Childhood constipation as an emerging public health problem

Table 1 Rome II, Rome III and Rome IV definitions of functional constipation in children

Rome II criteria (infants and young children)

At least 2 wk of:

Scybalous, pebble-like, hard stools for a majority of stools or firm stools two or less times/week; and there is no evidence of structural, endocrine, or metabolic disease.

Rome III criteria (children and adolescents)

Diagnostic criteria1 must include two or more of the following in a child with a developmental age of at least 4 yr with insufficient criteria for diagnosis of irritable bowel syndrome.:

Two or fewer defecations in the toilet per week

At least one episode of faecal incontinence per week

History of retentive posturing or excessive volitional stool retention

History of painful or hard bowel movements

Presence of a large faecal mass in the rectum

History of large diameter stools which may obstruct the toilet

Rome IV criteria (Children and adolescents)

Must include 2 or more of the following occurring at least once per week for a minimum of 1 mo with insufficient criteria for a diagnosis of irritable bowel syndrome

Two or fewer defecations in the toilet per week in a child with a developmental age of at least 4 yr

At least 1 episode of faecal incontinence per week

History of retentive posturing or excessive volitional stool retention

History of painful or hard bowel movements

Presence of a large fecal mass in the rectum

History of large diameter stools which may obstruct the toilet

After appropriate evaluation, the symptoms cannot be fully explained by another medical condition.

¹Criteria fulfilled at least once per week for at least 2 mo prior to diagnosis.

Table 2 Recognized risk factors of childhood constipation

Psychological stress

Home related

School related

Siblings with health problems

Not living with either parents

Low social class

Poor child rearing styles

Dietary problems

Diet low in fibre

Cow’s milk protein

Not having regular meals with parents

Consumption of junk food

Childhood obesity

Child maltreatment

Physical abuse

Sexual abuse

Emotional abuse

Civil unrest (exposure to war)