Constipation In Young Children Research Articles

Facilitators and barriers of adherence to rectal interventions by parents of young children with functional constipation: a qualitative study.

Functional constipation in children is a worldwide problem that impacts both children's gastrointestinal function and the quality of family life. The treatment of this condition often depends on parental involvement to administer rectal interventions to their children to stimulate defecation. However, adherence to rectal interventions is currently suboptimal. We sought to explore the factors that facilitate and hinder parents from adherence to rectal interventions. A descriptive qualitative study was conducted involving semi-structured interviews with parents of infants and young children with functional constipation requiring rectal interventions from March to May 2023. The data were analyzed using content analysis. Fourteen parents participated in the study. Parents reported the main facilitators of adherence to prescribed rectal interventions as recognition of illness severity, support from family and friends, and medical resource support and e-health literacy. Parents reported the primary barriers as information barriers, family conflict, cognitive misalignment, and difficulties in accessing healthcare services. Rectal interventions are often essential in managing constipation in young children, with parental compliance being crucial for effective treatment. Healthcare providers must consider the psychosocial aspects of parents' perceptions, adhere to guidelines to standardize communication, and ensure comprehensive education to improve medication literacy.

Medical management of anorectal malformations.

Anorectal malformations (ARMs) are congenital anomalies of the anorectum and the genitourinary system that result in a broad spectrum of hindgut anomalies. Despite surgical correction patients continue to have late postoperative genitourinary and colorectal dysfunction that have significant impact on quality of life. This paper will review the current evidence and discuss the evaluation and management of postoperative patients with ARMs who present with persistent defecation disorder. A literature search was conducted using PubMed/MEDLINE/EMBASE databases applying the following terms: ARMs, imperforate anus, constipation, faecal incontinence, neurogenic bowel, posterior sagittal anorectoplasty. Patients who present with postoperative defecation disorders require timely diagnostic and surgical evaluation for anatomic abnormalities prior to initiation of bowel management. Goals of management are to avoid constipation in young children, achieve faecal continence in early childhood and facilitate independence in older children and adolescents. Treatment options vary from high dose stimulant laxatives to high-volume retrograde and antegrade enemas that facilitate mechanical colonic emptying. Appropriate diagnostic work-up and implementation of treatment can decrease long-term morbidity and improve quality of life in postoperative patients with ARMs who presents with defecation disorders.

Effect of prebiotic oligosaccharides on bowel habit and the gut microbiota in children with functional constipation (Inside study): study protocol for a randomised, placebo-controlled, multi-centre trial

BackgroundFunctional constipation (FC) in children is a common gastrointestinal disorder with a worldwide-pooled prevalence of 9.5%. Complaints include infrequent bowel movements, painful defecation due to hard and/or large stools, faecal incontinence, and abdominal pain. Prebiotic oligosaccharides have been shown to relieve constipation symptoms in young adults and elderly. However, sufficient evidence is lacking linking additional prebiotic intake to improve symptoms in children with FC. We hypothesise that prebiotic oligosaccharides are able to relieve symptoms of constipation in young children as well.MethodsIn the present randomised, double-blind, placebo-controlled, multi-centre study, we will study the effects of two prebiotic oligosaccharides in comparison to placebo on constipation symptoms in children of 1–5 years (12 to 72 months) of age diagnosed with FC according to the Rome IV criteria for functional gastrointestinal disorders. The primary outcome measure will be change in stool consistency. Secondary outcomes include stool frequency and stool consistency in a number of cases (%). Tertiary outcomes include among others painful defecation, use of rescue medication, and quality of life. In addition, the impact on gut microbiome outcomes such as faecal microbiota composition and metabolites will be investigated. Participants start with a run-in period, after which they will receive supplements delivered in tins with scoops for 8 weeks, containing one of the two prebiotic oligosaccharides or placebo, followed by a 4-week wash-out period.DiscussionThis randomised double-blind, placebo-controlled multi-centre study will investigate the effectiveness of prebiotic oligosaccharides in children aged 1–5 years with FC.Trial registrationClinicalTrials.gov NCT04282551. Registered on 24 February 2020.

Effectiveness of Bowel Management Program for Functional Constipation in Children

Functional constipation (FC) is a common problem in childhood, with an estimated prevalence of 3% worldwide. Objective: To determine the effectiveness of bowel management program in children with functional constipation. Methods: This quasi-experimental study was conducted at Department of Pediatric Surgery, NICH, Karachi, from September 2019 to November 2021. 91 children were included in the study. Informed consent was taken. A plain X-ray abdomen prior to the start of bowel management program was done to assess the fecal loading in the colon. Effectiveness of program was assessed in terms of stool frequency of 1, 2 per day and non-loading of rectum radiologically after one month of treatment. High dose laxatives were started after the patient had recovered from the first impact in older kids who had previously completed toilet training but now suffer soiling from faux incontinence or severe constipation without soiling. Daily big volume enemas were used in children who had never been toilet trained, had a history of soiling, or had a megarectum. Results: The mean age was 5.26 ± 2.20 years (95% confidence interval [CI]: 4.80-5.72), the mean weight was 17.49 ± 3.24 kg (95% CI: 16.82-18.17), the mean height was 107.27 ± 19.32 cm (95% CI: 103.24-111.29). The average duration of functional constipation was 88.11 ± 68.79 days (95% CI: 73.78-102.44). In terms of gender distribution, 63 (69.2%) patients were male, while 28 (30.8%) were female. Conclusions: The results of this study provide evidence that a bowel management programme is successful in treating functional constipation in young children.

Effect of L. reuteri on bowel movements in children aged 6months to 4 years: A double-blind randomized controlled trial.

Chronic constipation is common in children and often requires prolonged laxative treatment. Preliminary studies suggest that the probiotic Limosilactobacillus reuteri (L. reuteri) may be useful in treating constipation in children, but these preliminary results need to be replicated. The objective of this study was to assess the efficacy of L. reuteri in infants and young children with chronic functional constipation. A prospective double-blind randomized placebo-controlled trial was conducted in 5 pediatric departments in France between June 2017 and June 2021. In all, 49 patients-ages 6 months to 4 years, and suffering from chronic constipation per Rome IV criteria-were randomly allocated to the test and control groups. For 4 weeks, all were orally administered 5 daily drops of the test (L. reuteri DSM 17938 at 108 colony-forming units per day) or control (placebo) treatment, respectively. Participants were clinically assessed at 4 and 8 weeks. Parents were asked to daily record the number of spontaneous bowel movements (SBMs), stool consistency, and the use of any additional laxatives. Informed consent was obtained from parents of all recruited patients, and the study was approved by both an ethics committee and the French National Agency for Medicines and Health Products Safety (ANSM). The study is registered on ClinicalTrials.gov (NCT03030664). The change in SBMs relative to baseline was greater in the control group at week 4 (control: 0.27 ± 0.5; test: 0.23 ± 0.5; P = 0.01) and in the test group at week 8 (control: 0.26 ± 0.4; test: 0.22 ± 0.5; P = 0.03). At week 4, the groups did not differ in number of responders (≥3 stools per week, with no non-retentive fecal incontinence), use of rescue medication, scoring of pain during defecation (Faces Pain Scale-Revised), or stool consistency (Bristol Stool Form Scale). This double-blind randomized controlled trial did not confirm the efficacy of L. reuteri for treatment of chronic functional constipation in young children.

Constipation in children in the practice of a pediatrician

Constipation in children is currently one of the major complaints that parents present at a pediatrician's appointment. The article discusses the issues of diagnosis and treatment of functional constipation in children based on the international and Russian clinical guidelines. The following are some major causes of constipation in young children. Constipation is most often caused by colon dyskinesia (hypo- and hypermotor disorders), impaired and painful bowel movement (spasm of the rectal sphincters, weakened smooth muscle tone, etc.) or a combination of these factors. In rare cases, the cause of constipation is organic disorders. Also, low parental socio-economic status, low educational level, depression, neuroticism, attitude of parents towards their children's upbringing such as being overprotective, and attitudes that promote high or low levels of autonomy, increase the risk of functional constipation. In addition, the article sets detailed factors leading to constipation in older children and adolescents. The pathogenesis of functional constipation is given, and the problem of psychological constipation is described. The outlined therapeutic approach includes dietary intervention, compliance with drinking water treatment, behavioural and drug therapy. The author presents its own experience of using sodium picosulfate to treat constipation in children. Constipation in children is a common problem, functional constipation accounts for 95% of cases, therefore in most cases they do not require clarifying diagnostic methods. Besides, you shouldn't forget about the possibility of organic pathology, malformations in young children. Constipation in children requires the timely administration of complex treatment.

A Narrative Review on the Update in the Prevalence of Infantile Colic, Regurgitation, and Constipation in Young Children: Implications of the ROME IV Criteria.

Regurgitation, colic, and constipation are frequently reported Functional Gastrointestinal Disorders (FGIDs) in the first few years of life. In 2016, the diagnostic criteria for FGIDs were changed from ROME III to ROME IV. This review assesses the prevalence of the most frequent FGIDs (colic, regurgitation and constipation) among children aged 0–5 years after the introduction of the later criteria. Articles published from January 1, 2016 to May 1, 2021 were retrieved from PubMed and Google Scholar using relevant keywords. A total of 12 articles were further analyzed based on the inclusion and exclusion criteria. This review consists of two studies (17%) from the Middle East, three (25%) from Asia, two (17%) from the USA, three (25%) from Europe, and one (8%) from Africa. Three studies (25%) were based on data obtained from healthcare professionals, while the rest were parent or caregiver reports. About half of the retrieved studies used the ROME IV criteria. Among infants aged 0–6 months, the reported prevalence of colic ranged between 10–15%, whilst that of regurgitation was 33.9%, and constipation was 1.5%. Among infants aged 0–12 months, the reported prevalence of regurgitation and constipation were 3.4–25.9% and 1.3–17.7%, respectively. The reported prevalence of constipation was 1.3–26% among children aged 13–48 months and 13% among children aged 4–18 years. Despite the large variations due to differences in diagnostic criteria, study respondents and age group, the prevalence of infantile colic was higher, while that for infantile regurgitation and constipation were similar using the ROME IV or III criteria.

Promelaxin Microenemas Are Non-inferior to Oral Polyethylene Glycol for the Treatment of Functional Constipation in Young Children: A Randomized Clinical Trial.

Background: Polyethylene glycol (PEG) is recommended as first-line treatment of pediatric functional constipation. However, the oral route of administration is often poorly feasible in children mostly due to poor palatability. Promelaxin microenemas exert a topical evacuative action and may offer a valuable option in pediatric FC.Aim: To assess whether Promelaxin microenemas would be non-inferior to PEG 4000 in young children with FC.Methods: This is a randomized, open-label, multi-centric, non-inferiority trial enrolling infants and young children aged 6–48 months, with FC according to Rome III criteria. After 1 week of run in, children were randomized to 2 weeks of Promelaxin or PEG, followed by a 6-week on-demand treatment period. Primary endpoint was response rate to randomized treatment, with “response” defined as at least 3 evacuations per week and an average increase of at least one evacuation per week as compared to baseline. Safety, stool consistency and the analysis of fecal microbiota were secondary endpoints.Results: Out of the 158 patients who entered the trial, 153 patients were treated (77 and 76, PEG and Promelaxin arm, respectively). In the primary analysis, the 95% confidence interval (CI) for the treatment's effect lay entirely above the non-inferiority margin in both Full Set (FAS) and Per Protocol (PP) analyses, providing evidence of the non-inferiority of Promelaxin vs. PEG 4000 [response rate difference: 16.5% (CI 1.55–31.49%) and 11.03% (CI −5.58 to 27.64%), FAS and PP analyses, respectively]. Mean compliance to the randomized treatment was >80% in both arms. Secondary endpoints did not significantly differ between the two arms, except for the average number of total days of on-demand treatment that was significantly lower in the Promelaxin arm [14.6 (12.7) vs. 9.8 (9.1), mean (SD); primary endpoint responders in PEG and Promelaxin arm, respectively; p = 0.027]. Microbiota evenness significantly increased in the PEG 4000 arm at V4 as compared to the Promelaxin arm (p < 0.05). In addition, at V5, patients treated with PEG showed a significantly decreased microbiota density as compared to patients treated with Promelaxin (p = 0.036).Conclusions: Promelaxin microenemas are non-inferior to oral PEG in children with FC.Clinical Trial Registration: www.ClinicalTrials.gov, identifier: NCT02751411.

Lactobacillus reuteri DSM 17938 and Magnesium Oxide in Children with Functional Chronic Constipation: A Double-Blind and Randomized Clinical Trial.

Objective: Chronic functional constipation is a frequent condition. The aim of the study was to evaluate the efficacy of the probiotic Lactobacillus (L.) reuteri DSM 17938 and magnesium oxide (MgO) for relieving chronic functional constipation in children. Study design: A prospective, double-blind, placebo-controlled, randomized, and parallel-group trial was conducted in five pediatric outpatient clinics in Japan. Sixty patients who were more than six months old and under six years of age with a diagnosis of functional constipation according to Rome IV criteria were randomly divided into three groups: group A (n = 20) received L. reuteri DSM 17938 and lactose hydrate as a placebo of MgO; group B (n = 19) received L. reuteri DSM 17938 and MgO; and group C (n = 21) received a placebo of L. reuteri DSM 17938 and MgO. Results: All three groups exhibited significant improvement in defecation frequency in the fourth week compared with the baseline condition (group A: p < 0.05; group B: p < 0.05; group C: p < 0.05). The MgO group and combination group showed a significant decrease in stool consistency, but the L. reuteri DSM 17938 group did not (group A: p = 0.079; group B: p < 0.05; group C: p < 0.05). MgO significantly suppressed the presence of the genus Dialister. Defecation frequency negatively correlated with the frequency of Clostridiales-belonging bacteria among the gut microbiome. Conclusions: L. rueteri DSM 17938 and MgO were both effective in the management of functional constipation in young children. MgO caused an imbalance in the gastrointestinal microbiome, which was not the case in the probiotic group.

Functional constipation in young children: causes, diagnostic criteria and therapeutic strategies

The article gives a modern definition of constipation and working classification used in Pediatrics; frequency of defecation and qualitative characteristics of stool depending on age and type of feeding are presented. Particular attention is paid to the reasons for the development of functional constipation in young children, diagnostic criteria in accordance with the Rome consensus IV revision (2016) and tactics of management of children with constipation. Part of the information is devoted to the use of osmotic laxatives. The main mechanism of action of polyethylene glycol and its advantages in stopping constipation in infants older than 6 months are shown. age’s.

Сучасні підходи до діагностики та лікування функціонального запору у дітей раннього віку

Сучасні підходи до діагностики та лікування функціонального запору у дітей раннього віку

Effect of a follow‐up formula containing prebiotics on constipation in young children (LB348)

Objectives: Constipation affects up to 30% of children. Insufficient fiber intake is associated with functional constipation and changes in dietary composition, such as the addition of prebiotics, ...

Use of Rome II versus Rome III criteria for diagnosis of functional constipation in young children

There has been no study to evaluate the use of the Rome III criteria for diagnosis of constipation in the unselected young pediatric population. The aim of this study was to evaluate and compare the use of the Rome II and Rome III criteria for diagnosis of constipation in a group of unselected young Thai children. This cross-sectional study was conducted in 3010 healthy children aged 4 months-5 years who attended a well-baby clinic. Data concerning bowel habits and behavioral components of defecation of the children were obtained by interviewing the parents. Presence of a large fecal mass in the rectum of children with possible constipation was evaluated by abdominal palpation. Seventy-one children (2.4%) were found to have constipation, based on at least one of the two sets of criteria, at the time of interview. The prevalence of constipation as defined according to the Rome II and Rome III criteria for functional constipation (FC) was 1.9% and 1.6%, respectively. The majority of constipated children (47.9%) met the diagnostic criteria of both the Rome II and Rome III for FC, followed by the Rome II criteria for FC alone (32.4%) and the Rome III criteria for FC alone (18.3%). Twenty-one children (0.7%) whose parents reported defecation difficulties did not fulfill any diagnostic criteria for constipation. The prevalence of FC in young Thai children is low. For unselected young children, the Rome II criteria for FC are still appropriate for diagnosis of FC.

Efficacy of Fiber Supplements in the Management of Constipation in Young Children

Efficacy of Fiber Supplements in the Management of Constipation in Young Children

Treatment of Encopresis and Chronic Constipation in Young Children: Clinical Results from Interactive Parent-Child Guidance

To describe the source of and treatment for encopresis in a series of 40 children under age 9 years. Referral for psychological based treatment followed upon limited success of standard gastroenterologic intervention. The treatment provided is defined as interactive parent-child family guidance. This includes a variety of specific psychologically based recommendations offered to parents, and, when indicated, direct interventions with the symptomatic child. These are different from various forms of behavioral corrective reward-punishment interventions frequently recommended for young children with encopresis. The pediatric and the psychological literature offer few reports of successful treatment of young children with this syndrome. Also, there are few specific descriptions of psychologically based interventions. The results reported here are of the successful treatment of 38 of 40 cases referred specifically for psychologically based intervention following the prior limited success of standard gastroenterologic treatment. The interactive parent-child family guidance intervention described in this report, differentiated from typical behavior therapies, is a notably successful mode of psychologically based therapy for these children. It offers an important alternative to standard pediatric gastroenterological treatment for encopresis, as well as to reward-punishment oriented behavioral therapies.

Occult Spinal Cord Lesions in Young Children with Intractable Constipation

Constipation in young children usually responds to nutritional intervention; in more severe cases, medication is usually effective. Pediatricians occasionally encounter a child with intractable constipation but no associated cognitive, neurologic, or behavioral problems. These authors used magnetic resonance imaging (MRI) of the spine to evaluate 88 children with intractable constipation who were referred to a gastroenterology clinic. …

Precipitants of constipation during early childhood.

Childhood constipation is a common problem, accounting for 3% of visits to pediatric clinics and 30% of visits to pediatric gastroenterologists. Estimates of the prevalence of childhood constipation vary from 0.3% to 28% with younger children being affected most often. We were unable to find any studies that specifically examine the causes of constipation in young children. Our objective of the study was to determine precipitants to constipation during early childhood. Findings from 125 families visiting their primary care physician for the first time with a child aged between 2 and 7 years with the complaint of constipation were compared with findings from 95 children between 2 and 7 years without any history of constipation. Parents answered questions concerning family history, toilet training, and bowel habits. Parents of constipated children were asked to describe events that occurred during the 3 months before the onset of constipation and whether these events contributed to the child's constipation. The age and sex of children who did and did not suffer from constipation were comparable (P > .3). When compared with control children, constipated children were no more likely to have a parent (30% vs 40%, P = .14) or sibling (17% vs 14%, P = .54) with a history of constipation. Constipated children did not begin toilet training earlier than did control children (28 +/- 7 vs 27 +/- 6 months, P = .30). When compared with parents of control children, parents of constipated children reported more difficulties with toilet training (P < .001). Parents of constipated children indicated their children had more difficult and more painful defecation experiences than did parents of control children (P < .001), and constipated children were more likely to express worry about future painful defecation than were control children (P < .001). Parents of constipated children described a number of events that occurred before the onset of constipation; however, they did not consider many of the events important contributors to the constipation. Painful defecation was the event most often reported as causing the constipation. Painful defecation is the primary precipitant of constipation during early childhood. Parents should be counseled to be attentive to such experiences and taught to intervene quickly to lessen the risk that their child will develop persistent constipation or fecal soiling.

Constipation in Young Children with Developmental Disabilities

Constipation is a common problem for children with disabilities. The inability of children with disabilities to communicate abdominal discomfort or pain with stooling may impair the ability to diagnose constipation. The causes of constipation may vary with the type of disability. The type and degree of disability also has an impact on treatment modalities. Constipation may have many adverse consequences, including behavioral problems, poor feeding, pain, rectal bleeding, the social stigma and emotional stress associated with incontinence, as well as potentially serious problems such as megacolon and bowel obstruction. Identification and treatment of constipation in children with disabilities is, therefore, of high importance.

Soy milk decreased chronic constipation in young children

(1998) N Engl J Med 339, 1100; Iacono G, Cavataio F, Montalto G, . et al. . Intolerance of cow's milk and chronic constipation in children. . Oct 15; ....

Intolerance of cowʼs milk and chronic constipation in children

Background: Chronic diarrhea is the most common gastrointestinal symptom of intolerance of cow's milk among children. On the basis of a prior open study, we hypothesized that intolerance of cow's milk can also cause severe perianal lesions with pain on defecation and consequent constipation in young children. Methods: We performed a double-blind, crossover study comparing cow's milk with soy milk in 65 children (age range, 11 to 72 months) with chronic constipation (defined as having one bowel movement every 3 to 15 days). All had been referred to a pediatric gastroenterology clinic and had previously been treated with laxatives without success; 49 had anal fissures and perianal erythoma or edema. After 15 days of observation, the patients received cow's milk or soy milk for 2 weeks. After a one week washout period, the feedings were reversed. A response was defined as eight or more bowel movements during a treatment period. Results: Forty-four of the 65 children (68 percent) had a response while receiving soy milk. Anal fissures and pain with defecation resolved. None of the children who received cow's milk had a response. In all 44 children with a response, the response was confirmed with a double blind challenge with cow's milk. Children with a response had a higher frequency of coexistent rhinitis, dermatitis, or bronchospasm than those with no response (11 of 44 children vs. 1 of 21, P = 0.05); they were also more likely to have anal fissures and erythema or edema at base line (40 of 44 vs. 9 of 21, P < 0.001), evidence of inflammation of the rectal mucosa on biopsy (26 of 44 vs. 5 of 21, P = 0.008), and signs of hypersensitivity, such as specific IgE antibodies to cow's-milk antigens (31 of 44 vs. 4 of 21, p < 0.001). Conclusions: In young children, chronic constipation can be a manifestation of intolerance of cow's milk.