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©The Author(s) 2022.
World J Clin Pediatr. Sep 9, 2022; 11(5): 385-404
Published online Sep 9, 2022. doi: 10.5409/wjcp.v11.i5.385
Published online Sep 9, 2022. doi: 10.5409/wjcp.v11.i5.385
Table 1 Rome IV diagnostic criterial for constipation in children
Diagnostic criteria must include at least 2 of the following features of constipation in a child with a development age of at least 4 yr with insufficient criteria to diagnose irritable bowel syndrome |
Two or fever defecations in the toilet per week |
History of retentive posturing or excessive volitional stool retention |
History of painful or hard bowel motion |
Presence of a large fecal mass in the rectum |
History of large diameter stools which may obstruct the toilet |
After appropriate evaluation, the fecal incontinence cannot be explained by another medical condition |
Table 2 Clinical history-taking
Component and subcomponents |
Onset of symptoms and duration of the disease |
Bowel habits |
Frequency of stools |
Nature of the stools |
Fecal incontinence |
Blood in stools |
Passage of meconium |
Other associated symptoms |
Withholding behavior |
Somatic symptoms |
Past medical and surgical history |
Bowel surgeries |
Medications |
Neuromuscular diseases |
Dietary history |
Fiber continent in the diet |
Frequency of junk food |
Family history |
Psychological history |
Developmental history |
Table 3 Physical examination
Component and subcomponents |
General examination |
Assessment of growth |
Assessment of development |
Abdominal examination |
Abdominal distension |
Surgical scars |
Palpable fecal masses |
Perianal observation |
Position of the anus |
Perianal excoriation and dermatitis |
Scars, fissures, and tags |
Patulous anus |
Neurological evaluation |
Spine |
Lower limb neurological assessment |
Table 4 Red flag features and their clinical relevance
Features and subfeatures |
Hirschsprung disease |
Delayed passage of meconium |
Positive family history |
Ribbon like stools |
Significant abdominal distension |
Child sexual abuse |
Extreme fear of anal examination |
Scars in the perianal region |
Fissures in children > 2 yr of age |
Neurological abnormalities |
Hair tuft/hemangioma/scars on spine |
Abnormal anal and cremasteric reflex |
Deficiencies in lower limb neurology |
Developmental delay |
Other organic disorders |
Bilious vomiting |
Blood in stools |
Failure to thrive |
Malposition of the thyroid gland |
Table 5 Factors negatively affect the prognosis of functional constipation
Factor |
Constipation during the 1st yr of life |
Longer duration of symptoms before presentation |
Low defecation frequency at presentation |
Presence of fecal incontinence |
Large diameter stools |
Stool withholding |
Nighttime urinary incontinence |
Presence of fecal mass in abdomen/rectum |
Prolonged colonic transit > 100 h |
Failed balloon expulsion test |
- Citation: Rajindrajith S, Devanarayana NM, Benninga MA. Childhood constipation: Current status, challenges, and future perspectives. World J Clin Pediatr 2022; 11(5): 385-404
- URL: https://www.wjgnet.com/2219-2808/full/v11/i5/385.htm
- DOI: https://dx.doi.org/10.5409/wjcp.v11.i5.385