The literature search for the current update was based on a supplemental Medline search of literature from 1997 through May 2001. The population was children (infancy to 18 years) and the results were limited to English language. The major key words were: constipation (e.g., constipation, idiopathic constipation, encoprisis, fecal incontinence, soiling), clinical trials (e.g., clinical trials, cohort studies, meta-analysis), and guidelines (e.g., clinical protocols, practice guidelines, consensus development conferences). Additional search terms were: symptoms (e.g., impacted feces, intestinal obstruction, painful defecation), coexisting conditions (e.g., lead poisoning, codeine, ritalin, chemotherapy), confused conditions (e.g., pseudo obstruction syndrome, spinal cord abnormal, hypothyroidism, autism), evaluation (e.g., thyrozine with analysis or blood, T4 analysis, calcium testing), diagnosis (e.g., diagnosis, sensitivity and specificity), behavioral treatment (e.g., behavioral therapy, toilet habits, parent-child relations, patient education, parental education), dietary and allergy (e.g., diet, dietary fiber, dairy products, lactose intolerance), and medications (e.g., bisacodyl, laxatives, suppositories, magnesium, enema, microlax, mineral oil, molasses). A complete list of search terms is available upon request.
The search was conducted in components each keyed to a specific causal link in a problem structure. The search was supplemented with recent clinical trials known to expert members of the panel. The search was single cycle.