Parents' Experiences and Information Needs While Caring for a Child With Functional Constipation: A Systematic Review

Pediatric functional constipation (FC) reportedly affects at least 1 in 10 children worldwide. Parent and family education is a key component for successful treatment, yet there is little research exploring what information families need and how to best support them. The aim of this review is to synthesize current evidence on the experiences and information needs of parents caring for a child with FC. We systematically searched published research and completed screening against a priori inclusion criteria. Thirteen studies (n = 10 quantitative, n = 3 qualitative) were included. We found 2 main themes, precarious footing and profound and pervasive effects. Heavy caregiving burdens fueled doubts, misinformation, relationship breakdown, and treatment deviation. In light of clinical recommendations, our findings reveal a potential mismatch between parents' needs and care provision for FC. It is likely that both parents and health care providers would benefit from resources and interventions to improve care related to pediatric FC.

Measuring the symptoms of pediatric constipation and irritable bowel syndrome with constipation: expert commentary and literature review

BACKGROUND

Symptom measurement in pediatric chronic idiopathic constipation (CIC) and irritable bowel syndrome with constipation (IBS-C) trials requires appropriately developed clinical outcome assessments (COAs).

METHODS

Literature was reviewed to identify symptom COAs meeting regulatory standards. Searches were conducted in Pubmed/Medline, EMBASE, and PsychINFO. Title/abstracts were reviewed to identify qualitative studies and those using COAs to measure pediatric CIC/IBS symptoms. Pediatric functional gastrointestinal experts provided input on relevant symptom-concepts to measure.

RESULTS

Review of 1,105 abstracts identified 1 relevant qualitative article and 113 articles including COAs. Symptoms most frequently measured in CIC studies were frequency of bowel movements, fecal incontinence/encopresis, abdominal pain, stool consistency, and painful defecation. Symptoms most frequently measured in IBS were abdominal pain, abdominal distention/bloating, stool consistency, frequency of bowel movements, and gas. Evidence of development/validity of COAs was limited. Expert feedback was broadly consistent with the literature.

CONCLUSION

Findings demonstrate consistency in the literature on key CIC/IBS symptoms to measure in pediatric trials, but existing COAs do not meet regulatory standards.

Impact of a nurse-led clinic for chronic constipation in children

The impact of a nurse-led constipation clinic was assessed by evaluating the first 50 patients, aged 1.5 to 10 years, using a questionnaire before initial clinic visit and at the third clinic visit, three to four months later. Patients had been constipated for at least six months. The nurses explained the physiology of constipation, the rationale for laxative treatment and the need to comply with treatment. Good toileting behaviour was encouraged. This resulted in an increase in defaecation frequency and stool softness, whereas soiling and pain on defaecation decreased. There was no significant change in the amount of laxatives taken, although it was suspected that compliance improved. Parental understanding of constipation and its management increased. Overall, the control of constipation in children improved markedly through attendance at a nurse-led clinic.