Functional constipation in infancy and early childhood: epidemiology, risk factors, and healthcare consultation

Anne Willemijn Walter,Niranga Manjuri Devanarayana,Shaman Rajindrajith,Roshani Solanga,Anne Hovenkamp,Marc Alexander Benninga

doi:10.1186/s12887-019-1652-y

Anne Willemijn Walter, Niranga Manjuri Devanarayana + Show 4 more

Open Access

https://doi.org/10.1186/s12887-019-1652-y

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Abstract

BackgroundFunctional 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.MethodsChildren 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.ResultsA 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.ConclusionsFC 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 registrationSLCP/ERC/2014/12, December 2014.

Highlights

Functional constipation (FC) is a pediatric problem that is seen frequently
It was noted that children under the age of one year had the highest rate of emergency department visits for constipation and related symptoms in the USA and the costs of care had risen by 121% from 2006 to 2011 [5]
A representative community study in the USA noted that 4.7% of infants and 9.4% of toddlers were suffering from functional constipation (FC) [3]

Summary

Introduction

Functional constipation (FC) is a pediatric problem that is seen frequently. its prevalence in Asia remains undetermined. Childhood functional constipation (FC) is a significant health problem [1]. It was noted that children under the age of one year had the highest rate of emergency department visits for constipation and related symptoms in the USA and the costs of care had risen by 121% from 2006 to 2011 [5]. A retrospective chart review of children with constipation revealed that the median age of onset was 2.3 years, with the 25th percentile to 75th percentile range being 0.8 to 4.8 years respectively [6]. An Italian birth cohort study has shown that the prevalence/ onset of constipation at 3, 6, and 12 months was 11.6, 13.7 and 10.7%, respectively [7]. A representative community study in the USA noted that 4.7% of infants and 9.4% of toddlers were suffering from functional constipation (FC) [3]

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