Optimizing care for children with constipation

There is no question that pediatricians are experienced in managing constipation considering its prevalence among children. Research shows, however, that the majority of pediatricians are not aware of recently released evidence-based recommendations for both the diagnostic evaluation of children with constipation and the treatment of functional constipation, said Samuel Nurko, MD, MPH, associate professor of pediatrics, Harvard Medical School, Boston, Massachusetts.

Speaking on Saturday, October 24, at a session titled “Got Colon Congestion?”, Dr Nurko discussed the guidelines that were developed as a collaborative project of the North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition and the European Society for Paediatric Gastroenterology, Hepatology, and Nutrition. The guidelines were published in the Journal of Pediatric Gastroenterology and Nutrition.

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“Pediatricians have a very important role in the successful treatment of patients with functional constipation, and, in general, it can be said that clinicians are mostly doing the right things. Hopefully, their becoming familiar with these evidence-based recommendations will improve the quality of patient care,” said Dr Nurko, who served as a member of the writing committee for the evidence-based guidelines.

The guidelines underscore that diagnosis of functional constipation is made clinically based on history and physical examination without the need for any testing. However, as outlined in the guidelines, pediatricians should know the alarm signs and symptoms raising suspicion that the constipation is associated with an underlying disease so that they initiate a work-up when appropriate.

Treatment for functional constipation is geared toward educational counseling for patients and parents combined with interventions to make defecation easier. Osmotic laxatives are the mainstay of treatment with polyethylene glycol (PEG)-based solutions considered as first-line and lactulose recommended if PEG is not available.

According to the guidelines, maintenance treatment should continue for at least 2 months. However, treatment should not be discontinued if the child is undergoing toilet training or until all constipation symptoms are resolved for at least 1 month, and then it should be decreased gradually.

 “There is a lot of evidence to support the safety of PEG-based solutions and to show that children with functional constipation usually need prolonged treatment,” said Dr Nurko.

“The biggest mistake pediatricians make is to use a too-short duration of therapy.”