Functional constipation in the first-year-old onset at the first visit to a specialized clinic elicits a delay in referrals, the worst symptoms, and the excessive use of rectal laxatives

Abstract

Purpose: To assess and compares sociodemographic, clinical, anthropometric, and treatment characteristics in two subgroups of children with FC: 1) with onset in the first 12 months old and 2) with onset after 13 months old. Methods: Observational, retrospective cohort study, including consecutive cases of children/adolescents for initial evaluation of constipation. Data were collected in a pre-designed standard protocol, and the parents answered all the questions during the first visit. Inclusion criteria: age between 01 month to 15 years of age, with a diagnosis of FC defined according to the Rome Criteria III and Rome IV criteria. Exclusion criteria: constipation of organic etiology; other chronic health problems such as neurological, genetic, mental/psychiatric disorders or growth and development disorders. The stool form was evaluated according to Bristol Stool Form Scale. Two experienced pediatric gastroenterologists determined the patients' final diagnoses of FC. Approval was obtained from the ethics committee. Results: Five hundred and four children were identified with constipation at their initial visit. Thirty-two were excluded based on the inclusion and exclusion criteria. The remaining 472 children (225 with onset within the first 12 months and 247 after 13 months) were included. There was a long time to first visit in those with onset in the first 12 months of life. There is no difference in BMI/age scores between the two groups. FC onset in the first 12 months has more scybalous stools, painful defecation, bloody stools, a lower proportion with bowel toilet training, and bladder control. In FC starting in the first 12 months of life, only half of the children (55%) were treated with laxatives, and an entire group used rectal treatment. Conclusion: FC is a common Functional Gastrointestinal Disorder affecting infants during the first months of life. The primary inadequate treatment and referral delay implies worsening symptoms, chronicity, and non-implementing North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition guidelines.