
Abstract
OBJECTIVE To describe the effects of childhood functional constipation compared with functional constipation plus fecal incontinence on quality of life, evaluating effects on physical, psychosocial, and family functioning. STUDY DESIGN This prospective, multicenter study collected data from 5 regional children's hospitals. Children meeting Rome III criteria for functional constipation were included. Parents completed the following 5 instruments: Pediatric Quality of Life Inventory (PedsQL), PedsQL-Family Impact Module, Functional Disability Inventory-Parent Version, Pediatric Inventory for Parents (PIP), and Pediatric Symptom Checklist-Parent Report. RESULTS Families of 410 children aged 2-18 years (mean [SD], 7.8 [3.5] years; 52% male) were included. Children with functional constipation+fecal incontinence had worse quality of life than children with functional constipation alone (PedsQL Total Score, P ≤ .03). Older children with functional constipation + fecal incontinence had lower quality of life than their younger counterparts (PedsQL Total Score, P ≤ .047). Children with functional constipation+fecal incontinence had worse family functioning (PedsQL-Family Impact Module Total Score, P ≤ .012), greater parental stress (PIP-F Total Score, P ≤ .016; PIP-D Total Score, P ≤ .013), and poorer psychosocial functioning (Pediatric Symptom Checklist Total Score, P ≤ .003). There were no statistically significant between-group differences in physical functioning based on the functional Disability Inventory. CONCLUSION Fecal incontinence significantly decreases quality of life compared with functional constipation alone in children. Older children with functional constipation+fecal incontinence may be at particular risk. Strategies for early identification and treatment of constipation along with diagnosis and treatment of related adjustment difficulties may mitigate the negative impact of this highly prevalent condition.
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Affiliation(s)
- Katja Kovacic
- Center for Pediatric Neurogastroenterology, Motility, and Autonomic Disorders, Medical College of Wisconsin, Milwaukee, WI
| | - Manu R Sood
- Center for Pediatric Neurogastroenterology, Motility, and Autonomic Disorders, Medical College of Wisconsin, Milwaukee, WI
| | - Suzanne Mugie
- Division of Pediatric Gastroenterology, Nationwide Children's Hospital, Columbus, OH
| | - Carlo Di Lorenzo
- Division of Pediatric Gastroenterology, Nationwide Children's Hospital, Columbus, OH
| | - Samuel Nurko
- Center for Motility and Functional Gastrointestinal Disorders, Boston Children's Hospital, Boston, MA
| | - Nicole Heinz
- Center for Motility and Functional Gastrointestinal Disorders, Boston Children's Hospital, Boston, MA
| | - Ananthasekar Ponnambalam
- Division of Pediatric Gastroenterology, University of South Alabama Children's and Women's Hospital, Mobile, AL
| | - Christina Beesley
- Center for Pediatric Neurogastroenterology, Motility, and Autonomic Disorders, Medical College of Wisconsin, Milwaukee, WI
| | - Rina Sanghavi
- Division of Pediatric Gastroenterology, University of Texas Southwestern Medical Center, Dallas, TX
| | - Alan H Silverman
- Center for Pediatric Neurogastroenterology, Motility, and Autonomic Disorders, Medical College of Wisconsin, Milwaukee, WI
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Farahmand F, Abedi A, Esmaeili-Dooki MR, Jalilian R, Tabari SM. Pelvic Floor Muscle Exercise for Paediatric Functional Constipation. J Clin Diagn Res 2015; 9:SC16-7. [PMID: 26284199 DOI: 10.7860/jcdr/2015/12726.6036] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2014] [Accepted: 03/29/2015] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Functional constipation (FC) is one of the most common gastrointestinal problems among children. This study was designed to investigate the effectiveness of pelvic floor muscle exercise on treatment of FC. MATERIALS AND METHODS In this study which was conducted in Children's Medical Center, children with a diagnosis of FC (aged 4-18 y) who did not respond to medical treatment, performed sessions of pelvic floor muscle exercise at home twice a day for 8 wk. Frequency of defecation, overall improvement of constipation, stool withholding, painful defecation and stool consistency were measured at the final week of the intervention compared to baseline. RESULTS Forty children (16 males, 24 females mean age 5.6±1.03 y) completed the 8-wk exercise program. Subjective overall improvement of the symptoms was present in 36 patients (90%). The changes in stool frequency, stool diameter and consistency were statistically significant. However, there were no statistically significant differences in the stool withholding, fecal impaction, fecal incontinence and painful defecation. CONCLUSION Pelvic floor muscle exercise is an effective non-pharmacologic treatment for Paediatric FC.
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Affiliation(s)
- Fatemeh Farahmand
- Faculty, Department of Paediatric, Gastroenterology, Children Medical Center, Tehran University of Medical Sciences , Tehran, Iran
| | - Aidin Abedi
- Faculty, Department of Paediatric, Tehran University of Medical Sciences , Tehran, Iran
| | - Mohammad Reza Esmaeili-Dooki
- Faculty, Department of Paediatric, Non-Communicable Pediatric Diseases Research Center, Health Research Institute, Babol University of Medical Sciences , Babol, IR Iran
| | - Rozita Jalilian
- Faculty, Department of Paediatric, Tehran University of Medical Sciences , Tehran, Iran
| | - Sanaz Mehrabani Tabari
- Faculty, Department of Paediatric, Non-Communicable Pediatric Diseases Research Center, Health Research Institute, Babol University of Medical Sciences , Babol, IR Iran
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Park R, Mikami S, LeClair J, Bollom A, Lembo C, Sethi S, Lembo A, Jones M, Cheng V, Friedlander E, Nurko S. Inpatient burden of childhood functional GI disorders in the USA: an analysis of national trends in the USA from 1997 to 2009. Neurogastroenterol Motil 2015; 27:684-92. [PMID: 25809794 PMCID: PMC5549670 DOI: 10.1111/nmo.12542] [Citation(s) in RCA: 66] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2014] [Accepted: 02/16/2015] [Indexed: 12/12/2022]
Abstract
BACKGROUND Functional gastrointestinal disorders (FGIDs) are among the most common outpatient diagnoses in pediatric primary care and gastroenterology. There is limited data on the inpatient burden of childhood FGIDs in the USA. The aim of this study was to evaluate the inpatient admission rate, length of stay (LoS), and associated costs related to FGIDs from 1997 to 2009. METHODS We analyzed the Kids' Inpatient Sample Database (KID) for all subjects in which constipation (ICD-9 codes: 564.0-564.09), abdominal pain (ICD-9 codes: 789.0-789.09), irritable bowel syndrome (IBS) (ICD-9 code: 564.1), abdominal migraine (ICD-9 code: 346.80 and 346.81) dyspepsia (ICD-9 code: 536.8), or fecal incontinence (ICD-codes: 787.6-787.63) was the primary discharge diagnosis from 1997 to 2009. The KID is the largest publicly available all-payer inpatient database in the USA, containing data from 2 to 3 million pediatric hospital stays yearly. KEY RESULTS From 1997 to 2009, the number of discharges with a FGID primary diagnosis increased slightly from 6,348,537 to 6,393,803. The total mean cost per discharge increased significantly from $6115 to $18,058 despite the LoS remaining relatively stable. Constipation and abdominal pain were the most common FGID discharge diagnoses. Abdominal pain and abdominal migraine discharges were most frequent in the 10-14 year age group. Constipation and fecal incontinence discharges were most frequent in the 5-9 year age group. IBS discharge was most common for the 15-17 year age group. CONCLUSIONS & INFERENCES Hospitalizations and associated costs in childhood FGIDs have increased in number and cost in the USA from 1997 to 2009. Further studies to determine optimal methods to avoid unnecessary hospitalizations and potentially harmful diagnostic testing are indicated.
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Affiliation(s)
- Richard Park
- Department of Medicine, Division of Gastroenterology, Beth Israel Deaconess Medical Center, Boston, MA
| | - Sage Mikami
- Department of Medicine, Division of Gastroenterology, Beth Israel Deaconess Medical Center, Boston, MA
| | - Jack LeClair
- Department of Medicine, Division of Gastroenterology, Beth Israel Deaconess Medical Center, Boston, MA
| | - Andrea Bollom
- Department of Medicine, Division of Gastroenterology, Beth Israel Deaconess Medical Center, Boston, MA
| | - Cara Lembo
- Department of Medicine, Division of Gastroenterology, Beth Israel Deaconess Medical Center, Boston, MA
| | - Saurabh Sethi
- Department of Medicine, Division of Gastroenterology, Beth Israel Deaconess Medical Center, Boston, MA
| | - Anthony Lembo
- Department of Medicine, Division of Gastroenterology, Beth Israel Deaconess Medical Center, Boston, MA
| | - Mike Jones
- Macquarie University, Sydney, New South Wales, Australia
| | - Vivian Cheng
- Department of Medicine, Division of Gastroenterology, Beth Israel Deaconess Medical Center, Boston, MA
| | - Elizabeth Friedlander
- Department of Medicine, Division of Gastroenterology, Beth Israel Deaconess Medical Center, Boston, MA
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Campeotto F. Les mesures diététiques dans la constipation: toujours d'actualité? Arch Pediatr 2015; 22:111-2. [DOI: 10.1016/s0929-693x(15)30056-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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van Dijk M, de Vries GJ, Last BF, Benninga MA, Grootenhuis MA. Parental child-rearing attitudes are associated with functional constipation in childhood. Arch Dis Child 2015; 100:329-33. [PMID: 25359759 DOI: 10.1136/archdischild-2014-305941] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
OBJECTIVE Parenting factors are assumed to play a role in the development and maintenance of childhood constipation. However, knowledge about the association between parenting factors and childhood constipation is limited. This study investigates the association between parental child-rearing attitudes and prominent symptoms of functional constipation and assesses the strength of this association. DESIGN Cross-sectional data of 133 constipated children and their parents were collected. SETTING The gastrointestinal outpatient clinic at the Emma Children's Hospital in the Netherlands. PATIENTS Children with functional constipation aged 4-18 years referred by general practitioners, school doctors and paediatricians. MAIN OUTCOME MEASURES Parental child-rearing attitudes were assessed by the Amsterdam version of the Parental Attitude Research Instrument (A-PARI). Symptoms of constipation in the child were assessed by a standardised interview. Negative binomial and logistic regression models were used to test the association between child-rearing attitudes and constipation symptoms. RESULTS Parental child-rearing attitudes are associated with defecation and faecal incontinence frequency. Higher and lower scores on the autonomy attitude scale were associated with decreased defecation frequency and increased faecal incontinence. High scores on the overprotection and self-pity attitude scales were associated with increased faecal incontinence. More and stronger associations were found for children aged ≥6 years than for younger children. CONCLUSIONS Parental child-rearing attitudes are associated with functional constipation in children. Any parenting issues should be addressed during treatment of children with constipation. Referral to mental health services is needed when parenting difficulties hinder treatment or when the parent-child relationship is at risk. TRIAL REGISTRATION NUMBER ISRCTN2518556.
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Affiliation(s)
- Marieke van Dijk
- Psychosocial Department, Emma Children's Hospital/Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
| | - Giel-Jan de Vries
- Psychosocial Department, Emma Children's Hospital/Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands Department of Paediatric Gastroenterology and Nutrition, Emma Children's Hospital/Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands Department of Developmental Psychology, Vrije Universiteit, Amsterdam, The Netherlands Department of Psychiatry, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
| | - Bob F Last
- Psychosocial Department, Emma Children's Hospital/Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands Department of Developmental Psychology, Vrije Universiteit, Amsterdam, The Netherlands
| | - Marc A Benninga
- Department of Paediatric Gastroenterology and Nutrition, Emma Children's Hospital/Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
| | - Martha A Grootenhuis
- Psychosocial Department, Emma Children's Hospital/Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
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Bidirectional associations between fussy eating and functional constipation in preschool children. J Pediatr 2015; 166:91-6. [PMID: 25443999 DOI: 10.1016/j.jpeds.2014.09.028] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2014] [Revised: 08/12/2014] [Accepted: 09/17/2014] [Indexed: 01/02/2023]
Abstract
OBJECTIVE To examine bidirectional associations between a child's fussy eating behavior and functional constipation. STUDY DESIGN Participants were 4823 children enrolled in a prospective cohort study from pregnancy onward. We assessed fussy eating at age 4 years with the Child Eating Behavior Questionnaire, and assessed functional constipation using ROME II and III criteria with parental questionnaires at age 2, 3, 4, and 6 years. RESULTS Higher food fussiness at age 4 years was associated with a greater risk of functional constipation at both 4 years (OR, 1.30; 95% CI, 1.20-1.42; P < .001 per 1 SD increase) and 6 years (OR, 1.12; 95% CI, 1.03-1.23; P < .05 per 1 SD increase). The converse was also observed; previous constipation predicted a greater risk of being a fussy eater at age 4 years (constipation at 2 years: OR, 2.05; 95% CI 1.43-2.94; P < .001; constipation at 3 years: OR, 1.72; 95% CI, 1.26-2.35, P < .001). Path analyses confirmed that the association between fussy eating and functional constipation was indeed bidirectional, showing that functional constipation at age 3 years predicted fussy eater classification at age 4 years (β = 0.06; P < .001), which in turn predicted functional constipation at age 6 years (β = 0.08: P < .001) independent of each other. CONCLUSION A vicious cycle might develop in which children with functional constipation develop unhealthy eating behavior, which in turn increases the risk of functional gastrointestinal disease.
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Dehghani SM, Kulouee N, Honar N, Imanieh MH, Haghighat M, Javaherizadeh H. Clinical Manifestations among Children with Chronic Functional Constipation. Middle East J Dig Dis 2015; 7:31-5. [PMID: 25628851 PMCID: PMC4293798] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2014] [Accepted: 11/12/2014] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Constipation is one of the most frequent cause of patient visits to pediatric gastroenterology clinics. Early diagnosis and treatment is important. There are few studies about clinical manifestations of constipation in children. We aimed to find the relative frequency of gastrointestinal manifestations of constipation among constipated children. METHODS This cross-sectional study was carried out on children aged < 18 years old with chronic functional constipation referred to Imam Reza Clinic of Shiraz University of Medical Sciences. Children with organic causes of chronic constipation were excluded from study. Rome III criteria were used for defining constipation. The duration of study was 1 year starting from September 2010. Abdominal pain, fecal mass, rectal bleeding, anorexia, fecal soiling, retentive posture, withholding behavior, anal fissure, and peri-anal erythema were recorded for each case based on history and physical examination. Data were analyzed using SPSS software, version 13.0 (Chicago, IL, USA). RESULTS Of 222 children with functional constipation, 124(55.9%) were girls and 98 (44.1%) were boys with a mean ± SD age of 5±3.12 years. The mean ± SD duration of constipation was 2.2±1.9 years. Large and hard stool was present in 93.7% of the patients. Painful defecation and withholding behavior were seen in 92.3% and 91.9% of the patients, respectively. Fecal impaction was more frequent among boys compared with girls (p<0.01). Fecal soiling was present in 40.8% of the boys and 28.2% of the girls (p=0.04). CONCLUSION Large and hard stool, painful defecation and withholding behavior were the most frequent signs or symptoms among children with chronic functional constipation. Fresh rectal bleeding and anal fissure were the least frequent signs and symptoms in this group.
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Affiliation(s)
- Seyed Mohsen Dehghani
- 1. Professor, Gastroenterohepatology Research Center, Shiraz Transplant Research Center, Nemazee Teaching Hospital, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Niloofar Kulouee
- 2. Medical Student, Department of Pediatric Gastroenterology, Nemazee Teaching Hospital, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Naser Honar
- 3. Assistant Professor, Department of Pediatric Gastroenterology, Gastroenterohepatology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran .
| | - Mohammad-Hadi Imanieh
- 1. Professor, Gastroenterohepatology Research Center, Shiraz Transplant Research Center, Nemazee Teaching Hospital, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mahmood Haghighat
- 1. Professor, Gastroenterohepatology Research Center, Shiraz Transplant Research Center, Nemazee Teaching Hospital, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Hazhir Javaherizadeh
- 4. Fellow of Pediatric Gastroenterology, Gastroenterohepatology Reseach Center, Nemazee Teaching Hospital, Shiraz University of Medical Sciences, Shiraz, Iran
, Corresponding Author: Hazhir Javaherizadeh, MD Gastroenterohepatology Reseach Center, Nemazee Teaching Hospital, Shiraz University of Medical Sciences, Shiraz, Iran Tel: + 98 711 36474298 Fax:+ 98 711 36474298
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Altamimi E. Clinical characteristics of pediatric constipation in South jordan. Pediatr Gastroenterol Hepatol Nutr 2014; 17:155-61. [PMID: 25349831 PMCID: PMC4209320 DOI: 10.5223/pghn.2014.17.3.155] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2014] [Revised: 04/15/2014] [Accepted: 07/04/2014] [Indexed: 11/22/2022] Open
Abstract
PURPOSE Constipation is a common pediatric problem worldwide. This study aims to describe the clinical characteristics of pediatric constipation in south Jordan according to gender and age group. METHODS All patients with constipation managed at our pediatric gastroenterology service between September 2009 and December 2012 were included. Hospital charts were reviewed. Demographic data, clinical characteristics, and final diagnosis were recorded. Data were analyzed according to gender and the following age groups: infants, pre-school, school age, and adolescents. RESULTS During the study period, 126 patients were enrolled. The number (percentage) of patients according to age were the following infants: 43 (34.1%), pre-school: 55 (43.7%), school age: 25 (19.8%), and adolescents: 3 (2.4%). Males made up 54.8% of the study population. There were no statistical gender differences in any age group. The most common symptom in all age groups was dry, hard stool. Infrequent defecation was found in almost one-half of the patients. Fecal incontinence was more common in school-aged children compared to pre-school-aged children and adolescents. Abdominal pain was seen in almost 40% of the constipated children. Abdominal pain was more prevalent in girls and older children. Fecal mass in the rectum was the most common physical finding, with constipated boys exhibiting higher rates. Functional constipation was the most common etiology. CONCLUSION Clinical characteristics of constipation in children vary according to age group and gender. Older children had less frequent bowel motions, a longer duration of symptoms, and a higher prevalence of long-standing constipation compilations (fecal incontinence and abdominal pain).
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Affiliation(s)
- Eyad Altamimi
- Department of Pediatrics, Mu`tah University, Al Karak, Jordan
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Kammacher Guerreiro M, Bettinville A, Herzog D. Fecal overflow often affects children with chronic constipation that appears after the age of 2 years. Clin Pediatr (Phila) 2014; 53:885-9. [PMID: 24860106 DOI: 10.1177/0009922814535659] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Chronic functional constipation with or without encopresis is a common problem in the pediatric population, and the prevalence of encopresis may be underestimated. The aim of this study was to assess the prevalence and risk factors for overflow incontinence in patients with chronic constipation seen at a pediatric gastroenterology consultation. A retrospective study of 270 files of patients seen between 1997 and 2012 was conducted, and a classification according to Rome III criteria was done. Among 145 (53.7%) boys and 125 (46.2%) girls, 117 had overflow incontinence (43.3%) - 41 (35%) girls and 76 (65%) boys. The first symptoms of chronic constipation appeared at a median age of 30 and 33 months in encopretic and 16 and 12 months in nonencopretic girls and boys, respectively. The first specialized consultation took place after a median disease duration of 26.5 and 24 months in encopretic and 16 and 9 months in nonencopretic girls and boys, respectively. A history of stool retention and the presence of scybala at examination, but not of pain at defecation or anal fissure, were associated with encopresis. The onset of chronic constipation after the age of 2 years, a longer disease duration, male gender, and a history of stool retention were seen as risk factors for the development of encopresis in patients with chronic functional constipation.
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White paper of Italian Gastroenterology: delivery of services for digestive diseases in Italy: weaknesses and strengths. Dig Liver Dis 2014; 46:579-89. [PMID: 24913902 DOI: 10.1016/j.dld.2014.02.019] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2014] [Revised: 02/19/2014] [Accepted: 02/22/2014] [Indexed: 12/11/2022]
Abstract
In 2011 the three major Italian gastroenterological scientific societies (AIGO, the Italian Society of Hospital Gastroenterologists and Endoscopists; SIED, the Italian Society of Endoscopy; SIGE, the Italian Society of Gastroenterology) prepared their official document aimed at analysing medical care for digestive diseases in Italy, on the basis of national and regional data (Health Ministry and Lombardia, Veneto, Emilia-Romagna databases) and to make proposals for planning of care. Digestive diseases were the first or second cause of hospitalizations in Italy in 1999-2009, with more than 1,500,000 admissions/year; however only 5-9% of these admissions was in specialized Gastroenterology units. Reported data show a better outcome in Gastroenterology Units than in non-specialized units: shorter average length of stay, in particular for admissions with ICD-9-CM codes proxying for emergency conditions (6.7 days versus 8.4 days); better case mix (higher average diagnosis-related groups weight in Gastroenterology Units: 1 vs 0.97 in Internal Medicine units and 0.76 in Surgery units); lower inappropriateness of admissions (16-25% versus 29-87%); lower in-hospital mortality in urgent admissions (2.2% versus 5.1%); for patients with urgent admissions due to gastrointestinnal haemorrhage, in-hospital mortality was 2.3% in Gastroenterology units versus 4.0% in others. The present document summarizes the scientific societies' official report, which constitutes the "White paper of Italian Gastroenterology".
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Abstract
OBJECTIVE This multicenter prospective study aimed to establish possible risk factors for functional constipation (FC) in the first year of life. METHODS At the infant's age of 3, 6, and 12 months, parents of all included infants completed 2 questionnaires: one about the presence of FC and the other screened the possible risk factors for FC. Parents of 465 infants completed the questionnaires at 3 and 6 months and of 402 infants at 12 months of life. RESULTS According to the Rome III criteria, FC was found in 11.6% of the infants at 3 months, in 13.7% at 6 months, and in 10.7% at 12 months after birth. Family history of atopy was present in 38.8% and 45.3% of infants with constipation at 3 and 6 months (P = 0.04 and P = 0.02, respectively), but no significant association was found at 12 months (P = 0.80). Breast-feeding was significantly related to a normal evacuation pattern at 3 months (P = 0.05), but not at 6 and 12 months (P = 0.12 and P = 0.9, respectively). Acetaminophen and female sex appeared to be risk factors for FC at 12 months. After the adjustment for all analyzed variables, FC in infants was significantly associated with the use of acetaminophen (odds ratio 6.98, 95% confidence interval 0.82-13.50). CONCLUSIONS Our results confirmed that breast-feeding is a protective factor for FC in the first 3 months of life and that the female sex is at risk to have FC. We found that the use of acetaminophen was associated with a higher incidence of FC in the first year of life.
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Evaluation and treatment of functional constipation in infants and children: evidence-based recommendations from ESPGHAN and NASPGHAN. J Pediatr Gastroenterol Nutr 2014; 58:258-74. [PMID: 24345831 DOI: 10.1097/mpg.0000000000000266] [Citation(s) in RCA: 581] [Impact Index Per Article: 58.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND Constipation is a pediatric problem commonly encountered by many health care workers in primary, secondary, and tertiary care. To assist medical care providers in the evaluation and management of children with functional constipation, the North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition and the European Society for Pediatric Gastroenterology, Hepatology, and Nutrition were charged with the task of developing a uniform document of evidence-based guidelines. METHODS Nine clinical questions addressing diagnostic, therapeutic, and prognostic topics were formulated. A systematic literature search was performed from inception to October 2011 using Embase, MEDLINE, the Cochrane Database of Systematic Reviews and Cochrane Central Register of Controlled Clinical Trials, and PsychInfo databases. The approach of the Grading of Recommendations Assessment, Development and Evaluation was applied to evaluate outcomes. For therapeutic questions, quality of evidence was assessed using the Grading of Recommendations, Assessment, Development, and Evaluation system. Grading the quality of evidence for the other questions was performed according to the classification system of the Oxford Centre for Evidence-Based Medicine. During 3 consensus meetings, all recommendations were discussed and finalized. The group members voted on each recommendation, using the nominal voting technique. Expert opinion was used where no randomized controlled trials were available to support the recommendation. RESULTS This evidence-based guideline provides recommendations for the evaluation and treatment of children with functional constipation to standardize and improve their quality of care. In addition, 2 algorithms were developed, one for the infants <6 months of age and the other for older infants and children. CONCLUSIONS This document is intended to be used in daily practice and as a basis for further clinical research. Large well-designed clinical trials are necessary with regard to diagnostic evaluation and treatment.
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Veiga ML, Lordêlo P, Farias T, Barroso C, Bonfim J, Barroso U. Constipation in children with isolated overactive bladders. J Pediatr Urol 2013; 9:945-9. [PMID: 23462384 DOI: 10.1016/j.jpurol.2013.01.013] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2012] [Accepted: 01/07/2013] [Indexed: 02/05/2023]
Abstract
OBJECTIVE To evaluate the prevalence of constipation in children with isolated overactive bladder (IOAB) and no micturition complaints. MATERIALS AND METHODS A questionnaire was used to evaluate constipation in 51 children with IOAB, as well as in a control group of 74 children between the ages of 4 and 14 years. The Rome III criteria for children were used to assess constipation. IOAB was defined as the presence of symptoms such as urgency with or without daytime incontinence or frequency, a bell-shaped uroflow, and no post-residual urine. RESULTS Mean patient ages were 7.94 (±2.8) and 8.28 (±3.4) years in the OAB and control group, respectively (p = 0.54). Twenty-eight (54.9%) of the OAB group were girls, and 34 (45.9%) were girls in the control group (p = 0.32). More of the children with IOAB had constipation than those without urinary symptoms (54.9% vs. 29.7%, p = 0.005; or 2.87, 95% CI: 1.3-6.0). The results were statistically significant regarding the following Rome III criteria: "history of stool retention", "presence of painful or hard bowel movements", "the presence of a large fecal mass in the rectum" and "large diameter stools which may obstruct the toilet". Within the group with OAB, constipation was more common among males (p = 0.05). There was no association between the type of OAB symptoms and constipation. The average dysfunctional voiding symptom score was 9.76 (±4.1). Eleven children (21.6%) presented alterations on ultrasound. Girls with OAB presented more frequently with UTI than boys (18 vs. 10, p = 0.13). CONCLUSION This was the first comparative study with respect to constipation in children with IOAB and without urinary symptoms. Children with IOAB have a greater risk of having constipation compared to those with no urinary symptoms.
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Affiliation(s)
- Maria Luiza Veiga
- CEDIMI, (Center for Childhood Urinary Disorders), Department of Urology and Physiotherapy, Bahiana School of Medicine, Bahia, Brazil
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Hedsund C, Joensson IM, Gregersen T, Fynne L, Schlageter V, Krogh K. Magnet tracking allows assessment of regional gastrointestinal transit times in children. Clin Exp Gastroenterol 2013; 6:201-8. [PMID: 24399881 PMCID: PMC3875367 DOI: 10.2147/ceg.s51402] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Background Data on small intestinal transit time in healthy children are lacking, and normal values for gastric emptying and colonic transit time are sparse. Conventional methods, including radiopaque markers, scintigraphy, and PillCam™ involve radiation or require the child to swallow a large pill. The minimally invasive, radiation-free Motility Tracking System-1 (MTS-1) has been introduced for description of gastrointestinal motility in adults. The aim of the study was to evaluate the MTS-1 for assessment of gastrointestinal transit times and motility patterns in healthy children. Methods Twenty-one healthy children (nine girls), median age 10 (range 7–12) years were included. For evaluation with MTS-1, a small magnetic pill was ingested and tracked through the gastrointestinal tract by a matrix of 16 magnetic sensors placed behind a nonmagnetic bed. The children were investigated for 8 hours after swallowing the magnetic pill and again for 4 hours the following morning. After leaving the unit, each child came back after every bowel movement to determine if the pill had been expelled. Results Nineteen children could swallow the pill. Characteristic contraction patterns were identified for the stomach (three per minute), small intestine (9–11 per minute), and colon (4–5 per minute). Median total gastrointestinal transit time was 37.7 (range 9.5–95.8) hours, median gastric emptying time was 37 (range 2–142) minutes, median small intestinal transit time was 302 (range 164 to >454) minutes, and median colorectal transit time was 38.1 (range 5.6–90.0) hours. Conclusion MTS-1 allows minimally invasive evaluation of gastrointestinal motility in children. Use of the method is, however, restricted by the nonambulatory setup.
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Affiliation(s)
- Caroline Hedsund
- Neurogastroenterology Unit, Department of Hepatology and Gastroenterology, Aarhus, Denmark ; Department of Pediatrics, Aarhus University Hospital, Aarhus, Denmark
| | | | - Tine Gregersen
- Neurogastroenterology Unit, Department of Hepatology and Gastroenterology, Aarhus, Denmark
| | - Lotte Fynne
- Neurogastroenterology Unit, Department of Hepatology and Gastroenterology, Aarhus, Denmark
| | | | - Klaus Krogh
- Neurogastroenterology Unit, Department of Hepatology and Gastroenterology, Aarhus, Denmark
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Impact of functional constipation on health-related quality of life in preschool children and their families in Xi'an, China. PLoS One 2013; 8:e77273. [PMID: 24130872 PMCID: PMC3795078 DOI: 10.1371/journal.pone.0077273] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2013] [Accepted: 08/31/2013] [Indexed: 02/07/2023] Open
Abstract
Aim Functional constipation (FC) is one of the common diseases among children. The aim of this study was to investigate the health-related quality of life (HRQOL) in preschool children diagnosed with FC and the impact of the condition on affected families. Methods In this cross-sectional, case-control study, 152 children aged 3–6 years with FC, 176 healthy children aged 3–6 years without FC, and their primary caregivers were selected. Chinese versions of the PedsQLTM 4.0 Generic Core Scale and the Family Impact Module (FIM) were used to assess childhood HRQOL and the impact of FC on family members, respectively. HRQOL scores were compared between children with FC and healthy children. In addition, a multiple step-wise regression with demographic variables of children and their caregivers, family economic status, duration and symptoms of FC, as independent variables, was used to determine factors that influenced HRQOL in children and had impacted caregivers. Results Scores of physical, emotional, social and school functions, and summary scales were significantly lower in children with FC than in healthy children (p < 0.05). Physical, emotional, social, cognitive, and communication scores for caregivers, as well as daily activities and relationships for families of children with FC, were significantly lower than those of caregivers and families with healthy children (p < 0.05). Children’s ages, duration of FC, symptoms of FC, the child-caregiver relationship, family economic status, and caregiver education level emerged as the main factors influencing HRQOL in children, caregivers, and family members. Conclusions FC had a significant impact on HRQOL of affected children and their caregivers, as well as their family functions. Social characteristics of children and caregivers, duration and symptoms of FC and family economic status significantly affected HRQOL of children and caregivers, as well as family functions of children with FC.
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