Constipation is a common problem in children and is more common in primary and secondary schools and health care settings. To assist health care providers in the evaluation and treatment of children with functional constipation, the North American Society of Pediatric Gastroenterology, Hepatology and Nutrition (NASPGHAN) and the European Society of Pediatric Gastroenterology, Hepatology and Nutrition (ESPGHAN) have jointly developed evidence-based guidelines.
The guidelines focus on nine major clinical issues related to the diagnosis, treatment, and prognosis of functional constipation in infants and children. The quality of evidence grading was based on the Oxford Center’s evidence-based medical grading system, and this approach was also used to address other issues. There were 3 meetings in which all recommendations were discussed and voted on. The panel members voted on each recommendation by nominal ballot. Because no randomized controlled trial was designed, expert opinion could be used to support the recommendation.
Regarding the treatment of functional constipation in infants and children, the guideline recommends the following recommendations.
1. Ensure a normal fiber intake.
2. Ensure normal fluid intake.
3. Ensure a normal amount of exercise.
4. The routine use of prebiotics is not recommended for children with constipation.
5. The use of probiotics is not recommended for children with constipation.
6. Intensive behavioral therapy based on traditional treatment methods is not recommended.
7. According to expert opinion, toilet training is recommended for children with constipation over 4 years of age, with explanation and guidance.
8. Other biofeedback treatments are not recommended.
9. The routine use of multidisciplinary therapy is not recommended.
10. The use of alternative therapies is not recommended.
11. First-line treatment for children with fecal impaction: polyethylene glycol electrolyte (Fosamax, hereafter referred to as PEG) orally at 1,5 g/(kg?d) for 3-6 days.
12. If PEG is ineffective, children with fecal impaction can be treated with enemas once daily for 3-6 days.
13. PEG can be used as first-line maintenance therapy. The starting dose is first-line maintenance therapy. The starting dose is 0.4 g/(kg?d), and the dose is adjusted according to clinical performance.
14. Children treated with PEG do not require enema therapy.
If PEG is ineffective, lactulose can be used as first-line maintenance therapy.
16. Experts recommend that supplemental or second-line therapy may include milk of magnesia, mineral oil, and stimulant laxatives.
17. Maintenance therapy should be continued for at least 2 months. Treatment should not be discontinued until all symptoms of constipation have resolved for at least one month.
18. During toilet training, the drug may be stopped only once if the training is effective.
19. Rubiprostone, linaclotide and procapride are not recommended for children with intractable constipation.
20. Parallel enema examination is feasible in children with intractable constipation.
Routine use of TNS is not recommended in children with intractable constipation.
This evidence-based guideline regulates the evaluation and treatment of children with functional constipation, while also focusing on improving their quality of life. In addition, special evidence-based approaches should be used for children under 6 months of age and for older infants and children, respectively. These guidelines will serve as the basis for routine practice and additional clinical research. Further research is needed to better evaluate the diagnosis and treatment of functional constipation in infants and children.