81 Background: Children with constipation are managed by primary care providers (PCP) and/or specialists. Timing for referral to a specialist remains unclear. The purpose of this study is to characterize the clinical course and management of constipation in a primary care pediatric setting within a managed care organization. Methods: In a cross-sectional survey, we characterized the period prevalence of constipation, duration of clinical symptoms and therapeutic management of children, identified by questioning to have clinical constipation, during a well child care (WCC) visit. WCC visits transpired at 6 pediatric offices, staffed by 25 pediatricians, owned by the Fallon Clinic, an HMO in Central MA. To identify children with a clinical history of constipation, all parents of children (ages 1-14yo) were asked to complete a screening questionnaire, prior to seeing the pediatrician. An extensive follow-up (F/U) questionnaire was conducted by telephone within 3 months of WCC visit. Results: Over a 7 month period, screening questionnaires were distributed to the parents of 8093 children, undergoing consecutive WCC visits, with 6193 completed (76.5% response rate). 320 (5.2%) children were found to have clinical constipation, defined as: a recent history of bowel movements (BM)< every other day and at least 1 of the following: abdominal pain, soiling, painful defecation, withholding behavior and/or excessive large BMs. To date, F/U was completed on 261/320 eligible children (81.6%). 87(33%) children continued to exhibit a clinical history of constipation on F/U questionnaire: 87(100%) Bms <every other day for 36/36 (mean/median) months, 46(52%) abdominal pain for 23/12 months, 42(48%) soiling for 31/24 months, 38(43%) painful defecation for 26/24 months, 43(49%) withholding behavior for 23/12 months, Approximately, one third of these 87 children were receiving medication/high fiber supplements. Conclusion: Although the majority of constipation in children is self limiting, approximately one third of patients exhibit long term refractory constipation requiring further intervention.