©Author(s) (or their employer(s)) 2026. No commercial re-use. See Permissions. Published by Baishideng Publishing Group Inc.
Functional constipation in Thai infants and toddlers: The role of genetic-gut-brain interaction and fiber supplementation
Kanticha Chatpermporn, Thitima Ngoenmak, Busara Charoenwat, Atchariya Chanpong, Hansa Sriphongphankul, Nipaporn Hanpitakpong, Palittiya Sintusek
Kanticha Chatpermporn, Department of Pediatrics, Police General Hospital, Bangkok 10330, Thailand
Thitima Ngoenmak, Department of Pediatrics, Naresuan University Hospital, Naresuan University, Phitsanulok 65000, Thailand
Busara Charoenwat, Department of Pediatric, Khon Kaen University, Khon Kaen 40002, Thailand
Atchariya Chanpong, Hansa Sriphongphankul, Department of Pediatrics, Prince of Songkla University, Songkhla 90110, Thailand
Nipaporn Hanpitakpong, Department of Pediatrics, Buddhachinnaraj Phitsanulok Hospital, Phitsanulok 65000, Thailand
Palittiya Sintusek, Center of Excellence in Thai Pediatric Gastroenterology, Hepatology and Immunology, Division of Gastroenterology, Department of Pediatrics, King Chulalongkorn Memorial Hospital, Chulalongkorn University, Bangkok 10330, Thailand
Author contributions: Chatpermporn K and Sintusek P conceptualized and designed the study, carried out the initial analyses; Chatpermporn K, Sintusek P, and Ngoenmak T designed the data collection instruments; Chatpermporn K collected data, drafted the initial manuscript, and critically reviewed the manuscript; Sintusek P coordinated and supervised data collection, critically reviewed and revised the manuscript; Ngoenmak T, Charoenwat B, Chanpong A, Sriphongphankul H, and Hanpitakpong N collected data and reviewed the manuscript; All authors approved the final manuscript as submitted and agree to be accountable for all aspects of the work.
Supported by Ratchadapiseksompotch Funds, Graduate Affairs, Faculty of Medicines, Chulalongkorn University, Bangkok, Thailand, No. GA66/067; and the Royal of Pediatricians of Thailand Research Funds, No. RC.Ped.T.R.2023.2.2.
Institutional review board statement: The study protocol was approved by the Institutional Review Board of Chulalongkorn University (IRB 0041/66, COA 0469/2023).
Informed consent statement: Written informed consent was obtained from all participants before the completion of the questionnaire.
Conflict-of-interest statement: All authors have no conflict of interest.
STROBE statement: The authors have read the STROBE Statement—checklist of items, and the manuscript was prepared and revised according to the STROBE Statement—checklist of items.
Data sharing statement: Data set available from the corresponding author at
palittiya.s@chula.ac.th. Participants gave informed consent for data sharing.
Corresponding author: Palittiya Sintusek, MD, PhD, Associate Professor, Center of Excellence in Thai Pediatric Gastroenterology, Hepatology and Immunology, Division of Gastro
enterology, Department of Pediatrics, King Chulalongkorn Memorial Hospital, Chulalongkorn University, 1873 Rama IV, Pathumwan, Bangkok 10330, Thailand.
palittiya.s@chula.ac.th
Received: July 10, 2025
Revised: July 28, 2025
Accepted: October 23, 2025
Published online: March 9, 2026
Processing time: 239 Days and 16.4 Hours
BACKGROUND
Functional constipation (FC) is a global burden, and data on its prevalence based on Rome IV diagnostic criteria in young children, particularly after the coronavirus disease 2019 era, are limited.
AIM
To determine the prevalence of FC in Thai infants and toddlers using the Rome IV criteria and identify associated factors.
METHODS
The Thai version of the Rome IV Diagnostic Questionnaire for Pediatric Functional Gastrointestinal Disorder (R4PDQ-Toddler) was developed and then officially approved by the Rome Foundation. Guardians of children aged 6-48 months from six hospitals in five regions in Thailand were surveyed between August 2023 and September 2024. The questionnaire collected demographic data, the R4PDQ-Toddler gathered defecation data, and factors potentially associated with FC were recorded.
RESULTS
A total of 1874 guardians participated, yielding a high response rate of 98.1%. The mean age of the children was 20.3 months ± 11.4 months, and 53.5% were male. The prevalence of FC was 16.1% [95% confidence interval (CI), 14.5%-17.8%]. Painful or hard bowel movements (81.5%), large-diameter stools (77.5%), and excessive stool retention (72.2%) were the most common symptoms. Factors independently associated with FC were age > 1 year [adjusted odds ratio (aOR), 3.36; 95%CI: 2.29-4.94], a first-degree relative with a history of constipation (aOR: 2.48; 95%CI: 1.85-3.35), fiber supplementation (aOR: 7.85; 95%CI: 3.56-17.30), and exposure to stressful family events (aOR: 1.41; 95%CI: 1.03-1.92).
CONCLUSION
FC is prevalent in Thai infants and toddlers. Older age, family history, fiber supplementation, and stress are key factors, highlighting genetic, dietary, and gut-brain influences that need further investigations.
Core Tip: To our knowledge, this nationwide study is the first to report the prevalence of functional constipation (FC) in Thai infants and toddlers using the validated Rome IV Diagnostic Questionnaire. FC affected 16.1% of children, demonstrating strong associations with age > 1 year, family history of constipation, fiber supplementation, and family-related stress. Findings highlight a complex interplay among genetic factors, dietary practices, and gut-brain interactions, particularly in the post-pandemic context while exploring the clinical value of fiber supplementation as a treatment. This study underscores the need for improved awareness and holistic management strategies to improve pediatric gastrointestinal health in Thailand.
