Pediatric Constipation Questions & Answers

1. van den Berg MM, Benninga MA, Di Lorenzo C. Epidemiology of childhood constipation: a systematic review. Am J Gastroenterol. 2006 Oct. 101(10):2401-9. [QxMD MEDLINE Link].

2. Borowitz SM, Cox DJ, Kovatchev B, et al. Treatment of childhood constipation by primary care physicians: efficacy and predictors of outcome. Pediatrics. 2005 Apr. 115(4):873-7. [QxMD MEDLINE Link].

3. [Guideline] North American Society for Pediatric Gastroenterology, Hepatology and Nutrition. Evaluation and treatment of constipation in children: summary of updated recommendations of the North American Society for Pediatric Gastroenterology, Hepatology and Nutrition. J Pediatr Gastroenterol Nutr. 2006 Sep. 43(3):405-7. [QxMD MEDLINE Link].

4. Benninga M, Candy DC, Catto-Smith AG, et al. The Paris Consensus on Childhood Constipation Terminology (PACCT) Group. J Pediatr Gastroenterol Nutr. 2005 Mar. 40(3):273-5. [QxMD MEDLINE Link].

5. Issenman RM, Hewson S, Pirhonen D, et al. Are chronic digestive complaints the result of abnormal dietary patterns? Diet and digestive complaints in children at 22 and 40 months of age. Am J Dis Child. 1987 Jun. 141(6):679-82. [QxMD MEDLINE Link].

6. Loening-Baucke V. Prevalence rates for constipation and faecal and urinary incontinence. Arch Dis Child. 2007 Jun. 92(6):486-9. [QxMD MEDLINE Link].

7. Saps M, Sztainberg M, Di Lorenzo C. A prospective community-based study of gastroenterological symptoms in school-age children. J Pediatr Gastroenterol Nutr. 2006 Oct. 43(4):477-82. [QxMD MEDLINE Link].

8. Yong D, Beattie RM. Normal bowel habit and prevalence of constipation in primary-school children. Ambulatory Child Health. 1998. Vol 4: 277-82.

9. de Araujo Sant Anna AM, Calcado AC. Constipation in school-aged children at public schools in Rio de Janeiro, Brazil. J Pediatr Gastroenterol Nutr. 1999 Aug. 29(2):190-3. [QxMD MEDLINE Link].

10. Borowitz SM, Cox DJ, Tam A, et al. Precipitants of constipation during early childhood. J Am Board Fam Pract. 2003 May-Jun. 16(3):213-8. [QxMD MEDLINE Link].

11. Tabbers MM, DiLorenzo C, Berger MY, Faure C, Langendam MW, Nurko S, et al. Evaluation and treatment of functional constipation in infants and children: evidence-based recommendations from ESPGHAN and NASPGHAN. J Pediatr Gastroenterol Nutr. 2014 Feb. 58 (2):258-74. [QxMD MEDLINE Link].

12. MacGeorge CA, Williams DC, Vajta N, Morella K, Thacker PG, Russell S, et al. Understanding the Constipation Conundrum: Predictors of Obtaining an Abdominal Radiograph During the Emergency Department Evaluation of Pediatric Constipation. Pediatr Emerg Care. 2017 Jun 20. [QxMD MEDLINE Link].

13. Ferguson CC, Gray MP, Diaz M, Boyd KP. Reducing Unnecessary Imaging for Patients With Constipation in the Pediatric Emergency Department. Pediatrics. 2017 Jul. 140 (1):[QxMD MEDLINE Link].

14. Hackethal V. Abdominal X-rays Decreased in Children With Constipation. Medscape News & Perspective. Available at http://www.medscape.com/viewarticle/881602. June 14, 2017; Accessed: August 2, 2017.

15. De Lorijn F, Reitsma JB, Voskuijl WP, et al. Diagnosis of Hirschsprung's disease: a prospective, comparative accuracy study of common tests. J Pediatr. 2005 Jun. 146(6):787-92. [QxMD MEDLINE Link].

16. Doniger SJ, Dessie A, Latronica C. Measuring the Transrectal Diameter on Point-of-Care Ultrasound to Diagnose Constipation in Children. Pediatr Emerg Care. 2016 Jun 14. [QxMD MEDLINE Link].

17. Abrahamian FP, Lloyd-Still JD. Chronic constipation in childhood: a longitudinal study of 186 patients. J Pediatr Gastroenterol Nutr. 1984 Jun. 3(3):460-7. [QxMD MEDLINE Link].

18. Varni JW, Bendo CB, Nurko S, Shulman RJ, Self MM, Franciosi JP, et al. Health-Related Quality of Life in Pediatric Patients with Functional and Organic Gastrointestinal Diseases. J Pediatr. 2014 Sep 17. [QxMD MEDLINE Link].

19. Loening-Baucke V. Polyethylene glycol without electrolytes for children with constipation and encopresis. J Pediatr Gastroenterol Nutr. 2002 Apr. 34(4):372-7. [QxMD MEDLINE Link].

20. Bekkali NL, van den Berg MM, Dijkgraaf MG, et al. Rectal fecal impaction treatment in childhood constipation: enemas versus high doses oral PEG. Pediatrics. 2009 Dec. 124(6):e1108-15. [QxMD MEDLINE Link].

21. Miller MK, Dowd MD, Friesen CA, Walsh-Kelly CM. A Randomized Trial of Enema Versus Polyethylene Glycol 3350 for Fecal Disimpaction in Children Presenting to an Emergency Department. Pediatr Emerg Care. 2012 Jan 20. [QxMD MEDLINE Link].

22. Pijpers MA, Tabbers MM, Benninga MA, Berger MY. Currently recommended treatments of childhood constipation are not evidence based: a systematic literature review on the effect of laxative treatment and dietary measures. Arch Dis Child. 2009 Feb. 94(2):117-31. [QxMD MEDLINE Link].

23. Corkins MR. Are diet and constipation related in children?. Nutr Clin Pract. 2005 Oct. 20(5):536-9. [QxMD MEDLINE Link].

24. Iacono G, Cavataio F, Montalto G, et al. Intolerance of cow's milk and chronic constipation in children. N Engl J Med. 1998 Oct 15. 339(16):1100-4. [QxMD MEDLINE Link].

25. Lloyd B, Halter RJ, Kuchan MJ, et al. Formula tolerance in postbreastfed and exclusively formula-fed infants. Pediatrics. 1999 Jan. 103(1):E7. [QxMD MEDLINE Link].

26. Vandenplas Y, Benninga M. Probiotics and functional gastrointestinal disorders in children. J Pediatr Gastroenterol Nutr. 2009 Apr. 48 Suppl 2:S107-9. [QxMD MEDLINE Link].

27. Guandalini S, Cernat E, Moscoso D. Prebiotics and probiotics in irritable bowel syndrome and inflammatory bowel disease in children. Benef Microbes. 2014 Nov 12. 1-9. [QxMD MEDLINE Link].

28. Indrio F, Di Mauro A, Riezzo G, Civardi E, Intini C, Corvaglia L, et al. Prophylactic use of a probiotic in the prevention of colic, regurgitation, and functional constipation: a randomized clinical trial. JAMA Pediatr. 2014 Mar. 168 (3):228-33. [QxMD MEDLINE Link].

29. Wegh CAM, Baaleman DF, Tabbers MM, Smidt H, Benninga MA. Nonpharmacologic treatment for children with functional constipation: a systematic review and meta-analysis. J Pediatr. 2022 Jan. 240:136-149.e5. [QxMD MEDLINE Link].

30. Wallace C, Sinopoulou V, Gordon M, et al. Probiotics for treatment of chronic constipation in children. Cochrane Database Syst Rev. 2022 Mar 29. 3:CD014257. [QxMD MEDLINE Link]. [Full Text].

31. Di Lorenzo C, Nurko S, Rodriguez-Araujo G, Xie W, Huh S, Hyams, Khlevner J, et al. Efficacy and safety of linaclotide in treating functional constipation in pediatric patients aged 6-17 years: A phase 3 pivotal randomized placebo-controlled trial. Abstract presented at Digestive Disease Week (DDW) 2023 Annual Meeting. Chicago, IL. 2023 May 6-10. [Full Text].

32. Sharifi-Rad L, Ladi-Seyedian SS, Manouchehri N, Alimadadi H, Allahverdi B, Motamed F, et al. Effects of Interferential Electrical Stimulation Plus Pelvic Floor Muscles Exercises on Functional Constipation in Children: A Randomized Clinical Trial. Am J Gastroenterol. 2018 Feb. 113 (2):295-302. [QxMD MEDLINE Link].

33. Muller-Lissner SA. Adverse effects of laxatives: fact and fiction. Pharmacology. 1993 Oct. 47 Suppl 1:138-45. [QxMD MEDLINE Link].

34. Schiller LR. Clinical pharmacology and use of laxatives and lavage solutions. J Clin Gastroenterol. 1999 Jan. 28(1):11-8. [QxMD MEDLINE Link].

35. Dupont C, Leluyer B, Amar F, et al. A dose determination study of polyethylene glycol 4000 in constipated children: factors influencing the maintenance dose. J Pediatr Gastroenterol Nutr. 2006 Feb. 42(2):178-85. [QxMD MEDLINE Link].

36. Khan S, Campo J, Bridge JA, et al. Long-term outcome of functional childhood constipation. Dig Dis Sci. 2007 Jan. 52(1):64-9. [QxMD MEDLINE Link].

Stephen M Borowitz, MD Professor of Pediatrics and Public Health Sciences, Department of Pediatrics, Division of Pediatric Gastroenterology, Hepatology, and Nutrition, University of Virginia School of Medicine

Stephen M Borowitz, MD is a member of the following medical societies: American Academy of Pediatrics, American Gastroenterological Association, American Pediatric Society, North American Society for Pediatric Gastroenterology, Hepatology and Nutrition, Society for Pediatric Research

Disclosure: Nothing to disclose.

Mary L Windle, PharmD Adjunct Associate Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Nothing to disclose.

Carmen Cuffari, MD Associate Professor, Department of Pediatrics, Division of Gastroenterology/Nutrition, Johns Hopkins University School of Medicine

Carmen Cuffari, MD is a member of the following medical societies: American College of Gastroenterology, American Gastroenterological Association, North American Society for Pediatric Gastroenterology, Hepatology and Nutrition, Royal College of Physicians and Surgeons of Canada

Disclosure: Received honoraria from Prometheus Laboratories for speaking and teaching; Received honoraria from Abbott Nutritionals for speaking and teaching. for: Abbott Nutritional, Abbvie, speakers' bureau.

Chris A Liacouras, MD Director of Pediatric Endoscopy, Division of Gastroenterology and Nutrition, Children's Hospital of Philadelphia; Associate Professor of Pediatrics, University of Pennsylvania School of Medicine

Chris A Liacouras, MD is a member of the following medical societies: American Gastroenterological Association

Disclosure: Nothing to disclose.

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