Treatment of children with constipation includes the presence or absence of fecal impaction and its treatment, oral medication, parental education, close follow-up and adjustment of medication if necessary. Education Educating parents and eliminating their worries is the first step in treatment, including explaining the pathogenesis of functional constipation. In case of fecal soiling, it is important to remove negative attitudes of the child and parents, especially to make parents understand that this is not a deliberate or provocative act, and to encourage parents to maintain a positive attitude during the treatment. If necessary, education should be repeated. 2.Remove the embedded feces in the rectum An embedded fecal matter is a hard fecal mass clearly found in the lower abdomen during physical examination, or a large amount of feces in the dilated rectum during rectal examination, or excessive feces in the colon on abdominal X-ray. It is necessary to remove the blocked stool before treatment, and oral medication, rectal medication, or both are effective. The decision is best made after discussion with the parents and the child. Oral medications can be high doses of mineral oil, polyethylene glycol, magnesium hydroxide, magnesium citrate, lactulose, sorbitol, senna, diacetin, and other laxatives alone or in combination. Rectal administration can be done with phosphate soda enemas, saline enemas, or mineral oil enemas after phosphate soda enemas; soap and water, tap water, and magnesium are not recommended (potential toxicity). Infants use glycerin suppositories, older children use diacetin suppositories are also more effective. 3.Maintenance therapy After removing the embedded stool, the treatment focuses on preventing the recurrence of constipation. For those who do not have embedded stools or those who successfully remove embedded stools from the rectum, maintenance therapy (including dietary intervention, behavioral modification and laxatives) should be started to ensure normal intermittent bowel movements and maintain good bowel movements. Advise children to change their diet, especially to increase the intake of water, absorbable and non-absorbable starches to soften the stool. Starch, especially sorbitol (high in fruit juices such as pears and apples), can increase the frequency of stools and the amount of water in the stool. The use of laxatives along with glucomannan is also beneficial in the treatment of constipation. A balanced diet (including whole grains, fruits and vegetables) is also part of the treatment of constipation, but should not be forced. The role of fiber is controversial. Behavior modification Behavior modification and regular toileting habits are an important part of the treatment of constipation. Regardless of whether there is overflow incontinence, there should be sufficient toilet time after meals to help children and caregivers keep a memory of the frequency of bowel movements (e.g., marked on a calendar). Those with behavioral problems that interfere with outcomes should be referred to a mental health practitioner for behavioral modification or other interventions. Successful treatment of constipation (especially overflow incontinence) requires a cooperative family that is able to complete time-consuming interventions and is patient enough to tolerate slow progression and relapse. 5. Medication Medication is necessary to maintain regular bowel movements. Laxatives are the most beneficial until the child can maintain regular bowel habits. Laxatives include: osmotic laxatives (lactulose, sorbitol, barley malt extract, magnesium hydroxide, magnesium citrate, polyethylene glycol 3350), osmotic enemas (phosphate enemas), gavage (polyethylene glycol), lubricants (liquid paraffin), stimulant laxatives (senna, bisacodyl, glycerin suppositories). When the drug is necessary, the lubricant mineral oil, magnesium hydroxide, lactulose, sorbitol, polyethylene glycol or the combination of lubricant and laxative is recommended. These drugs are equally effective and can be chosen according to safety, cost, child preference, ease of administration and the experience of the physician. Stimulant laxatives can be used intermittently for a short period of time (i.e., rescue therapy) to avoid the recurrence of stool impaction. Maintenance therapy is required for several months, and discontinuation is considered only after the child has developed regular and easy bowel movements. It should be realized that recurrence is more common and defecation difficulties can persist into adolescence. In some ways, the evaluation of constipation in infants differs from that of older children. Most constipation in infants is also functional. However, congenital megacolon or other abnormalities should be especially considered when treatment fails, when there is delayed passage of fetal stool or when there is fever, vomiting, bloody stool, growth disturbance, anal stenosis, empty and tight rectum, impaction, or abdominal distention. In constipated infants with delayed fecal passage, after excluding congenital megacolon, a sweating test should be performed to exclude cystic fibrosis (because constipation can be an early manifestation, even in the absence of growth disturbances and pulmonary symptoms).