Functional Constipation In Children Research Articles

The use of polyethylene glycol as a maintenance treatment of functional constipation in children living in Egypt

BackgroundConstipation is an underestimated but common health problem worldwide, decreasing the quality of life. Functional constipation (FC) is a common pediatric problem, with reported prevalence ranging from 0.7 to 29.6%. In Egypt, there are no established guidelines for the treatment of constipation in children.ObjectivesThe aim of this study was to investigate the efficacy of polyethylene glycol (PEG) as a maintenance treatment for functional constipation (FC) in comparison with the classic treatment using (lactulose and senna) in children living in Egypt.Patients and methodThis is a randomized single-blinded clinical trial study on pediatric patients who presented with functional constipation at the outpatient clinic of Cairo University Specialized Pediatric Hospital. The study was conducted on 80 children with functional constipation, who were divided into 2 groups: group 1 (40 children), who received polyethylene glycol as maintenance treatment; group 2 (40 children), who received classic treatment in the form of osmotic laxative (lactulose) with or without stimulant (senna-sennosides or senna-glycoside) according to the stool consistency.ResultsOur data showed significant improvement in the fecal masses and the number of defecation, fecal pseudo incontinence, painful or hard bowel movement, history of retentive posturing or excessive violation, and large fecal masses in the rectum between group 1 and group 2 after treatment. In group 1, there was a significant improvement in anthropometric measures, CBC parameters, abdominal circumference, and anal fissures and piles after treatment; also, there was a significant decrease in the number of patients that need to continue treatment in group 1 in comparison with group 2 and number of patients that had impaction during treatment. However, there was a statistically significant increase in the number of patients who complained of palatability in group 1.ConclusionPEG has long-term efficacy in the management of pediatric functional constipation. Significant improvement of results in comparison with the classic treatment (lactulose or senna-lax).

Treat functional constipation in children with conventional options first and consider alternatives if needed

Treat functional constipation in children with conventional options first and consider alternatives if needed

Efficacy and safety of probiotics and synbiotics for functional constipation in children: A systematic review and meta-analysis of randomized clinical trials

We aimed to evaluate the efficacy and safety of probiotics and synbiotics in childhood functional constipation. PubMed, Embase, Cochrane Library, ClinicalTrials.gov, and the International Clinical Trials Registry Platform (ICTRP) were searched up to June 2023. Randomized controlled trials involving children diagnosed with FC with Rome III/IV criteria were included. Treatment success, defecation frequency, stool consistency, painful defecation, fecal incontinence, and adverse events were assessed as outcomes. Odds ratios (ORs) and standard mean difference (SMD) with 95% confidence intervals (CIs) were calculated for dichotomous and continuous variables as appropriate. Cochrane risk-of-bias tool version 2 assessed the risk of bias. Seventeen RCTs with 1504 patients were included. Compared to placebo, probiotics significantly improved defecation frequency (SMD 0.40, 95% CI 0.10 to 0.70, I2=0%) and fecal incontinence (OR 0.53, 95% CI 0.29 to 0.96, I2=0%). However, it did not significantly improve treatment success, painful defecation, and abdominal pain. Probiotics, as add-on therapy, failed to yield a significant difference in treatment success (OR 0.82, 95% CI 0.15 to 4.48, I2=52%), defecation frequency (SMD 0.13, 95% CI -0.13 to 0.39, I2=0%), defecation consistency (SMD -0.01, 95% CI -0.40 to 0.38, I2=1%), fecal incontinence (OR 0.95, 95% CI 0.48 to 1.90, I2=0%), and abdominal pain (OR, 0.60, 95% CI 0.24 to 1.53, I2=0%) versus laxatives monotherapy. Synbiotics plus laxatives showed no significant effect on defecation frequency (SMD -0.57; 95% CI -1.29 to 0.14, I2=74%) and painful defecation (OR, 3.39; 95% CI 0.74 to 15.55, I2=0%) versus laxatives alone. Current evidence did not advocate using probiotics and synbiotics in treating functional constipation in children. At this time, the effects of strain-specific probiotics, probiotics mixtures, and the optimal doses and treatment durations of the probiotics and synbiotics were unclear. Additional rigorous evidence is required to evaluate and establish the effectiveness and safety of probiotics and synbiotics for childhood functional constipation. CRD42020195869.

Functional constipation in preschool and school age children: ways to solve the problem

Functional constipation is a significant medical problem in pediatrics. Constipation often causes discomfort in children of any age and, in the absence of timely and effective treatment, can lead to chronic intoxication and the development of various complications, ultimately affecting the patient's quality of life. The article presents the definition of functional constipation in children over 4 years of age in accordance with the Rome IV Criteria (2016), etiology, pathophysiological mechanisms, clinic, diagnostic criteria and differential diagnosis of functional and organic constipation in preschool and school age children, possible complications. In accordance with the draft Consensus of the Society of Pediatric Gastroenterologists (2013), for a more objective assessment of the nature of the stool, the Bristol scale of stool forms is given. The physiology of the colon and the role of motor disorders in the occurrence of functional constipation are described. The physiology of the colon and the role of motor disorders in the occurrence of functional constipation are described. In accordance with the recommendations of the National School of Gastroenterology, the National Institute of Health and Clinical Excellence (NICE) in the UK, ESPGHAN and NASPGHAN, the basic principles of constipation therapy in preschool and school age children are given. The main groups of drugs that are used in the treatment of constipation in children of this age are described: stimulating and osmotic laxatives, prokinetics. Numerous foreign studies and clinical recommendations indicate that stimulants are effective and safe for the treatment of functional constipation, including in children's practice and are most in demand. The analysis of the use of one of the main drugs of the group of stimulating laxatives - sodium picosulfate in numerous international and Russian clinical studies is presented. The effectiveness and favorable safety profile of sodium picosulfate, the possibility of individual dose selection in connection with the liquid form of release are shown. A clinical example of the treatment of functional constipation in a 6-year-old child is given.

The relationship between functional constipation and overweight/obesity in children: a systematic review and meta-analysis.

Studies have reported the relationship between functional constipation and obesity in pediatric population. However, the results are contradictory. The purpose of this study is to evaluate the possible association between these two disorders in pediatric population. Four databases including PubMed, Embase, CENTRAL, and Web of Science were searched until 30 September 2022. The review was done in accordance with PRISMA guidelines and registered in PROSPERO (CRD42022328992) RESULTS: Nine studies met the eligibility criteria, including 7444 participants. Studies showed the risk of obesity was significantly increased in boys with functional constipation (CI: 1.12, 3.07; P = 0.016). Such an association was also observed in girls (CI: 1.42-4.47; P = 0.00). A statistically significant association was observed between overweight/obesity and increased risk of functional constipation in children and adolescents (CI: 1.14-3.97; P = 0.02). Especially in developed countries (CI: 1.49-3.46; P = 0.00); however, no significant association was observed in developing countries (CI: 0.81-5.3; P = 0.13). There is a risk of obesity in either boys or girls with functional constipation. An association exists between the risk of functional constipation and children/adolescents with obesity, especially in developed countries, but not in developing countries. Our study encourages further research in this field because early detection and intervention are crucial for both functional constipation and overweight/obesity in children, to better identify its complex biology and possibly optimize the treatment approaches.

Probiotics and Functional Constipation in Children

Functional constipation (FC) definition as by the "Rome IV" diagnostic criteria as persistently difficult, infrequent, or seemingly incomplete defecation without evidence of a primary anatomic or biochemical cause This definition required at least two of six symptoms describing stool frequency, hardness, and size; faecal incontinence; or volitional stool retention, with the stipulation that organic causes of constipation are excluded by a thorough evaluation. Children visiting outpatients clinic with defecation-related complaint account for 3% and 25% of pediatric gastroenterology consultations. Functional constipation aetiology is still unclear. So is typically classified into normal transit constipation (NTC), slow transit constipation (STC), and defecatory or rectal evacuation disorders. The World Health Organization defines probiotics as “live microorganisms, which, when administered in adequate amounts, confer a health benefit on the host”.

Outcome of Functional Constipation in Children Age 1 to 12 Year in Tertiary Care Hospital

Background: Both parents and children are bothered by constipation. Even then, it continues to go untreated, delaying medical intervention. It causes both physical and psychological morbidity. It has an impact on children's quality of life. The issue is exacerbated by delayed medical care. The young person could become less confident. Children may experience impaction of the faeces in 1%–3% of cases, which can result in faecal matter soiling. Aim: To investigate the outcomes of functional constipation in children between the ages of 1 and 12 in tertiary care facilities. Methodology: After receiving ethical approval from the committee, this cross-sectional study was conducted at Lady Reading Hospital in Peshawar from June 2021 to May 2022. The study included a total of 381 children’s. After obtaining parental assent, the ROME IV criteria was applied to the children who had functional constipation, and the children were treated according to the recommended recommendations and protocols. Result: 381 kids were enrolled in a study using the Rome IV criteria for constipation manifestation. The ratio was highest when passing 188 hard stools (49.34%) and lowest when passing 13 unpleasant stools (22.30%). Similar high ratio was observed in type-1 129(33.83%) of Bristol stool type. The ratio of males to females in the age range 3-6 year group was highest in the age group 6-12 year group, with 166 males and 63 females. The majority of restrooms (65.09%) were located outside door 248. Constipation-causing factors were shown to be highest in avoiding school lavatory use 181(47.50%) and lowest in opposing behavior 73(19.16%). History of food intake revealed a high ratio of 211(55.38%) from stores and a low ratio of 13(3.41%) from home-cooked meals. The hygienic care ratio was 178(46.71%) for not using water and soap and 19(4.98%) for using soap after using the loo.By exposing the concerns and their solutions for the health of their children, this will raise mothers' knowledge and be beneficial to society as a whole. Conclusion: All children need hygienic care and adequate education as a foundation. Dietary nutrition is crucial for growth. Children who are taken to the hospital may develop phobias and parents may experience problems. Children who are not properly treated for constipation are more likely to have serious psychological harm and bowel dysfunction. Keywords: Children, constipation, phobia, temper, education, food

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.

Subtyping intractable functional constipation in children using clinical and laboratory data in a classification model.

Children with intractable functional constipation (IFC) who are refractory to traditional pharmacological intervention develop severe symptoms that can persist even in adulthood, resulting in a substantial deterioration in their quality of life. In order to better manage IFC patients, efficient subtyping of IFC into its three subtypes, normal transit constipation (NTC), outlet obstruction constipation (OOC), and slow transit constipation (STC), at early stages is crucial. With advancements in technology, machine learning can classify IFC early through the use of validated questionnaires and the different serum concentrations of gastrointestinal motility-related hormones. A hundred and one children with IFC and 50 controls were enrolled in this study. Three supervised machine-learning methods, support vector machine, random forest, and light gradient boosting machine (LGBM), were used to classify children with IFC into the three subtypes based on their symptom severity, self-efficacy, and quality of life which were quantified using certified questionnaires and their serum concentrations of the gastrointestinal hormones evaluated with enzyme-linked immunosorbent assay. The accuracy of machine learning subtyping was evaluated with respect to radiopaque markers. Of 101 IFC patients, 37 had NTC, 49 had OOC, and 15 had STC. The variables significant for IFC subtype classification, according to SelectKBest, were stool frequency, the satisfaction domain of the Patient Assessment of Constipation Quality of Life questionnaire (PAC-QOL), the emotional self-efficacy for Functional Constipation questionnaire (SEFCQ), motilin serum concentration, and vasoactive intestinal peptide serum concentration. Among the three models, the LGBM model demonstrated an accuracy of 83.8%, a precision of 84.5%, a recall of 83.6%, a f1-score of 83.4%, and an area under the receiver operating characteristic curve (AUROC) of 0.89 in discriminating IFC subtypes. Using clinical characteristics measured by certified questionnaires and serum concentrations of the gastrointestinal hormones, machine learning can efficiently classify pediatric IFC into its three subtypes. Of the three models tested, the LGBM model is the most accurate model for the classification of IFC, with an accuracy of 83.8%, demonstrating that machine learning is an efficient tool for the management of IFC in children.

Probiotics for Functional Constipation in Children: Does it Help?

Probiotics for Functional Constipation in Children: Does it Help?

An Update of Pharmacological Management in Children with Functional Constipation.

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.

Investigating Probiotics in the Management of Childhood Functional Constipation: A Never-Ending Story?

Investigating Probiotics in the Management of Childhood Functional Constipation: A Never-Ending Story?

Overweight status, abdominal circumference, physical activity, and functional constipation in children.

The aim of this study was to assess the prevalence of functional constipation and its relationship with the food intake, overweight status, and physical activity of children. This cross-sectional study included students from two public schools in the municipality of Osasco, which is located in the metropolitan area of São Paulo. Functional constipation was diagnosed if the clinical manifestations of the Rome IV criteria were present for more than 2 months. A 24-h recall survey was used to determine the daily food intake. Weight, height, abdominal circumference, and bioelectrical impedance were used to evaluate the weight status. Active commuting to school and physical activity scores were assessed using a questionnaire that has been validated in Brazil. A total of 452 children, aged 6-12 years, were evaluated. Functional constipation was observed in 22.3% of participants. A greater abdominal circumference was associated with functional constipation in girls (p=0.036) in the bivariate analysis but not in the logistic regression model. Boys with functional constipation consumed higher quantities of fats (p=0.041). There was no statistically significant relationship between functional constipation and overweight status (44.6 and 34.5% of children with and without constipation, respectively; p=0.083) and active commuting to school (48.5 and 56.7% of children with and without constipation, respectively; p=0.179). Functional constipation was associated with a greater abdominal circumference in girls in the bivariate analysis, however, without association in the logistic regression model. Boys with functional constipation consumed higher quantities of fat. No association was found between functional constipation, overweight status, and physical activity.

Functional constipation in children: What physicians should know.

Functional constipation (FC) is considered the most common functional gastrointestinal disorder in children with a pooled global prevalence of 14.4% (95% confidence interval: 11.2-17.6) when diagnosed based on the Rome IV criteria. Its pathophysiological mechanisms are thought be multifactorial and complicated, resulting in difficult management. Currently, the most effective medication, when used in parallel with toilet training, is osmotic laxatives. Children's adherence to medication and parental concern regarding long-term laxative use are the main contributors to treatment failure. Recently, novel therapies with a high safety profile have been developed, such as probiotics, synbiotics, serotonin 5-hydroxytryptamine 4 receptor agonists, chloride channel activators, and herbal and transitional medicines; nonetheless, well-designed research to support the use of these therapies is needed. This review aims to focus on multiple aspects of FC in children, including global prevalence, pathogenesis, diagnostic criteria, tools, as well as conventional and novel treatment options, such as non-pharmacological management, including adequate fiber and fluid intake, physiotherapy, or neuromodulators. We also report that in very difficult cases, surgical intervention may be required.

Management of Intractable Functional Constipation in Children by Interferential Therapy: Transabdominal or Pelvic Floor.

To compare the effectiveness of pelvic floor interferential (IF) therapy with trans-abdominal IF therapy in children with intractable functional constipation. Information of 64 children (38 boys, 26 girls; mean age: 6.6 ± 2.2) with functional constipation who had been treated with IF therapy were considered for this retrospective study. Group A (n = 32) underwent pelvic IF electrical stimulation + pelvic floor muscle (PFM) exercises while the group B (n = 32) received transabdominal IF therapy + PFM exercises. A complete bowel habit diary, a constipation score questionnaire and a seeable pain scores had been recorded before, after the ending of treatment courses and six months later for children in both groups. Additionally, children had been assessed with a constipation-related quality of life questionnaire before and six months after treatment. The number of patients who compiled the diagnostic criteria for constipation significantly decreased in both groups after treatment, in which 27/32 (84.3%) of patients in each group had no constipation after the ending of therapy courses (P = 1). Fecal soiling episodes reduced in both groups after treatment, this finding was significantly higher in group A than in group B after the ending of therapy courses (P = 0.05) and six months later (P = 0.01). Results of this study showed that using IF therapy both pelvic floor and transabdominal significantly boosts the effects of treatment among patients with functional constipation. Pelvic floor IF therapy is more effective in patients who had concomitant fecal soiling.

The Uniformed Services Constipation Action Plan: An effective tool for the management of children with functional constipation.

To implement and to evaluate the effectiveness of the Uniformed Services Constipation Action Plan (USCAP) in our gastroenterology clinic for children with functional constipation. This implementation science study included toilet-trained subjects aged 4years and older who met the Rome IV criteria for functional constipation. Children were block randomized to receive either the USCAP or control. All clinic functional constipation plans recommended subjects continue pharmacotherapy for 4months. Endpoints measured were clinical outcomes (resolution of functional constipation and achievement of a Pediatric Bristol Stool Form Scale [PBSFS] score of 3 or 4), patient-related outcomes (health-related quality of life [HRQoL] total scale score), and health confidence outcomes (Health Confidence Score [HCS]). Fifty-seven treatment group subjects (44%) received a USCAP (52% male; mean age, 10.9 [4.9] years) compared with 73 controls (56%; 48% male; mean age,10.9 [5.3] years). A PBSFS score of 3 or 4 was achieved by 77% of the treatment group compared with 59% of controls (P=.03). Subjects from the treatment group were more likely than the controls to endorse adherence to the 4-month course of pharmacotherapy (P<.001). Subjects who received a USCAP had greater improvements in HRQoL total scale score by the end of the project (P=.04). The USCAP is a simple, inexpensive tool that has the potential to improve global outcomes for functional constipation in children and should be recommended as standard clinical practice.

Serotonin, ghrelin, and motilin gene/receptor/transporter polymorphisms in childhood functional constipation.

Functional constipation is the most common form of constipation, and its exact aetiology is still unclear. However, it is known that deficiencies in hormonal factors cause constipation by changing physiological mechanisms. Motilin, ghrelin, serotonin acetylcholine, nitric oxide, and vasoactive intestinal polypeptide are factors that play a role in colon motility. There are a limited number of studies in the literature where hormone levels and gene polymorphisms of serotonin and motilin are examined. Our study aimed to investigate the role of motilin, ghrelin, and serotonin gene/receptor/transporter polymorphisms in constipation pathogenesis in patients diagnosed with functional constipation according to the Rome 4 criteria. Sociodemographic data, symptom duration, accompanying findings, the presence of constipation in the family, Rome 4 criteria, and clinical findings according to Bristol scale of 200 cases (100 constipated patients and 100 healthy control) who applied to Istanbul Haseki Training and Research Hospital, Pediatric Gastroenterology Outpatient Clinic, between March and September 2019 (6-month period) were recorded. Polymorphisms of motilin-MLN (rs2281820), serotonin receptor-HTR3A (rs1062613), serotonin transporter-5-HTT (rs1042173), ghrelin-GHRL (rs27647), and ghrelin receptor-GHSR (rs572169) were detected by real-time PCR. There was no difference between the two groups in terms of sociodemographic characteristics. Notably, 40% of the constipated group had a family history of constipation. The number of patients who started to have constipation under 24 months was 78, and the number of patients who started to have constipation after 24 months was 22. There was no significant difference between constipation and control groups in terms of genotype and allele frequencies in MLN, HTR3A, 5-HTT, GHRL, and GHSR polymorphisms (p<0.05). Considering only the constipated group, the rates of gene polymorphism were similar among those with/without a positive family history of constipation, constipation onset age, those with/without fissures, those with/without skin tag, and those with type 1/type 2 stool types according to the Bristol stool scale. Our study results showed that gene polymorphisms of these three hormones may not be related to constipation in children.

The role of rectal ultrasound in children with functional constipation.

The study aimed primarily to compare the transverse rectal diameter in children with functional constipation (FC) and children without constipation in different age groups, and between cases of constipation at baseline and after treatment. Secondary aim was to determine factors that could affect the transverse rectal diameter. A controlled prospective study, including a total of 100 children between the ages of 2 and 11 years, who were divided into 50 patients suffering from constipation according to Rome IV criteria and 50 age- and sex-matched controls. Transverse rectal diameter was measured at presentation, and after 3months of laxative therapy and behavioural modification. Initial rectal diameter was significantly different between cases (3.55 cm (interquartile range, IQR), 3.2-4) and controls (2.3cm (IQR, 1.8-2.5)), P value < 0.001, and it was also significantly different between those above and below 4 years, so a separate cut-off point for diagnosis of constipation was suggested being >3cm for the former and >2.5cm for the latter. After 3months of follow-up, rectal diameter significantly reduced to become 2.6 (IQR, 2-2.8), P value < 0.001. Duration of symptoms positively correlated with rectal diameter. Ultrasound measurement of rectal diameter is an important tool to diagnose and follow-up functional constipation in children. Different values of rectal diameter are found between those above and below 4 years of age.

Comparing the Safety and Efficacy of Two Different Synbiotics in the Treatment of Infantile Functional Constipation Resistant to Non-Pharmacological Therapy: A Randomized Clinical Trial

Background: Recent evidence emphasizes the positive effect of probiotics and synbiotics in the treatment of functional constipation in childhood, but no study has surveyed the effectiveness of synbiotics in improving the clinical conditions in infants ≤6 months suffering from functional constipation, so we performed this study. Aims: Comparing the efficacy and safety of two types of synbiotics including PediLact® (Zist-Takhmir Co., Tehran, Iran) drop containing Bifidobacterium infantis, Lactobacillus reuteri, Lactobacillus rhamnosus plus fructooligosaccharides with BBCare® (Zist-Takhmir Co., Tehran, Iran) drop containing Bifidobacterium lactis BB-12 plus fructooligosaccharides in the treatment of infantile functional constipation. Study Design: This trial was performed on infants less than 6 months of age who met the ROME IV criteria for infantile functional constipation. The patients were randomly assigned to receive PediLact drop (n = 44) or BB-Care drop (n = 45) for one month and were evaluated on the seventh day and at the end of the first month. Results: A significant downward trend was revealed in the responsive rate of every clinical symptom in both intervention groups but BB-Care was more effective than PediLact in improving the frequency of weekly defecation. Both synbiotics also improved significantly all symptoms of constipation in all types of feeding methods after one week and one month of intervention (primary outcomes). There was no side effect of synbiotics through intervention (secondary outcome). Conclusions: This study shows that both synbiotics improved significantly all symptoms of functional constipation after one week and one month of intervention apart from type of feeding method in infants less than 6 months of age. Due to the greater effectiveness of BB-care in increasing stool frequency, B. lactis may play a more prominent role in this age group. This study has been registered at the Iranian Registry of Clinical Trails (IRCT20160827029535N7).

Relationship between psychological stress with functional constipation in children: a systematic review.

constipation affects up to 29.6% of children worldwide, making it one of the most common gastrointestinal illnesses in the pediatric population. As a functional disorder, the development of constipation is mostly influenced by a child´s psychosocial condition, even considered as one of important contributing factors. This systematic review aims to evaluate the relationship between psychological stress with constipation in the pediatric population. three online databases were searched as study sources, including PubMed, the Cochrane Library, and Google Scholar. Study selection was carried out using the PRISMA diagram. Studies that met the eligibility criteria were then included in the data extraction and synthesis. The study quality assessment was done using the Joanna Briggs Institute's (JBI) critical appraisal checklist. eleven studies are included in this systematic review, consisting of four cross sectional studies, four case control studies and three cohort studies. The included studies have good quality based on the assessment. Majority of the studies showed a significant relationship between psychological stress and constipation in children. Psychological stress in children can be classified into family-related stressors, school-related stressors, exposure to stressful life events, stress related to psychological disorders, and other factors. psychological stress and burden are associated to constipation in children. To overcome functional constipation in children, a collaborative effort is required between parents, children, and the healthcare professional.