• University of Michigan Health System. Functional constipation and soiling in children. Ann Arbor (MI): University of Michigan Health System; 2008 Sep. 15 p. [15 references]

This is the current release of the guideline.

This guideline updates a previous version: University of Michigan Health System. Functional constipation and soiling in children. Ann Arbor (MI): University of Michigan Health System; 2003 Feb. 10 p.

Note from the National Guideline Clearinghouse (NGC): The following key points summarize the content of the guideline. Refer to the full text of the original guideline document for additional information, including detailed information on diagnosis and "red flag" signs and symptoms; dosing and possible side effects for infants and children; cost of medications; instructions on education and behavioral training; and dietary choices.

The levels of evidence [A-D] are defined at the end of the "Major Recommendations" field.

For overview of diagnosis and treatment for age < 1 year, see Table 1 and for age > 1 year see Table 2 in the original guideline document.

Diagnosis

Functional constipation often begins during late infant to toddler age. [C*] Inquiring at doctor visits about stool frequency, character, and painful stool passage may aide earlier diagnosis. [IC & D]

• Symptoms and signs (Tables 3 and 4 in the original guideline document) are the best guides for accurate diagnosis. [IC & D]
• Red Flags (Table 5 in the original guideline document) should be checked to exclude other disorders. [IC & D]

Treatment

Child and family adherence to treatment recommendations is a likely predictor of success. [IC & D]

• Educate child and family (see Table 6 in the original guideline document). [IC & D]
• Clean-out impaction if present – applies only to age > 1yr (see Table 7 in the original guideline document). [IB]
• Diet modification to increase fiber and clear fluids (see Table 8 in the original guideline document). [IC & D]
• Behavioral training initiated for age > 1 year (see Table 9 in the original guideline document). [IC & D]
• Medication (see Table 10 in the original guideline document) often needed to achieve stool frequency ≥ 3 times per week. [IA]
• Consider referral for additional evaluation-management if treatment failure within first month. [ID]
• Wean from medications – if used – after about 6 months if stool frequency ≥ 3 per week. [ID]
• Dietary and behavioral components should continue. [ID]

Definitions:

Levels of Evidence

1. Randomized controlled trials
2. Controlled trials, no randomization
3. Observational trials
4. Opinion of expert panel

Strength of Recommendation

I = Generally should be performed

II = May be reasonable to perform

III = Generally should not be performed

None provided

When possible, conclusions were based on prospective randomized clinical trials. In the absence of randomized controlled trials, observational studies were considered. If none were available, expert option was used.

The type of evidence supporting the recommendations is specifically stated for each recommendation (see 'Major Recommendations' field).

• University of Michigan Health System. Functional constipation and soiling in children. Ann Arbor (MI): University of Michigan Health System; 2008 Sep. 15 p. [15 references]

Not applicable: The guideline was not adapted from another source.

1997 Sep (revised 2008 Sep)

University of Michigan Health System - Academic Institution

University of Michigan Health System

Functional Constipation and Soiling in Children Guideline Team

Team Leader: Barbara T. Felt, MD, Developmental-Behavioral Pediatrics

Team Members: Pamela I. Brown, MD, Pediatric Gastroenterology; R. Van Harrison, PhD, Medical Education; Paramjeet K. Kochhar, MD, General Pediatrics; Susana R. Patton, PhD, Pediatric Psychology

Consultants: Sheila M. Marcus, MD, Psychiatry; Daniel H. Teitelbaum, MD, Pediatric Surgery

Guidelines Oversight Team: William E Chavey, MD; R Van Harrison, PhD; Connie J. Standiford, MD

Neither the members of the guideline team nor the consultant have a relationship with commercial companies whose products are discussed in this guideline.

This is the current release of the guideline.

This guideline updates a previous version: University of Michigan Health System. Functional constipation and soiling in children. Ann Arbor (MI): University of Michigan Health System; 2003 Feb. 10 p.

This summary was completed by ECRI on May 20, 1999. The information was verified by the guideline developer on June 17, 1999. This NGC summary was updated by ECRI on January 19, 2004. The updated information was verified by the guideline developer on February 6, 2004. This NGC summary was updated by ECRI Institute on March 19, 2009. The updated information was verified by the guideline developer on April 8, 2009.

This NGC summary is based on the original guideline, which is copyrighted by the University of Michigan Health System (UMHS).